An artificial intelligence-based system assisted endoscopists to detect early gastric cancer: a case report

Background: The mucosal changes of early gastric cancers (EGC) are slight and difficult to be recognized, leading to a high miss rate. Artificial intelligence (AI) systems have the potential to improve the detection rate of EGC. Here, we reported a case of EGC discovered by an endoscopist with the assistance of an AI system.   Case presentation: A 67-year-old male patient came to our hospital for Esophagogastroduodenoscopy (EGD) due to a routine physical examination. He had previously been healthy but was treated for a Helicobacter pylori infection two years ago. In the process of EGD, the AI system flagged a tiny mucosal lesion that was far away and was not detected by the endoscopist, and this lesion attracted the endoscopist's additional attention. After the close observation of the lesion, the AI system immediately gave a red prompt box, suggesting that the endoscopist further observe it. Under magnifying endoscopy with narrow-band imaging (ME-NBI), the mucosal glands and blood vessels of the lesion were found to be irregular, and this patient was diagnosed with suspicious gastric carcinoma by AI. Biopsy pathology showed that it was high-grade intraepithelial neoplasia, and after endoscopic mucosal dissection (ESD), post-ESD histology confirmed that the lesion was a highly differentiated adenocarcinoma confined to the mucosa, with a lesion range of 1.1 cm × 1.0 cm. The patient was discharged from the hospital without any postoperative complications.   Conclusion: AI has been widely applied in the field of gastrointestinal endoscopy and has the potential to help improve the detection rate of early gastrointestinal cancers. We reported a case of early gastric cancer discovered by the endoscopist with the assistance of AI.