Development of Artificial Intelligence to Represent Quantitative Inflammation Assessment of Ulcerative Colitis Diagnosed by Inflammatory Bowel Disease Expert Endoscopists

Background: The existing endoscopic scores for UC are typically utilized to objectively categorize the severity of the disease based on presence or absence of endoscopic findings. Therefore, they may not reflect the range of clinical severity within each category. On the other hand, expert endoscopists do not only categorize the severity, but rather diagnose the overall impression of degree of inflammation in clinical practice. Therefore, the purpose of this study was to develop an AI that can accurately represent the complexed assessment of endoscopic severity of UC by expert endoscopists.Methods: This study was conducted using a method that incorporates data on relationships identified by comparing the severity of paired images created from 59595 endoscopic images by an IBD expert endoscopist into a Ranking- Convolutional Neural Network, and then the severity was then expressed on a scale called UC Endoscopic Gradation Scale (UCEGS) rather than a score. Correlation coefficients were calculated to ensure that there were no inconsistencies in assessments of severity made using UCEGS diagnosed by AI and the current Mayo Endoscopic Subscore (MES), and also calculated correlation coefficients and the standard errors of the mean for 50 test images that had been assessed using UCEGS by five IBD experts as well as the AI.Findings: Spearman's correlation coefficient between UCEGS diagnosed by AI and MES was approximately 0.89. Correlation coefficient between IBD expert endoscopists and the AI of the evaluation results were all higher than 0.95 (P<0.01). The standard errors of the means of the severity scores for IBD experts and AI were 0.7.Interpretation: The innovative AI developed here can act as a proxy of expert IBD endoscopists by reliably presenting comprehensive assessments regarding the severity of UC, which was not previously possible.Funding Information: This work was supported by Japan Agency for Medical Research and Development under Grant Number JP19lk1010026h0002.Declaration of Interests: K.Takabayashi has received personal fees from OLYMPUS, Janssen Co Ltd. T. Kobayashi has received personal fees from Abbvie GK, Ajinomoto Pharma, Alfresa Pharma, Asahi Kase Medical, Astellas Covidien, Celltrion, EA Pharma Co Ltd, Eisai Co Ltd, 21 Eli Lilly, Ferring Pharmaceuticals, Galapagos, Gilead Sciences, Google, Janssen, JIMRO Co Ltd, Kyorin Pharmaceutical Co Ltd, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Nippon Kyaku, Pfizer, Takeda Pharmaceutical, Thermo Scientific and ZERIA; grants from Abbvie GK, Alfresa Pharma, EA Pharma Co Ltd, Kyorin Pharmaceutical Co Ltd, Mochida Pharmaceutical, Nippon Kyaku, Mitsubishi Tanabe Parma, Otsuka Holdings Co Ltd, Sekisui Medical, Thermo Fisher Scientific and ZERIA; K. Matsuoka has received speaker fee from Mitsubishi Tanabe Pharma, Takeda Pharmaceutical Co., Ltd., Janssen Pharmaceutical K.K., Abbvie Inc., EA Pharma Co., Ltd., Pfizer Inc., Mochida Pharmaceutical Co., Ltd., Kyorin Pharmaceutical Co., Ltd., ZERIA Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., Nippon Kayaku Co., Ltd., JIMRO Co., Ltd., Gilead Sciences, research grants from Mitsubishi Tanabe Pharma, Abbvie Inc., EA Pharma Co., Ltd., Mochida Pharmaceutical Co., Ltd., Kyorin Pharmaceutical Co., Ltd., ZERIA Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., Nippon Kayaku Co., Ltd., JIMRO Co., Ltd.,and leadership advisory role for Advisory: EA Pharma Co., Ltd., Eli Lilly, Bristol-Myers Squibb, Janssen Pharmaceutical K.K. B. Levesque is a shareholder and employee of Gossamer Bio, Inc. T. Kawamura received speaker fee from Olympus Corporation, Boston Scientific Co Ltd, MC Medical Inc, Kyorin Pharmaceutical Co Ltd, Takeda Pharmaceutical Co Ltd, Bayer Yakuhin Ltd, EA Pharma Co Ltd, Daiichi Sankyo Co Ltd, and Mitsubishi Tanabe Pharma 22 Corporation. S. Uchida has received personal fees from Nippon Telegraph and Telephone and CyberAgent, Inc. T. Kanai has received speaker fee from Mitsubishi Tanabe Pharma, Takeda Pharmaceutical Co., Ltd., Abbvie Inc., EA Pharma Co., Ltd., Miyarisan Pharmaceutical Co., Ltd., research grants from Miyarisan Pharmaceutical Co., Ltd. Glico Co., Ltd., Nissin Foods Co., Ltd., and and leadership advisory role for Advisory: Chugai Pharmaceutical Co., Ltd. H. Ogata has received speaker fee from FUJIFILM Co., Ltd., OLYMPUS Co., Ltd., Covidien, research grants from Boston Scientific Co., Ltd. All other authors have nothing to declare. Ethics Approval Statement: The study was approved by the ethics committees at each medical institution (Keio Ethics Committee approval no.: 20180315), and informed consent was obtained from each potential participant.