Published online Jun 28, 2022. doi: 10.3748/wjg.v28.i24.2721
Peer-review started: October 30, 2021
First decision: March 11, 2022
Revised: March 25, 2022
Accepted: May 8, 2022
Article in press: May 8, 2022
Published online: June 28, 2022
Bleeding is one of the major complications after endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) patients. There are limited studies on estimating the bleeding risk after ESD using an artificial intelligence system.
To derivate and verify the performance of the deep learning model and the clinical model for predicting bleeding risk after ESD in EGC patients.
Patients with EGC who underwent ESD between January 2010 and June 2020 at the Samsung Medical Center were enrolled, and post-ESD bleeding (PEB) was investigated retrospectively. We split the entire cohort into a development set (80%) and a validation set (20%). The deep learning and clinical model were built on the development set and tested in the validation set. The performance of the deep learning model and the clinical model were compared using the area under the curve and the stratification of bleeding risk after ESD.
A total of 5629 patients were included, and PEB occurred in 325 patients. The area under the curve for predicting PEB was 0.71 (95% confidence interval: 0.63-0.78) in the deep learning model and 0.70 (95% confidence interval: 0.62-0.77) in the clinical model, without significant difference (P = 0.730). The patients expected to the low- (< 5%), intermediate- (≥ 5%, < 9%), and high-risk (≥ 9%) categories were observed with actual bleeding rate of 2.2%, 3.9%, and 11.6%, respectively, in the deep learning model; 4.0%, 8.8%, and 18.2%, respectively, in the clinical model.
A deep learning model can predict and stratify the bleeding risk after ESD in patients with EGC.
Core Tip: Bleeding is one of the major complications after endoscopic submucosal dissection (ESD) in early gastric cancer patients and requires hospital-based intervention. We established a deep learning model to stratify the bleeding risk after ESD and demonstrated its performance compared with a clinical model. The deep learning model showed acceptable area under the curve and could stratify the post-ESD bleeding risk as low-, intermediate-, and high-risk categories, which correlated with actual bleeding rate comparatively. A deep learning model would be valuable in assessing the bleeding risk after ESD in early gastric cancer patients.