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In this study, we aimed to develop an artificial intelligence clinical decision support solution to mitigate operator-dependent limitations during complex endoscopic procedures such as endoscopic submucosal dissection and peroral endoscopic myotomy, for example, bleeding and perforation. A DeepLabv3-based model was trained to delineate vessels, tissue structures and instruments on endoscopic still images from such procedures. The mean cross-validated Intersection over Union and Dice Score were 63% and 76%, respectively. Applied to standardised video clips from third-space endoscopic procedures, the algorithm showed a mean vessel detection rate of 85% with a false-positive rate of 0.75/min. These performance statistics suggest a potential clinical benefit for procedure safety, time and also training.

Background and study aims: Outbreaks of multi-drug resistant bacteria due to contaminated duodenoscopes and the Covid-19 pandemic have driven the development of single-use endoscopes. The first single-use gastroscope (Ambu aScope Gastro) is now available in Europe. Besides waste-disposal and cost issues, the infection risk and performance remain unclear. We aimed to evaluate single-use gastroscopes in patients with upper gastrointestinal bleeding. Patients and methods: Twenty consecutive patients presenting with stigmata of upper gastrointestinal bleeding were included in this case series between October and November 2022. The primary aim was the technical success rate defined as access to the descending duodenum and adequate assessment of the upper gastrointestinal tract for the presence of a bleeding site. Results: The primary aim was achieved in 19 out of 20 (95%) patients. The bleeding site was identified in 18 patients. A therapeutic intervention with a single-use gastroscope was performed in six cases (two cap-mounted clips, one standard hemoclip, , two variceal band ligations, one hemostatic powder, two adrenaline injections). Technical and clinical success were achieved in all six cases. Two crossovers to a standard gastroscope occurred. Conclusions: In this feasibility study, we propose a possible niche for single-use gastroscopes in patients presenting for urgent endoscopic evaluation and treatment of upper gastrointestinal bleeding.

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