An overview of deep learning algorithms and water exchange in colonoscopy in improving adenoma detection.

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Abstract

Introduction: Among the Gastrointestinal (GI) Endoscopy Editorial Board top 10 topics in advances in endoscopy in 2018, water exchange colonoscopy and artificial intelligence were both considered important advances in GI endoscopy. Artificial intelligence holds potential to increase and water exchange significantly increases adenoma detection.Areas covered: The authors searched MEDLINE (1998-2019) using the following medical subject terms and keywords: colonoscopy, adenoma, artificial intelligence, deep learning, computer-assisted detection, and neural networks. Additional related studies were manually searched from the reference lists of publications. Only fully published journal articles in English were reviewed. The latest date of the search was Aug 10, 2019. Artificial intelligence, machine learning and deep learning contribute to the promise of real time computer-aided detection and computer-aided diagnosis. For water exchange colonoscopy, the authors used a similar strategy using key word of water-aided, water-assisted and water exchange colonoscopy. By emphasizing near-complete suction of infused water during insertion, water exchange colonoscopy provides salvage cleaning and decreases cleaning-related multi-tasking distractions during withdrawal with important impact on increasing adenoma detection. Using the above strategy, the current review includes key relevant studies within four clinical areas: adenoma detection rate, water exchange, computer-aided detection, and quality assessment during colonoscopy. Some unresolved issues with artificial intelligence, and comparative efficacy and cost of different endoscopic techniques in adenoma detection and real time diagnosis are discussed. The review will address how artificial intelligence and water exchange can complement each other in improving adenoma detection during colonoscopy.Expert Opinion: In five years, research on artificial intelligence will likely achieve real time application, and evaluation of factors contributing to quality colonoscopy. The understanding of water exchange will mature and more widespread use will be possible.