Reproducibility of the electronic chromoendoscopy PICaSSO score (Paddington International Virtual ChromoendoScopy ScOre) in ulcerative colitis using multiple endoscopic platforms: a prospective multicenter international study (with video)

Cannatelli, Rosanna; Bazarova, Alina; Furfaro, Federica; Lorenzo, Parigi Tommaso; Zardo, Davide; Maria, Nardone Olga; Scocco, Paola; Villanacci, Vincenzo; Cadei, Moris; Labarile, Nunzia; Lloyd, Smith Samuel Charles; Danese, Silvio; Ghosh, Subrata; Iacucci, Marietta

doi:10.1016/j.gie.2022.02.012

Cited by 9 publications

(17 citation statements)

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“…VCE, through the PICaSSO score, has shown to bridge the discrepancy between traditional endoscopic and histologic evaluation, allowing the detection of subtle changes overlooked in conventional WL endoscopy, [23] regardless of the VCE platform. [24] We developed the first CAD system to evaluate endoscopic and histologic activity and remission and predict clinical specified outcomes through VCE, in addition to conventional WLE-HD, thus harnessing the potential of image enhancement technology. When applied to VCE videos, our system detected endoscopic inflammatory activity with excellent specificity (95%) and good sensitivity (79%).…”

Section: Discussionmentioning

confidence: 99%

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A virtual chromoendoscopy artificial intelligence system to detect endoscopic and histologic activity/remission and predict clinical outcomes in ulcerative colitis

et al. 2022

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Background and study aims Endoscopic and histologic remission (ER, HR) are therapeutic targets in ulcerative colitis (UC) and virtual chromoendoscopy (VCE) improves the endoscopic assessment and the prediction of histology. However, interobserver variability is a limitation for widespread standardised endoscopic assessment using all scoring systems. We aimed to develop an artificial intelligence tool to distinguish ER/activity, and predict histology and outcomes from white-light-endoscopy (WLE) and VCE videos. Patients and methods 1090 endoscopic videos (638287 frames), from 283 patients, were used to develop a convolutional neural network (CNN). UC endoscopic activity was graded by experts with Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and PICaSSO. The CNN was trained to distinguish ER/activity on endoscopy videos, and retrained to predict HR/activity, defined according to multiple indices, and predict outcome; CNN and humans agreement was measured. Results The AI system detected ER (UCEIS ≤1) in WLE videos with 72% sensitivity (Se), 87% specificity (Sp), and area under the ROC curve (AUROC) of 0.85; For detection of ER in VCE videos (PICaSSO ≤3) Se was 79%, Sp 95%, and the AUROC 0.94. Prediction of HR was similar between WLE and VCE videos (accuracies ranging 80%-85%). The model’s prediction of clinical outcomes was similar to that of physician-assessed endoscopy scores. Conclusions Our system accurately distinguished ER/activity and predicted HR and clinical outcomes from colonoscopy videos. This is the first computer model developed to detect inflammation/healing using VCE through the PICaSSO score and the first computer tool providing endoscopic, histologic, and clinical assessment.

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Section: Discussionmentioning

confidence: 99%

“…We recently reported that PICaSSO is valid for other optical enhancement platforms. [24] Nevertheless, a prospective multicentre study to validate the system on other VCE platforms is planned.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

A virtual chromoendoscopy artificial intelligence system to detect endoscopic and histologic activity/remission and predict clinical outcomes in ulcerative colitis

et al. 2022

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“…3 Notably training modules, representative of all the endoscopic mucosal and vascular findings and with all the endoscopy platforms, are now available. 3,5 In conclusion, PICaSSO made an important point in the current debate that using high-definition endoscopes and VCE to enhance mucosal and vascular details, discrepancy between endoscopy and histology has become small. Histology plays still a crucial role for the clinical management of UC and we should not think that endoscopy will replace histology but be complementary.…”

