United European Gastroenterology Journal最新文献

{"title":"Effectiveness of Gastric Cancer Endoscopic Screening in Intermediate-Risk Countries-A Systematic Review and Meta-Analysis.","authors":"M B Mourato, N Pratas, A Branco Pereira, R Chança, I Fronteira, R Dinis, M Areia","doi":"10.1002/ueg2.70084","DOIUrl":"https://doi.org/10.1002/ueg2.70084","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer remains a major cause of cancer-related mortality in intermediate-risk countries. Although endoscopic screening is widely implemented in high-risk regions, its effectiveness and economic viability in intermediate-risk settings remain uncertain. This systematic review and meta-analysis evaluated the effectiveness and cost-effectiveness of endoscopic screening in these countries.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted to assess the effectiveness and cost-effectiveness of upper gastrointestinal endoscopic screening by esophagogastroduodenoscopy (EGD) for gastric cancer. Searches were performed in Medline, Scopus, Embase, and Web of Science up to 30 September 2024. Pooled estimates were calculated for the detection of precancerous conditions, gastric cancer (overall and early-stage), and gastric cancer-specific mortality. Subgroup analyses were performed by screening strategy and geographic setting.</p><p><strong>Results: </strong>Thirty-two studies met inclusion criteria-24 on screening effectiveness and eight on cost-effectiveness. Among 404,159 individuals screened, the pooled detection rate for precancerous conditions was 25.5%, for gastric neoplastic lesions 3.3%, and for early-stage cancer among neoplastic cases 91.6%. Gastric cancer-specific mortality was 26.1%, and 5-year survival reached 75.7%. Subgroup analyses of studies using direct EGD versus pre-selection indicated higher detection of precancerous conditions (32.5% vs. 17.0%, p < 0.001) and early-stage cancer (95.8% vs. 87.3%, p < 0.001). Comparing Chinese versus other settings, similar detection rates were found for precancerous conditions (25.3% vs. 26.0%) and early-stage detection (91.5% vs. 100%). Economic analyses suggest that endoscopic screening is cost-effective in intermediate-risk settings, particularly when combined with colorectal screening, with incremental cost-effectiveness ratios within accepted willingness-to-pay thresholds.</p><p><strong>Conclusions: </strong>Endoscopic screening by EGD shows strong potential for early detection of gastric cancer in intermediate-risk countries. However, formal comparative analyses with unscreened populations are lacking, and most survival and mortality data originate from Chinese studies, limiting generalizability. Nevertheless, economic evaluations suggest implementing endoscopic screening-especially when integrated with colorectal screening or guided by risk stratification-could be a feasible and effective strategy.</p><p><strong>Trial registration: </strong>PROSPERO-CRD42024502174.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility\".","authors":"","doi":"10.1002/ueg2.70088","DOIUrl":"https://doi.org/10.1002/ueg2.70088","url":null,"abstract":"","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decline in Complications and Mortality in Chronic Liver Disease and Cirrhosis: A Population-Based Cohort Study From Northeastern Italy.","authors":"Francesco Paolo Russo, Alberto Zanetto, Laura Salmaso, Claudio Barbiellini Amidei, Sara Battistella, Salvatore Piano, Paolo Angeli, Patrizia Burra, Mario Saia, Ugo Fedeli","doi":"10.1002/ueg2.70085","DOIUrl":"https://doi.org/10.1002/ueg2.70085","url":null,"abstract":"<p><strong>Background: </strong>Current trends in complications and mortality among individuals with chronic liver disease and cirrhosis are largely unknown.</p><p><strong>Objective: </strong>To explore changes in mortality trends among patients with cirrhosis and chronic liver disease based on etiology in the Veneto Region (Italy), to differentiate mortality between liver-related and non-liver-related causes before and during the COVID-19 pandemic, and to determine trends in the development of cirrhosis complications.