Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2021; 27(26): 4088-4103
Published online Jul 14, 2021. doi: 10.3748/wjg.v27.i26.4088
Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence
Simon Bourcier, Julian Klug, Lee S Nguyen
Simon Bourcier, Department of Intensive Care Medicine, University Hospital of Geneva, Geneva 1201, Switzerland
Julian Klug, Department of Internal Medicine, Groupement Hospitalier de l’Ouest Lémanique, Nyon 1260, Switzerland
Lee S Nguyen, Department of Intensive Care Medicine, CMC Ambroise Paré, Neuilly-sur-Seine 92200, France
Author contributions: Bourcier S wrote the manuscript; Klug J significantly contributed to the manuscript; Nguyen LS co-wrote and supervised this work.
Conflict-of-interest statement: The authors have no conflict of interest regarding this work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Lee S Nguyen, MD, PhD, Doctor, Senior Researcher, Department of Intensive Care Medicine, CMC Ambroise Paré, 25 Boulevard Victor Hugo, Neuilly-sur-Seine 92200, France.
Received: January 28, 2021
Peer-review started: January 28, 2021
First decision: March 7, 2021
Revised: March 25, 2021
Accepted: June 18, 2021
Article in press: June 18, 2021
Published online: July 14, 2021

Acute mesenteric ischemia (AMI) is a severe condition associated with poor prognosis, ultimately leading to death due to multiorgan failure. Several mechanisms may lead to AMI, and non-occlusive mesenteric ischemia (NOMI) represents a particular form of AMI. NOMI is prevalent in intensive care units in critically ill patients. In NOMI management, promptness and accuracy of diagnosis are paramount to achieve decisive treatment, but the last decades have been marked by failure to improve NOMI prognosis, due to lack of tools to detect this condition. While real-life diagnostic management relies on a combination of physical examination, several biomarkers, imaging, and endoscopy to detect the possibility of several grades of NOMI, research studies only focus on a few elements at a time. In the era of artificial intelligence (AI), which can aggregate thousands of variables in complex longitudinal models, the prospect of achieving accurate diagnosis through machine-learning-based algorithms may be sought. In the following work, we bring you a state-of-the-art literature review regarding NOMI, its presentation, its mechanics, and the pitfalls of routine work-up diagnostic exams including biomarkers, imaging, and endoscopy, we raise the perspectives of new biomarker exams, and finally we discuss what AI may add to the field, after summarizing what this technique encompasses.

Keywords: Mesenteric ischemia, Biomarkers, Critically ill, Machine learning, Artificial intelligence

Core Tip: In this review we focus on non-occlusive mesenteric ischemia and discuss the challenges of a reliable diagnosis, which requires several simultaneous elements, including physical examination, biomarkers, and imaging elements. While taken individually these elements do not provide sufficient diagnostic accuracy, a multimodal approach relying on artificial intelligent algorithms may increase speed and accuracy in recognizing this rare but severe condition.