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confidence: 99%

“…3,4 To overcome this limitation, we have recently investigated PICaSSO reproducibility and validation by using narrow band imaging (NBI) Olympus and linked colour imaging/blue-laser imaging (LCI/BLI), Fujifilm and this has been recently published. 5 After a brief training for PICaSSO, we determined the interobserver variability (ICC) in a group of both experienced and less experienced endoscopists who were asked to score colonoscopies videos. In both Virtual Electronic Chromoendoscopy (VCE) platforms (NBI, LCI/BLI) the ICC for PICaSSO and its subscores (mucosal and vascular) were either good or very good, and most importantly, always numerically higher than for Mayo Endoscopic Score (MES) and Ulcerative colitis (UC) endoscopic Index of severity (UCEIS).…”

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confidence: 99%

“…These results confirm that PICaSSO is accurate and reliable score on all available VCE platforms. 5 However, we have already previously tested interobserver agreement in experienced consultant and trainees who had no prior exposure to Electronic Virtual Chromoendoscopy, by using a short training module (colonoscopy video library: 30 cases reviewed pretraining and 30 post-training) and PICaSSO revealed good interobserver agreement across all levels of experience in even non-expert setting reaching high ICC. 3 Notably training modules, representative of all the endoscopic mucosal and vascular findings and with all the endoscopy platforms, are now available.…”

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Endoscopy and histology in inflammatory bowel diseases patients: Complementary or alternatives?—Author’s reply

2022

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We read with great interest the editorial: "Endoscopy and histology in inflammatory bowel disease patients: complementary or alternatives?" 1 and we thank Dr. D'Amico et al. for insightful comments.The clinical relevance of an endpoint that combines histopathological and endoscopic assessments of mucosal healing versus only endoscopic endpoint is a matter of increasing debate. We have reported that PICaSSO endoscopic score can accurately predict histologic remission without having to combine both measures and this is of significant practical benefit. 2 However, we fully agree that we need randomized controlled trials before translating into routine clinical practice.None.

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New endoscopic tools in inflammatory bowel disease

et al. 2022

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Endoscopic remission is now considered the ultimate long‐term goal for treating inflammatory bowel disease (IBD). Recent advances in endoscopic techniques have progressively added new tools to the armamentarium of endoscopists for a deeper assessment and characterisation of the intestinal mucosa. Virtual Electronic chromoendoscopy is widely available in the endoscopic units, leading to a more accurate evaluation of the vascular and mucosal architecture of the colon, reducing the gap with histology, which is considered a favourable long‐term measure. In addition, advanced, sophisticated techniques such as endocytoscope and confocal laser endomicroscopy provide insights into individualised and personalised IBD therapy. Finally, high expectations are placed on the advent of Artificial Intelligence (AI) with promising applications that have the potential to revolutionise IBD diagnosis and management. Here, we discuss state‐of‐the‐art of endoscopic techniques and their applicability to accurate assess endoscopic and histological remission, predict response to therapy and detect, characterise and guide treatment of colonic dysplastic lesions. We are seeing the dawn of a new era wherein the applications of these new endoscopic tools, hand in hand with AI, offer the most incredible opportunity to deliver precision medicine to patients with IBD.

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Reproducibility of the electronic chromoendoscopy PICaSSO score (Paddington International Virtual ChromoendoScopy ScOre) in ulcerative colitis using multiple endoscopic platforms: a prospective multicenter international study (with video)

Cited by 9 publications

References 25 publications

A virtual chromoendoscopy artificial intelligence system to detect endoscopic and histologic activity/remission and predict clinical outcomes in ulcerative colitis

A virtual chromoendoscopy artificial intelligence system to detect endoscopic and histologic activity/remission and predict clinical outcomes in ulcerative colitis

Endoscopy and histology in inflammatory bowel diseases patients: Complementary or alternatives?—Author’s reply

New endoscopic tools in inflammatory bowel disease

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