</p><p><strong>Methods: </strong>Three subsequent population-based cohorts of individuals with chronic liver disease/cirrhosis were identified in Veneto (North-eastern Italy, 4.9 million residents): the first enrolled before introduction of direct-acting antivirals (DAA); the second corresponding to full availability of DAA treatment; and the last enrolled at the beginning of the pandemic. Risks of liver decompensation and death-liver and non-liver related-were recorded for each cohort during a 3-year follow-up. Changes in the risk of death across cohorts were measured by risk ratios (RR) obtained through Poisson regression models with robust error variance.</p><p><strong>Results: </strong>Across the cohorts spanning over 10 years, we found that the number of individuals with CLD and cirrhosis remained stable at about 40,000 and 10,000, respectively. The 3-year risk of ascites, hepatic encephalopathy, and hepatocellular carcinoma decreased across the study period, largely due to individuals with HCV-related liver disease. The overall 3-year mortality risk declined by 14% (liver cirrhosis, subjects enrolled in 2020 vs. 2013: RR = 0.86, 95% CI 0.83-0.89), especially among those with viral etiology. In contrast, mortality due to alcohol-related chronic liver disease/cirrhosis was stable or increasing during the COVID-19 pandemic, especially for non-liver causes of death.</p><p><strong>Conclusions: </strong>Despite increased awareness and proactive enrollment into patient care, chronic liver disease and cirrhosis remain significant health-challenges. The reduction in HCV-related mortality underscores the impact of antiviral treatments, while the persistently high mortality risk of alcohol-related disease highlights the need for targeted interventions.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professor Lars Aabakken: A Visionary in GI Endoscopy and Medical Education.","authors":"Mário Dinis-Ribeiro","doi":"10.1002/ueg2.70082","DOIUrl":"https://doi.org/10.1002/ueg2.70082","url":null,"abstract":"","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus on Upper Gastrointestinal Endoscopy Key Performance Indicators to Reduce Post Endoscopy Upper Gastrointestinal Cancer.","authors":"Umair Kamran, Toto Anne Gronlund, Eva J A Morris, Matthew Brookes, Matt Rutter, Mimi McCord, Nicola J Adderley, Nigel Trudgill","doi":"10.1002/ueg2.70001","DOIUrl":"https://doi.org/10.1002/ueg2.70001","url":null,"abstract":"<p><strong>Background: </strong>Upper gastrointestinal (UGI) endoscopy lacks established key performance indicators. Up to three-fold variation in post endoscopy upper gastrointestinal cancer rates has been observed among endoscopy providers in England, highlighting the need for standardisation of UGI endoscopy practices.</p><p><strong>Objective: </strong>We aimed to achieve consensus on evidence-based key performance indicators to reduce post endoscopy upper gastrointestinal cancer.</p><p><strong>Methods: </strong>Modified nominal group technique was employed in two consensus workshops, with representation from clinicians, patients and relatives, moderated by James Lind Alliance facilitators. Potential indicators were identified from the umbrella systematic review, English provider post endoscopy upper gastrointestinal cancer rates, and differences in endoscopy practices from the National Endoscopy Database between providers with the highest (worst) and lowest (best) post endoscopy upper gastrointestinal cancer rates. KPIs were categorised as provider or endoscopist/procedure related and ranked as of major or minor importance. Minimum standards were proposed where possible.</p><p><strong>Results: </strong>Participants included 14 clinicians (gastroenterologists and UGI surgeons), 3 nurse endoscopists, 2 UGI cancer nurse specialists, 14 patients, their relatives and representatives from patient support groups and four observers. Endoscopy provider related major key performance indicators and proposed standards included monitoring post endoscopy upper gastrointestinal cancer rates (minimum standard ≤ 7%); less intense endoscopy lists (maximum 10 'points' per list [one point is equivalent to 15 min]); endoscopy provider accreditation (all providers); and premalignant condition surveillance on dedicated lists by endoscopists with adequate training (> 90% surveillance endoscopies). Endoscopist/procedure related major key performance indicators included: examination time ≥ 7 min; training in early UGI neoplasia recognition (all endoscopists); mucosal view quality recorded and cleansing agents used if not excellent (> 90% endoscopies); intravenous sedation offered to all appropriate patients; recommended number of biopsies from cancer associated or premalignant lesions (> 90% endoscopy where such lesions identified); and endoscopists' annual UGI endoscopy volume > 100 (all endoscopists).