A novel endoscopic artificial intelligence system to assist in the diagnosis of autoimmune gastritis: a multicenter study

Shurong Chen; Louzhe Xu; Lingling Yan; Jie Zhang; Xuefeng Zhou; Jiayi Wang; Tianlian Yan; Jinghua Wang; Xinjue He; Han Ma; Xuequn Zhang; Shenghua Zhu; Yizhen Zhang; Chengfu Xu; Jianguo Gao; Xia Ji; Dezhi Bai; Yuan Chen; Hongda Chen; Yini Ke; Lan Li; Chaohui Yu; Xinli Mao; Ting Li; Yi Chen

doi:10.1055/a-2451-3071

Endoscopy, Table of Contents

Endoscopy 2025; 57(04): 299-309
DOI: 10.1055/a-2451-3071

Original article

A novel endoscopic artificial intelligence system to assist in the diagnosis of autoimmune gastritis: a multicenter study

Shurong Chen‡^‡

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Louzhe Xu‡^‡

²Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China

,

Lingling Yan

³Department of Gastroenterology, Taizhou Hospital, Taizhou, China

,

Jie Zhang

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Xuefeng Zhou

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

⁴Department of Gastroenterology, the Second Hospital of Jiaxing, Jiaxing, China

,

Jiayi Wang

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

⁵Department of Gastroenterology, CHC international hospital, Ningbo, China

,

Tianlian Yan

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Jinghua Wang

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Xinjue He

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Han Ma

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Xuequn Zhang

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Shenghua Zhu

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Yizhen Zhang

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Chengfu Xu

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Jianguo Gao

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Xia Ji

⁴Department of Gastroenterology, the Second Hospital of Jiaxing, Jiaxing, China

,

Dezhi Bai

⁶Department of Gastroenterology, the First People’s hospital of Yuhang, Hangzhou, China

,

Yuan Chen

⁷Department of Gastroenterology, the Third People’s hospital of Zhoushan, Zhoushan, China

,

Hongda Chen

⁸Department of Gastroenterology, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China

,

Yini Ke

⁹Department of Rheumatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Lan Li

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Chaohui Yu

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

,

Xinli Mao

³Department of Gastroenterology, Taizhou Hospital, Taizhou, China

,

Ting Li∗^*

²Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China

,

Yi Chen∗^*

¹Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

› Author Affiliations

Abstract

Background Autoimmune gastritis (AIG), distinct from Helicobacter pylori-associated atrophic gastritis (HpAG), is underdiagnosed due to limited awareness. This multicenter study aimed to develop a novel endoscopic artificial intelligence (AI) system for assisting in AIG diagnosis.

Methods Patients diagnosed with AIG, HpAG, or nonatrophic gastritis (NAG), were retrospectively enrolled from six centers. Endoscopic images with relevant demographic and medical data were collected for development of the AI-assisted system based on a multi-site feature fusion model. The diagnostic performance of the AI model was evaluated in internal and external datasets. Endoscopists’ performance with and without AI support was tested and compared using Mann–Whitney U test. Heatmap analysis was performed to interpret AI model outputs.

Results 18 828 endoscopy images from 1070 patients (294 AIG, 386 HpAG, 390 NAG) were collected. On testing datasets, AI identified AIG with 96.9 % sensitivity, 92.2 % specificity, and area under the receiver operating characteristic curve (AUROC) of 0.990 (internal), and 90.3 % sensitivity, 93.1 % specificity, and AUROC of 0.973 (external). The performance of AI (sensitivity 91.3 %) was comparable to that of experts (87.3 %) and significantly outperformed nonexperts (70.0 %; P = 0.01). With AI support, the overall performance of endoscopists was improved (sensitivity 90.3 % [95 %CI 86.0 %–93.2 %] vs. 78.7 % [95 %CI 73.6 %–83.2 %]; P = 0.008). Heatmap analysis revealed consistent focus of AI on atrophic areas.

Conclusions This novel AI system demonstrated expert-level performance in identifying AIG and enhanced the diagnostic ability of endoscopists. Its application could be useful in guiding biopsy sampling and improving early detection of AIG.

Full Text

References

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Supplementary Material

Supplementary material