Randomised controlled trial of WISENSE, a real-time quality improving system for monitoring blind spots during esophagogastroduodenoscopy
Randomised controlled trial of WISENSE, a real-time quality improving system for monitoring blind spots during esophagogastroduodenoscopy
复制标题
WISENSE 的随机对照试验，一种实时质量改进系统，用于监测食管胃十二指肠镜检查期间的盲点
DOI：
10.1136/gutjnl-2018-317366
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发表时间：
2019-12-01
期刊：
影响因子：
24.5
通讯作者：
Yu, Hong Gang
中科院分区：
文献类型：
--
作者：
Wu, Lianlian;Zhang, Jun;Yu, Hong Gang
目的食管胃镜检查（EGD）是上消化道疾病诊断的关键性检查方法。然而，内镜医师的EGD表现存在显著差异，影响了胃癌和前驱病变的发现率。本研究的目的是建立一个实时质量改进系统，WISENSE，以监测盲点，时间的程序和自动生成的照片记录在EGD，从而提高日常内窥镜检查的质量。设计WISENSE系统使用深度卷积神经网络和深度强化学习的方法开发。从武汉大学人民医院招募因健康检查、症状、监测而转诊的患者。入组的患者被随机分配到接受EGD（有或无WISENSE辅助）的组中。主要终点是确定WISENSE辅助组和对照组之间的盲点率是否存在差异。结果WISENSE在真实的EGD视频中监测盲点的准确率为90.40%。共招募并随机分配了324例患者。WISENSE组和对照组分别分析了153例和150例患者。WISENSE组的盲点率低于对照组（5.86% vs 22.46%，p<0.001），平均差异为-15.39%（95%CI-19.23至-11.54）。无显著不良事件。结论WISENSE可明显降低EGD检查的盲点率，提高日常内镜检查质量。试验注册号ChiCTR 1800014809;结果。
Objective Esophagogastroduodenoscopy (EGD) is the pivotal procedure in the diagnosis of upper gastrointestinal lesions. However, there are significant variations in EGD performance among endoscopists, impairing the discovery rate of gastric cancers and precursor lesions. The aim of this study was to construct a real-time quality improving system, WISENSE, to monitor blind spots, time the procedure and automatically generate photodocumentation during EGD and thus raise the quality of everyday endoscopy. Design WISENSE system was developed using the methods of deep convolutional neural networks and deep reinforcement learning. Patients referred because of health examination, symptoms, surveillance were recruited from Renmin hospital of Wuhan University. Enrolled patients were randomly assigned to groups that underwent EGD with or without the assistance of WISENSE. The primary end point was to ascertain if there was a difference in the rate of blind spots between WISENSE-assisted group and the control group. Results WISENSE monitored blind spots with an accuracy of 90.40% in real EGD videos. A total of 324 patients were recruited and randomised. 153 and 150 patients were analysed in the WISENSE and control group, respectively. Blind spot rate was lower in WISENSE group compared with the control (5.86% vs 22.46%, p<0.001), and the mean difference was −15.39% (95% CI −19.23 to −11.54). There was no significant adverse event. Conclusions WISENSE significantly reduced blind spot rate of EGD procedure and could be used to improve the quality of everyday endoscopy. Trial registration number ChiCTR1800014809; Results.