</p><p><strong>Conclusion: </strong>This study offers a consensus on the key performance indicators and minimum standards that should be used to improve UGI endoscopy quality and reduce post endoscopy upper gastrointestinal cancer.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to United European Gastroenterology Guidelines on Diagnosis and Therapy of Immunoglobulin-G4-Related Digestive Disease.","authors":"Miroslav Vujasinovic, Marco Lanzillotta, Emma L Culver, Vinciane Rebours, Joost P H Drenth, Milica Stojkovic Lalosevic, Jens Vikse, Natalya Gubergrits, Michael Hirth, Vincenzo Cardinale, Rodrigo Vieira Motta, Emanuel Della-Torre, Nicole Sciberras, Marcello Maida, Artemis Trikola, Frank Lammert, Clemence Descourvières, Cyriel Ponsioen, Jens Brøndum Frøkjær, Alexander Schneider, Domenico Alvaro, Gabriele Capurso, J-Matthias Löhr","doi":"10.1002/ueg2.70081","DOIUrl":"https://doi.org/10.1002/ueg2.70081","url":null,"abstract":"<p><strong>Introduction: </strong>United European Gastroenterology (UEG) Guidelines on immunoglobulin G4 (IgG4)-related digestive disease provides evidence-based recommendations for the diagnosis and management of IgG4-related digestive disease. The aim of this study is to evaluate the adherence to recommendations of this IgG4 guideline across centers in Europe.</p><p><strong>Patients and methods: </strong>Questionnaire-based data related to organ involvement, diagnosis, treatment and follow-up of newly diagnosed patients with IgG4-related digestive diseases over a 3-year period, were collected from 14 centers in 11 European countries.</p><p><strong>Results: </strong>One hundred and ninety-nine patients (76% males) were included. Median age at diagnosis was 64 years. Most of the patients had concomitant pancreatic and biliary tree involvement (46%), followed by isolated pancreatic involvement (33.5%), isolated biliary tree involvement (18.5%), esophageal involvement (1.5%) or bowel (0.5%) involvement. Most of the patients (64%) underwent a combination of computed tomography and magnetic resonance imaging at diagnosis. Among the 158 autoimmune pancreatitis patients with or without concomitant bile duct involvement, treatment was performed according to guidelines in 115 patients (73%; moderate adherence). Follow-up assessment was performed between 2 and 4 weeks in 75 patients (47%, partial adherence). Among 37 patients with liver- or biliary tree involvement, 29 patients were treated according to guidelines (78%; full adherence). In the follow-up of patients with isolated liver- or biliary tree involvement, we observed moderate adherence in 21 (57%). Disease monitoring for activity and damage using the IgG4 responder activity index was utilized in only 3/14 centers (poor adherence).</p><p><strong>Conclusions: </strong>IgG4-related digestive disease is restricted to the pancreas and bile ducts in the majority of patients. Even in specialist centers with an interest in IgG4-related digestive disease, UEG guideline treatment adherence was moderate, follow-up at 2-4 weeks was only partial, and monitoring for disease activity was poor. These findings highlight the need for ongoing education and improved adherence to monitoring among healthcare providers.