Using Artificial Intelligence to Improve Colonoscopy
Colonoscopy is called the “gold standard” of colorectal cancer screening for good reason: research suggests that older adults who get screened are 60% less likely to die of colon cancer than those who don’t.
Colonoscopy allows earlier diagnosis and treatment of colorectal cancers and also the removal of growths called polyps that could develop into cancer.
And yet colonoscopy isn’t perfect: it may miss about 20% of polyps.
New technology now in use at Einstein Healthcare Network may lead to even better results using artificial intelligence (AI) to assist the doctor in finding the maximum number of polyps and prevent more cancers.
The system, called GI GeniusTM Intelligent Endoscopy Module, was approved by the Food and Drug Administration less than a year ago. So far, it’s the only device of its type approved in the United States.
“This is currently state of the art technology, and we are the only institution in Philadelphia using this device,” says Michael Goldberg, Chair of Gastroenterology at Einstein Healthcare Network. “But my suspicion is that AI will be integrated into all endoscopy systems over the next five to 10 years as we continue to see its benefits.”
The clinical trial that led to the approval of the system showed that it significantly increased detection of polyps, especially smaller ones. The study included people at high risk as well as average risk of colorectal cancer.
The AI system is supported by a $40,000 grant from the Albert Einstein Society, says gastroenterologist James Walter, MD, who applied for the grant. “It’s very forward thinking for them to be willing to support that for our patients.”
How It Works
In a colonoscopy, a doctor uses an instrument (scope) that has a light and camera attached to go inside the colon and look for abnormalities, such as polyps. The doctor views all of this on a screen.
The GI Genius uses AI software to analyze everything the instrument sees on its way through the twists and turns of the colon.
“It’s looking for characteristic features that are consistent with polyps,” Dr. Walter says. “And polyps come in different shapes and sizes – small and big, flat and wartlike, and so on.
“If it detects a polyp, it alerts us in two different ways, by a sound like a beep, and also by creating a green bounding box around the polyp on the screen.”
It’s up to the doctor to decide whether there’s a polyp that needs to be removed, using tools attached to the scope.
“It just alerts us, draws our eye to it,” Dr. Walter says. “It’s almost like another doctor or second colonoscopist in the room.”
More Polyps Removed = Fewer Cancers
Results of a colonoscopy are affected by many factors, including “some things that are out of our control – like fatigue, focus, almost human nature,” Dr. Walter says. “If we can take out all those intangible factors by adding another set of eyes, my hope is we could detect more polyps.”
On average, it takes about 10 years for a type of polyp called an adenoma to turn into cancer. That’s why colonoscopy is recommended every 10 years for people ages 45 and older who are at average risk of developing colorectal cancer.
More polyps removed means fewer polyps that can develop into cancers, Dr. Walter explains.
“Every 1% increase in polyp detection translates into a 3% decrease in interval development of colorectal cancer,” he says. An interval cancer is one that develops in between screenings, such as colonoscopy.
Einstein Medical Center Philadelphia began using the AI technology in November. Any gastroenterologist can use it when performing a colonoscopy, Dr. Walter says.
For now, it’s too early to say what impact using AI will have on colonoscopy results at Einstein, Dr. Walter says, but he plans to keep track in hopes of expanding the program at Einstein Philadelphia and adding it at Einstein Medical Center Montgomery.
The Albert Einstein Society grant is expected to cover the cost of leasing the GI Genius from the manufacturer, Medtronic, for at least a year. “Throughout the time that we have the technology, patients will not incur any additional costs, as this technology is assisting with a standard screening colonoscopy,” Dr. Walter says.
“We strive to prevent as many colon cancers as possible, and our patients in this underserved community face many challenges,” he says. “We are grateful to the society for recognizing this need. Their support of bringing this system to Einstein is truly visionary.”
Janet Bynum
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