Goutham Reddy Katukuri1, Anudeep Katrevula1, Aniruddha Pratap Singh1, Inavolu Pradev1, Hardik Rughwani1, Siddhartha Reddy Alla1, Mohan Ramchandani2, Duvvur Nageshwar Reddy3

1Consultant Gastroenterologist, AIG Hospitals, Hyderabad, India, 2Director, Interventional Endoscopy, AIG Hospitals, Hyderabad, India, 3Chairman, AIG Hospitals, Hyderabad, India

Background/Aims: Precise optical diagnosis of colorectal polyps could improve the cost-effectiveness of colonoscopy and reduce polypectomy-related complications. Computer assisted Diagnosis (CAD) has potential for better accuracy and lower interobserver variability. The EndoBRAIN system uses optical diagnostic technologies like Endocytoscopy (EC) and Narrow Band Imaging(NBI). Aim of the study is to estimate the accuracy of EC in identifying a lesion as neoplastic or non-neoplastic by visual inspection alone and with EC-CAD

Methods: This is an observational, prospective pilot study. Subjects who were scheduled for screening, surveillance, diagnostic, or therapeutic colonoscopy and found to have a polyp on white light endoscopy were included. Patients underwent colonoscopy with Olympus colonoscope equipped with EndoBRAIN technology. The ENDOBRAIN diagnosis of the polyp on EC NBI (Non Neoplastic/Neoplastic) or EC stain (Non Neoplastic/Neoplastic) images is documented. The acquired images is assessed by endoscopist and is asked to give a diagnosis who is blinded to the ENDOBRAIN diagnosis and histopathological diagnosis. Resected polyps were sent for histopathological assessment who were blinded to the endoscopic diagnosis.

Results: Analysis of 55 polyps was done. The mean size of the lesions was 7.27 - 6.4 mm. 61.8% of polyps were diminutive polyps. 38.2% polyps were noted in rectum. EC image acquisition was done in 78.1% of all polyps. The sensitivity, specificity and accuracy of endoscopist in identifying a neoplastic lesion using EC is 91.3%, 80% and 86.05 % whereas the sensitivity, specificity and accuracy of EC-CAD is 100%, 78.95% and 90.7 % respectively.

Conclusion: Optical diagnosis using EC and EC-CAD has a potential role in predicting the histopathological diagnosis. The diagnostic accuracy of CAD seems to be better than endoscopist using EC for predicting neoplastic lesions. Large scale data analysis in Indian population is needed prior to community practice.

Keywords: ENDOBRAIN, Endocytoscopy, EC-NBI, CAD