Deep Learning-Based Confocal Laser Microendoscopy Feature Atlas Construction and Its Application in Intelligent Diagnosis of Irritable Bowel Syndrome

The study is prospective, observational, and diagnostic.

Research methodology Equipment Consumables The equipment consumables used include a colonoscopy operating system, pCLE system, fluorescein sodium injection, and single-use endoscopic biopsy forceps.

Phase 1 Endoscopy All enrolled person receive fluorescein sodium allergy test before pCLE examination, and fluorescein sodium is injected intravenously after observing no allergic reactions such as dizziness, rash, itching, shock, etc. for 15 min. 30 s later, the pCLE probe is placed from the biopsy clamp channel of enteroscopy, and six different intestinal segments of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum are examined in order and the images are collected, and each intestinal segment of the pCLE of all person is recorded continuously with 3-minute video recordings (operation is kept within 30 min after the procedure). and more than 4000 images are recorded for each person. During the operation, the probe is gently placed on the mucosal surface and kept as perpendicular to the bowel wall as possible, and the movements are gentle, slow, and soft to avoid mucosal injury. The endoscopist is performing targeted biopsies of all suspicious lesions and lesion margins observed in pCLE.

Pathological analysis After the specimens are fixed in formalin solution and embedded in paraffin, 2 sections with a thickness of 4 μm are cut. The first section is stained with HE to evaluate the mild inflammation of the intestine; the second section is stained with immunohistochemistry to evaluate the mast cell markers and tight junction proteins in the intestinal wall.

Screening of characteristic pCLE images All videos are measured and analyzed by the same experienced endoscopist, after screening all images with good stability, no artifacts, and clear display of microstructures. pCLE images are characterized by a ruler of 10 μm in length in the lower left corner, which allows real-time evaluation of a number of parameters in real time during the operation. Image J image analysis software is used to measure capillary diameter (CD), cell spacing (CS), gland spacing (GS), gland area (GA), and whether sodium fluorescein leak into the crypt lumen in the pCLE field of view. and other indicators. The images are categorized according to the healthy control group and the IBS patient group, and the characteristic images of each group are formed.

Phase 2 Diagnostic model construction of IBS patient images Deep learning is performed based on two sets of characteristic images to construct a diagnostic model for IBS.

Model evaluation Patients with healthy, IBS, early IBD, or celiac disease (total sample size of 30 cases for total diagnostic model efficacy validation in phases 2 and 3) are examined for pCLE in the same way as in phase 1, and high-quality images are screened for discriminative diagnosis of this model and evaluated for accuracy and inter-evaluator agreement of their diagnostic findings.

Phase 3 Construction of a multimodal diagnostic model for images of IBS patients with joint text On the basis of phase 2, the text data of various indicators corresponding to the images are added for joint deep learning to construct a multimodal diagnostic model for IBS patients.

Model evaluation Patients with healthy, IBS, early IBD, or celiac disease (total sample size of 30 cases for validation of diagnostic model efficacy in phases 2 and 3 combined) are examined for pCLE in the same way as in phase 1, with high-quality images and various types of indicators screened for discriminatory diagnosis of this model and evaluated for the accuracy of the diagnostic results and inter-appraisal agreement.

Inclusion criteria

• ①Healthy control group and test group of IBS with clear clinical diagnosis (Rome IV diagnostic criteria). Healthy controls are free of gastrointestinal symptoms, test results (blood count, CRP, ESR, etc.) and colonoscopy abnormalities.Patients with IBS have recurrent abdominal pain (≥1 day per week on average in the past 3 months), with onset ≥6 months before diagnosis, and the abdominal pain is accompanied by at least two of the following three symptoms: pain related to defecation, change in stool frequency, and change in the shape (appearance) of the feces, and other organic or metabolic disorders are excluded.② Age: between 18 and 80 years old.③ Probe-based confocal Laser Endomicroscopy (pCLE) is required, and patients have good compliance. ④ Normal coagulation function, and biopsies can be obtained for pathological examination.⑤ Voluntary signing of informed consent.

Exclusion criteria

• Fluorescein sodium allergy. ②Contraindications to colonoscopy (pregnant or breastfeeding patients, uncooperative psychiatric patients with severe mental disorders, colonic obstruction) or inadequate bowel preparation (Boston Bowel Preparedness Scale score of <2 for any colonic segment).③ Comorbidities with major organ dysfunction (with severe cardiopulmonary disease) or impaired renal function (blood creatinine >450umol/L). ④ Other conditions that, in the judgment of the investigator, make it unsuitable for participation in the study (inflammatory bowel disease, infected IBS, having taken nonsteroidal anti inflammatory drugs, corticosteroids or antibiotics within the last year, etc.).