The study aimed to construct an intelligent difficulty scoring and assistance system (DSAS) for endoscopic retrograde cholangiopancreatography (ERCP) treatment of common bile duct (CBD) stones.
From three hospitals, 1954 cholangiograms were collected for training and testing the DSAS. The D-LinkNet34 and U-Net were adopted to segment the CBD, stones and duodenoscope. Based on the segmentation results, the stone size, distal CBD diameter, distal CBD arm and distal CBD angulation were estimated. The performance of segmentation and estimation was assessed by mean intersection over union (mIoU) and average relative error (ARE). A technical difficulty scoring scale, which was used for assessing the technical difficulty of CBD stones removal, was developed and validated. We also analysed the relationship between scores evaluated by the DSAS and some clinical indicators including the stone clearance rate, endoscopic papillary large-balloon dilation (EPLBD) and lithotripsy.
The mIoU of the stone, CBD and duodenoscope segmentation was 68.35%, 86.42% and 95.85%, respectively. The estimation performance of the DSAS was superior to non-expert endoscopists. In addition, the technical difficulty scoring performance of the DSAS was more consistent with the expert endoscopists than two non-expert endoscopists. A DSAS assessment score ≥2 was correlated with lower stone clearance rates and more frequent EPLBD.
In this study, an intelligent DSAS based on deep learning was developed.The DSAS can automatically remind endoscopists of technical difficulties for CBD stone extraction, help them optimise therapeutic approaches and choose proper accessories during the process of ERCP.
Endoscopy. 2020 Aug 24 [Epub ahead of print]
Li Huang, Xiaoyan Lu, Xu Huang, Xiaoping Zou, Lianlian Wu, Zhongyin Zhou, Deqing Wu, Dehua Tang, Dingyuan Chen, Xinyue Wan, Zhongchao Zhu, Tao Deng, Lei Shen, Jun Liu, Yijie Zhu, Dexin Gong, Di Chen, Yanfei Zhong, Feng Liu, Honggang Yu
Wuhan University Renmin Hospital, Department of Gastroenterology, Wuhan, China., Wuhan University State Key Laboratory of Information Engineering in Surveying Mapping and Remote Sensing, State Key Laboratory of Information Engineering in Surveying, Mapping, and Remote Sensing, Wuhan, China., the Affiliated Drum Tower Hospital of Nanjing University, Medical School, Gastroenterology, Nanjing, China., Shanghai Tenth People's Hospital, Tongjii University School of Medicine, Gastroenterology, Shanghai, China., Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Department of Gastroenterology, Nanjing, China., Wuhan University State Key Laboratory of Information Engineering in Surveying Mapping and Remote Sensing, State Key Laboratory of Information Engineering in Surveying, Mapping, and Remote Sensing, Wuhan University, Wuhan, China., Renmin Hospital of Wuhan University, Department of Pancreatic Surgery, Wuhan, China., Renmin Hospital of Wuhan University, Department of Gastroenterology, Wuhan, China., Tenth People Hospital of Tongji University, Department of Gastroenterology, Shanghai, China., Wuhan University Renmin Hospital, department of gastroenterology, Wuhan, China.
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