Procedures
nodularity, depression, upper gastrointestinal tract landmarks, upper gastrointestinal lesion
GASTRIC NEOPLASM, BLIND
The ENDOANGEL-GC is an AI system designed for assisting in EGD and possesses three functions in real time: (1) to time the entire procedure (from the endoscope intubating into the mouth to it being drawn out), (2) to record observed upper gastrointestinal tract landmarks and blind spots, and (3) to mark the upper gastrointestinal lesion with a blue rectangular box (box colour turns red if the lesion is predicted to have a high risk of gastric neoplasm) [The ENDOANGEL-GC is connected to the endoscopy processor, receives digital images as input, and outputs the predictions of landmark monitoring and lesions. The ENDOANGEL-GC is installed on a separate computer system, and the output of the system appears on the same monitor as that of the endoscope. A button on the system is set to switch between “assistance” and “no assistance” modes. Before examination in the control group, the ENDOANGEL-GC is shifted to the “no assistance” mode, so the predictions will be concealed, as they are not displayed on the monitor. Before the examination in the experimental group, the ENDOANGEL-GC is shifted to the “assistance” mode, so the predictions and prompts are displayed on the screen.The endoscopists who participate in the study are required to have EGD experience with more than 500 cases. All participating endoscopists will be trained in the AI’s functions, including monitoring anatomical landmarks, detecting suspicious lesions, and becoming familiar with the operation requirements during endoscopy. Each endoscopist will perform at least 10 examinations with AI assistance. In both groups, endoscopists are required to screen the entire stomach under white light mode. Only when the screening process is completed and suspicious lesions are found, the image-enhanced mode will be allowed for further judgement. In the experimental group, the endoscopists will operate the endoscope with the assistance of ENDOANGEL-GC. They are required to adhere to the following criteria: (1) screen anatomical landmarks according to the feedback of ENDOANGEL-GC and (2) lesions marked in red boxes by ENDOANGEL-GC are required to undergo biopsy sampling. Lesions that are not marked in red boxes but meet any of the following criteria are also recommended for biopsy: differences in colour, loss of vascularity, slight elevation or depression, nodularity, thickening, abnormal convergence or flattening of folds, irregular margins, irregular discoloration, or irregular surfaces. In the control group, endoscopists will routinely operate on the endoscope. Lesions that meet the above criteria are also recommended for biopsy.