Artificial intelligence-based polyp size measurement in gastrointestinal endoscopy using the auxiliary waterjet as a reference

Boban Sudarevic, Philipp Sodmann, Ioannis Kafetzis, Joel Troya, Thomas J Lux, Zita Saßmannshausen, Katja Herlod, Stefan A Schmidt, Markus Brand, Katrin Schöttker, Wolfram G Zoller, Alexander Meining, Alexander Hann, Boban Sudarevic, Philipp Sodmann, Ioannis Kafetzis, Joel Troya, Thomas J Lux, Zita Saßmannshausen, Katja Herlod, Stefan A Schmidt, Markus Brand, Katrin Schöttker, Wolfram G Zoller, Alexander Meining, Alexander Hann

Abstract

Background: Measurement of colorectal polyp size during endoscopy is mainly performed visually. In this work, we propose a novel polyp size measurement system (Poseidon) based on artificial intelligence (AI) using the auxiliary waterjet as a measurement reference.

Methods: Visual estimation, biopsy forceps-based estimation, and Poseidon were compared using a computed tomography colonography-based silicone model with 28 polyps of defined sizes. Four experienced gastroenterologists estimated polyp sizes visually and with biopsy forceps. Furthermore, the gastroenterologists recorded images of each polyp with the waterjet in proximity for the application of Poseidon. Additionally, Poseidon's measurements of 29 colorectal polyps during routine clinical practice were compared with visual estimates.

Results: In the silicone model, visual estimation had the largest median percentage error of 25.1 % (95 %CI 19.1 %-30.4 %), followed by biopsy forceps-based estimation: median 20.0 % (95 %CI 14.4 %-25.6 %). Poseidon gave a significantly lower median percentage error of 7.4 % (95 %CI 5.0 %-9.4 %) compared with other methods. During routine colonoscopies, Poseidon presented a significantly lower median percentage error (7.7 %, 95 %CI 6.1 %-9.3 %) than visual estimation (22.1 %, 95 %CI 15.1 %-26.9 %).

Conclusion: In this work, we present a novel AI-based method for measuring colorectal polyp size with significantly higher accuracy than other common sizing methods.

Conflict of interest statement

The authors declare that they have no conflict of interest.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Figures

Fig. 1
Fig. 1
Endoscopic image of a polyp automatically outlined by a bounding box with a waterjet adjacent. The yellow line represents the length of the waterjet, while the red one represents its diameter, which is used as the measurement reference. The output of Poseidon, with the size estimation displayed above the bounding box, was not presented to the examiner during the study.
Fig. 2
Fig. 2
Box plots of percentage errors for each sizing method. The notch around the median value represents the 95 %CI derived using bootstrapping (n = 10 000).
Fig. 3
Fig. 3
Scatter plots of measurement results plotted against the corresponding gold standard sizes for each sizing method. The dashed lines represent exact values, with the points closer to the lines being more accurate measurements. Points above the dashed line are overestimates, while those below underestimate the polyp size. The fitted curves show the over- or underestimation tendency of each sizing method.

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