COLONOSCOPY
GI Genius is a small box that integrates within any colonoscopy platform and acts as virtual observer. This mitigates the ‘fatigue’ element of ADR, but may also, intriguingly be of benefit to less experienced (‘non-expert’) practitioners. Upon detection of a polyp, it alerts the endoscopist with a visual ‘bounding box’ on the screen. The development data indicated 99.7% sensitivity when there is a known polyp in the visual field (test videos) and a very low false positive rate of 0.9%. In clinical practice, it supports endoscopists to perform precise and consistent colonoscopies throughout the day and reducing variation in detection rates between endoscopists.17 Repici et al found that incorporating GI Genius in colonoscopies increased the adenoma detection rate by 14% even in ‘expert’ hands.18
Impact of the pandemic: delays in diagnosis
Early diagnosis is crucial to improve the prognosis of CRC. When diagnosed at its earliest stage, 92% of people with CRC will survive five years or more, but this reduces to only 10% of people surviving for five years when diagnosed at later stages.2
In
order respond to the pandemic there was a large-scale suspension of diagnostic endoscopy activity in 2020.11,19
This resulted
in postponed CRC screening and ultimately a backlog of patients requiring screening.10 The stark reality is that there will be a significant impact on the prognosis of those with colorectal cancer who have not been diagnosed. Prior to the pandemic, there were already concerns about colonoscopy services being under pressure and unable to meet the growing demand.1
The pandemic has
resulted in increased demand on services and it is expected endoscopists will have more intense and/or longer working periods, which will affect their ability to detect polyps. This further highlights the importance of using AI tools to support endoscopists with heavy workloads.20
To address the patients who are reluctant to come to hospitals due to
fears around viral transmission, best practice infection prevention and control policies have been adopted, including the use of full PPE such as face shields, masks, gloves and gowns10,21
UK data indicates that these measures are effective, with no cases of COVID transmission detected in over 6,000 outpatients.21
CRC
is highly prevalent and has a high mortality rate. However, with timely and accurate diagnosis, the mortality rate can be reduced. The pandemic has also presented additional challenges for the diagnosis of CRC but by healthcare providers effectively prioritising patients, the impact of the delays can be managed while minimising harm. It remains true that the risks of missed or delayed cancer diagnosis far outweigh the risk of COVID-19 transmission.14 The application of CADe enhances the performance of colonoscopies, improving detection rate and may help to increase the value of colonoscopy as a screening tool,
regardless of whom or where the procedure is carried out.
References for this article are available upon request.
CSJ
About the author
Dr. Hayee is a consultant gastroenterologist at King’s College Hospital and is clinical director for endoscopy and gastroenterology. He trained at Guy’s Hospital (GKT Medical School), graduating in 1999, and was appointed a Fellow of the Royal College of Physicians in 2015. He was clinical lead for the NHS London Endoscopy COVID recovery programme in 2020 and has recently been appointed as a Clinical Lead at NHSX. He is a Reader in gastroenterology at King’s College London and maintains an active research interest, supervising several PhD fellows and basic scientists in diverse topics including mucosal immunology, computer vision and robotics.
APRIL 2021
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