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of PredictSURE IBD Assay in a Multinational Cohort of Patients With Inflammatory Bowel Disease.","authors":"Dahham Alsoud, Nurulamin M Noor, Lea Ann Chen, Vivian Abadom, Simon H C Anderson, Lediona Ardolli, Jordan Axelrad, Peter Bossuyt, Kenneth Croitoru, Oriana M Damas, Lily Deng, Parakkal Deepak, Juan De La Revilla Negro, Shanika de Silva, Marc Ferrante, Karen Hills, Peter M Irving, James O Lindsay, Dana J Lukin, Paul A Lyons, Eoin F McKinney, Maria Oliva-Hemker, Caterina Oneto, Roohi Patel, Miles Parkes, Lieven Pouillon, João Sabino, Lawrence J Saubermann, Jenny S Sauk, Sarah Sheibani, Kenneth G C Smith, Keith S Sultan, Tony C Tham, Sare Verstockt, Raluca Vrabie, Melissa Weidner, Huimin Yu, Bram Verstockt, James C Lee, Séverine Vermeire","doi":"10.1002/ueg2.70050","DOIUrl":"https://doi.org/10.1002/ueg2.70050","url":null,"abstract":"<p><strong>Background and aims: </strong>PredictSURE IBD is a prognostic blood test that classifies newly diagnosed, treatment-naïve Inflammatory Bowel Disease (IBD) patients into 'IBDhi' (high-risk) or 'IBDlo' (low-risk) groups (risk of future aggressive disease). We evaluated this assay in a multinational cohort and explored the effect of concomitant corticosteroids on its discrimination.</p><p><strong>Methods: </strong>One hundred thirty-six (71 Ulcerative colitis [UC], 65 Crohn's Disease [CD]) and 41 (15 UC, 26 CD) patients with active IBD were 'unexposed' and 'exposed', respectively, to corticosteroids at baseline blood sampling. The number of treatment escalations, time to first escalation, and need for repeated escalations were compared between the biomarker subgroups. Another 20 patients (13 UC, 7 CD) were longitudinally sampled over 6 weeks after commencing corticosteroids.</p><p><strong>Results: </strong>In corticosteroids-naïve UC and CD patients, all bowel surgeries (n = 6) and multiple therapy escalations (n = 10) occurred in IBDhi patients. IBDhi UC patients required significantly more treatment escalations, had a shorter time to first escalation, and a greater need for multiple escalations than IBDlo patients. No statistically significant differences were observed among CD patients. In corticosteroid-exposed patients, 66.6% of 'misclassifications' were IBDlo patients who required escalations. Among corticosteroid-treated patients with longitudinal sampling, 81.3% of those classified as IBDhi before steroids switched to IBDlo during therapy.</p><p><strong>Conclusions: </strong>No significant differences in treatment escalations were observed between biomarker-defined subgroups in CD. However, IBDhi UC patients required significantly earlier and more frequent therapy escalations, highlighting the need to further investigate PredictSURE IBD in UC. Notably, the discrimination ability of the biomarker was unreliable in patients receiving corticosteroid therapy.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Inflammatory Bowel Disease: Opportunities and Challenges for a New Era.","authors":"Ignacio Catalan-Serra, Shaji Sebastian","doi":"10.1002/ueg2.70075","DOIUrl":"https://doi.org/10.1002/ueg2.70075","url":null,"abstract":"<p><p>Inflammatory Bowel Disease (IBD) has become a global disease. The increasing incidence of inflammatory bowel disease across the world is challenging the traditional view of IBD as a western disease and represents a unique opportunity to gain an understanding of the disease in diverse ethnic groups and in different socio-economical and geographical environments. However, the continued growth in prevalence in developing countries in the coming years will lead to increased use of health-care resources due to IBD-related complications, costs of drugs and indirect health costs. Here we analyze the challenges and opportunities that this situation represents and suggest actions and potential solutions to improve the quality of IBD care globally.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of Alcohol-Related Liver Disease and Alcohol Use Disorder in Asia.","authors":"Pojsakorn Danpanichkul, Yanfang Pang, Kanokphong Suparan, Preenapun Saokhieo, Pimtawan Jatupornpakdee, Natchaya Polpichai, Tanawat Attachaipanich, Thanathip Suenghataiphorn, Andrew F Ibrahim, Polathep Vichitkunakorn, Sakkarin Chirapongsathorn, Ashok Choudhury, Anand V Kulkarni, Karn Wijarnpreecha, Apichat Kaewdech, Suthat Liangpunsakul","doi":"10.1002/ueg2.70077","DOIUrl":"https://doi.org/10.1002/ueg2.70077","url":null,"abstract":"<p><strong>Background: </strong>As alcohol consumption continues to rise rapidly in Asia, research into its significant consequences, alcohol-related liver disease (ALD), and alcohol use disorder (AUD) is still limited.</p><p><strong>Objective: </strong>This study examines the burden of alcohol-related liver disease and alcohol use disorder in Asia from 2000 to 2021.