Hill-grade Knowledge Via Integrated Neural-network for Gastroscopy (HillKING)

Real Time Determination of the Hill Grade During Gastroscopy Using Artificial Intelligence

The Hill classification, also known as the Hill grade, is a system used to classify the severity of gastroesophageal valve incompetence, specifically related to gastroesophageal reflux disease (GERD) and hiatal hernia. This study aims to compare the ability of physicians versus an AI model to asses the Hill grade during gastroscopy.

Study Overview

• Status: Completed
• Conditions: Gastroesophageal Hernia
• Intervention / Treatment: Device: EndoMind

Detailed Description

Objective:

The primary goal of this study is to compare the accuracy in determining the Hill classification during gastroscopy between an artificial intelligence (AI) based system and physicians performing the examination. Secondary outcomes include evaluation of the per-class accuracy and other statistical measures such as precision, recall and f1 score.

Study Design:

Single center, endoscopist blinded study. The model considered in a previous study achieved a mean accuracy of 88%. All participants initially attended a lecture serving as a refresher regarding the Hill classification. Subsequently, physicians were asked to provide the Hill classification for test images expert annotated images depicting different Hill grades, achieving mean accuracy of 72%. Thus 127 paired measurements are required. Taking patient drop-out into consideration, at least 159 patients need to be recruited. Upon examination of the flap-valve during endoscopy, the physician is required to store an image of the flap-valve during retroflexion, which is part of the standard procedure, based on which they determine the Hill classification. The prediction of the AI model on this image is considered the model output and is considered the model's output. A group of three expert endoscopists determines the Hill classification for each image, based on majority vote, which is treated as the gold standard.

AI setup and limitations:

There are no limitations caused by the AI. The method performs a frame-by-frame analysis of the recording. These images are parsed from the AI based system in order to obtain predictions. The only interactions required with the method is a button press that initiates the examination recording process and a second button press to terminate the recording. This is performed at the beginning and end of the examination respectively. The model used in this study is an updated version of the model reported in a preliminary study, that has been trained with more data together with an auxiliary output for predicting if the Hill classification is relevant to the shown image.

Study population:

All adult patients appointed for gastroscopy that do not match the exclusion criteria will be asked for informed consent. Exclusion criteria include previous surgical interventions or altered anatomy that prevents the proper examination of the flap valve, examinations where the flap-valve is not inspected, and examinations where the expert committee does not produce a majority vote.

Intervention:

The physician performs the examination as usual. Upon inspection of the flap valve, the physician captures an image of the examination, as usual, and gives their assessment of the Hill grade. The output of the model for the same image is considered the model prediction. The physician is blinded to the model's prediction.

• Study Type: Observational
• Enrollment (Actual): 195

Contacts and Locations

Study Locations

• Germany
  • Bayern
    • Würzburg, Bayern, Germany, 97080
      • Universitatsklinikum Wurzburg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

All adult patients that have not undergone and are not undergoing a surgery for reconstruction of the flap-valve.

Description

Inclusion Criteria:

• Adult patients (>18 years)
• Scheduled gastroscopy

Exclusion Criteria:

Examination level

• Previous surgical interventions or altered anatomy that prevents the proper examination of the flap valve
• Flap-valve not inspected

Data Level:

• Image during flap-valve inspection not stored
• Expert committee not resulting in a majority vote

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Experimental: Intervention arm; All patients within the study are included in the intervention arm: The Hill classification is determined by the physician and the AI method.	Device: EndoMind; The EndoMind system is equipped with an AI model for predicting the Hill grade during gastroscopy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Accuracy of assessments for the Hill classification for physicians and AI method.	Binary assessment of physician vs AI correct and erroneous predictions.	Through study completion, an average of 5 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Accuracy of assessments for each Hill grade for physicians and AI method.	Description: The correct and erroneous predictions for each specific Hill class.	Through study completion, an average of 5 months
Precision and recall of the assessments for each Hill from endoscopists and AI method.	The precision, and recall statistics for each class (1v0) over the four different Hill classes.	Through study completion, an average of 5 months
Distance for label assessment from gold standard label.	Comparison of the distance between the gold standard label and the label assigned by the physician and AI method.	Through study completion, an average of 5 months

Collaborators and Investigators

• Sponsor: Wuerzburg University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): October 10, 2023
• Primary Completion (Actual): December 22, 2023
• Study Completion (Actual): December 22, 2023

Study Registration Dates

• First Submitted: September 8, 2023
• First Submitted That Met QC Criteria: September 8, 2023
• First Posted (Actual): September 15, 2023

Study Record Updates

• Last Update Posted (Actual): May 9, 2024
• Last Update Submitted That Met QC Criteria: May 8, 2024
• Last Verified: May 1, 2024

More Information

Terms related to this study

• Keywords: Artificial Intelligence; Gastroscopy; Gastroesophageal Flap Valve; Hill grade
• Additional Relevant MeSH Terms: Pathological Conditions, Anatomical; Hernia
• Other Study ID Numbers: AI04

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No