Marshall, Christopher

ABSTRACT Background Sampling techniques have poor accuracy for classifying biliary strictures as benign or malignant. Previously, a cholangioscopy artificial intelligence (AI) outperfromed sampling techniques based solely on analysis of previously recorded cholangioscopy footage. The aim of this trial was to compare the performance of a real-time cholangioscopy AI to both sampling techniques and human observers for the task of biliary stricture classification. Methods A cholangioscopy AI computer connected directly to a cholangioscope console. The computer analyzed the cholangioscopy video stream during procedures for suspected biliary strictures. The primary outcome of the study was comparison of the performance of cholangioscopy AI to sampling techniques – brush cytology and transpapillary forceps biopsy – for biliary stricture classification. Secondary outcomes included comparison of the AI classification performance to that of human observers (separated into junior-level and experienced-level cohorts) who reviewed the cholangioscopy footage. Results A total of 41 patients were enrolled in the trial and had biliary strictures analyzed by cholangioscopy AI. For the classification of strictures, the AI had greater classification accuracy than standard sampling techniques (87.8% versus 67.4%; p = 0.043). Additionally, the cholangioscopy AI was significantly more accurate for biliary stricture classification than both junior-level (87.8% versus 61.5%; p = 0.001) and experienced endoscopists (87.8% versus 63.15%; p = 0.011). Conclusions This trial demonstrates that sampling techniques and human assessment of biliary strictures are flawed and there may be a benefit to the use of a cholangioscopy AI system to aid in biliary stricture classification.

Abstract Cholecystectomy (CCY) is the standard treatment for acute cholecystitis. For non-surgical patients, percutaneous cholecystostomy tube (PT-GBD) is recommended but is associated with high readmission rates and poor quality of life. Endoscopic gallbladder decompression techniques, including endoscopic transpapillary gallbladder drainage (ET-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), are alternatives. Studies comparing ET-GBD and EUS-GBD have shown EUS-GBD to have superior outcomes. However, these studies assessed ET-GBD mostly via single transcystic stent placement (SSET-GBD). This study aimed to compare outcomes of dual transcystic stents (DSET-GBD) and EUS-GBD in non-surgical candidates with acute cholecystitis. A multicenter analysis was conducted on patients who underwent ET-GBD or EUS-GBD between January 2019 and January 2023. Data were extracted from electronic medical records and outcomes including technical success, success, adverse events (AEs), and recurrence rates of cholecystitis were measured. Of 129 procedures (56 EUS-GBD; 73 ET-GBD), technical success was achieved in 87.5% of EUS-GBD and 86.3% of ET-GBD attempts. Immediate clinical success was achieved in 98.1% for EUS-GBD and 100% for DSET-GBD. AE rates were similar between the groups. Recurrent cholecystitis rates were 5.3% for EUS-GBD and 8.2% for DSET-GBD (P = 0.692). This study demonstrates that DSET-GBD has similarly low rates of recurrent acute cholecystitis compared with EUS-GBD. DSET-GBD should be considered as an alternative management strategy for management of acute cholecystitis in patients who are unable to undergo CCY.