</p><p><strong>Methods: </strong>We analyzed data from the global burden of disease (GBD) Study 2021 to assess age-standardized prevalence, incidence, and mortality rates for alcohol-related liver disease and alcohol use disorder in Asia from 2000 to 2021.</p><p><strong>Results: </strong>In 2021, there were approximately 1.40 million cases of ALD, resulting in 175,370 deaths and 53.18 million cases of AUD, with 57,110 deaths. Asia accounted for 46.35% of the global prevalence of ALD (an increase of 6.87% since 2000) and 47.86% of the global prevalence of AUD (an increase of 0.82% since 2000). A 91.2% increase in crude ALD prevalence, incidence, and mortality from 2000 to 2021 in Asia was observed. South Asia exhibited the highest crude burden of ALD, while Central Asia had the highest age-standardized rate. Notably, ALD prevalence increased in South Asia (Annual Percent Change [APC]: 0.10%, 95% CI: 0.08-0.13) and Central Asia (APC: 0.88%, 95% CI: 0.79-0.97), even as other regions experienced declines.</p><p><strong>Conclusions: </strong>This study reveals a disproportionately increasing burden of ALD and AUD in Asia compared with global trends, with significant variability across subregions. Central and South Asia are identified as the primary drivers of the burden associated with ALD and AUD in this region.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Interpretable Artificial Intelligence System for Crohn's Disease Ulcer Identification and Grading on Double-Balloon Enteroscopy Images.","authors":"Qiuyuan Liu, Wanqing Xie, Aodi Wang, Wei Han, Yaonan Zhu, Jing Hu, Pengcheng Liang, Juan Wu, Xiaofeng Liu, Xiaodong Yang, Baoliang Zhang, Nannan Zhu, Bingqing Bai, Yiqing Mei, Zhen Liang, Mingmei Cheng, Qiao Mei","doi":"10.1002/ueg2.70068","DOIUrl":"https://doi.org/10.1002/ueg2.70068","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) is an incurable inflammatory bowel disease that can lead to a variety of complications and requires lifelong treatment. However, the diagnosis and management of Crohn's disease exhibit high rates of misdiagnosis and missed diagnoses, along with significant variability, among primary care facilities and novice endoscopists. Therefore, we established an interpretable artificial intelligence (AI) system using double-balloon enteroscopy to facilitate Crohn's disease ulcer identification and grading.</p><p><strong>Objective: </strong>To develop an interpretable AI system for the identification and grading of Crohn's disease ulcer images, offering bounding box localization for visual interpretability and factor-specific grading explanations for each ulcer to improve assessment performance.</p><p><strong>Methods: </strong>We constructed a region and grading model of individual ulcers based on the YOLO-v5 algorithm. By analyzing the predicted results of all ulcers in each image, the clinical interpretation for the screening and assessment of Crohn's disease ulcer images was further achieved. To evaluate the system, we prepared the training and validation datasets (17,036 double-balloon enteroscopy images, 558 patients) and further collected a test cohort (2018 images, 70 patients) and an external validation set. A further reader study was conducted on the internal test set in which nine endoscopists participated to evaluate the auxiliary effectiveness of the explainable system.</p><p><strong>Results: </strong>The Crohn's disease ulcer image detection sensitivity and area under the curve (AUC) were 91.8% and 0.949. The accuracies in assessing the severity of Crohn's disease ulcer images on three factors (size/ulcerated surface/depth) were 94.1%/92.5%/93.0%, respectively. With the system's support of visualized and analyzable predictions, junior endoscopists improved their Crohn's disease ulcer image recognition sensitivity by 12.7% and their accuracy and consistency of severity assessment by 26% and 27.4%.</p><p><strong>Conclusion: </strong>The AI system outperformed general endoscopists in approaching expert-level proficiency in Crohn's disease ulcer identification and assessment. Its transparency in decision-making facilitated integration into clinical workflows, enhancing trust and consistency among endoscopists.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}