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Artificial intelligence-assisted versus conventional reading in pan-intestinal capsule endoscopy for suspected

Bruno Rosa1,2, Miguel José Mascarenhas Saraiva3,4,5, João Afonso3,5

  • 1Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal bruno.joel.rosa@gmail.com.

BMJ Open Gastroenterology
|October 15, 2025
PubMed
Abstract

Insights

Artificial intelligence-assisted capsule endoscopy (AI-PCE) significantly improves detection of potentially haemorrhagic lesions in mid-lower gastrointestinal bleeding compared to conventional methods. This AI-PCE offers higher sensitivity and NPV, potentially setting a new standard for diagnosis.

Area of Science:

  • Gastroenterology
  • Medical Imaging
  • Artificial Intelligence

Background:

  • Pan-intestinal capsule endoscopy (PCE) is a safer alternative to colonoscopy for detecting potentially haemorrhagic lesions (PHL) in suspected mid-lower gastrointestinal bleeding (MLGIB).
  • Current PCE methods face limitations including time-consuming review and missed lesions.
  • Artificial intelligence (AI) offers potential to enhance PCE diagnostic performance.

Purpose of the Study:

  • To compare the diagnostic performance of AI-assisted PCE (AI-PCE) against conventional reading PCE (CR-PCE) and colonoscopy.
  • To evaluate the accuracy of AI-PCE in detecting PHL in patients with suspected MLGIB.

Main Methods:

  • Retrospective analysis of 100 prospectively enrolled patients undergoing PCE for suspected MLGIB.
  • Utilized an externally validated convolutional neural network for AI-PCE analysis.
  • Diagnostic performance metrics (sensitivity, specificity, PPV, NPV) were assessed against a consensus reference standard.

Main Results:

  • AI-PCE detected PHL in 60% of patients, significantly higher than CR-PCE (42%, p<0.01).
  • AI-PCE demonstrated superior sensitivity (95% vs 67%, p<0.0001) and NPV (92% vs 63%, p=0.0015) compared to CR-PCE.
  • AI-PCE significantly outperformed colonoscopy in sensitivity (90% vs 32%, p<0.0001), PPV (100% vs 65%, p<0.001), and NPV (94% vs 65%, p<0.0001).

Conclusions:

  • AI-PCE significantly enhances diagnostic accuracy for PHL detection in MLGIB.
  • AI-PCE offers superior sensitivity and NPV without compromising specificity compared to conventional methods.
  • AI-PCE may establish a new standard for capsule endoscopy in diagnosing mid-lower gastrointestinal bleeding.
Keywords:
COLONIC DISEASESGASTROINTESTINAL BLEEDINGSMALL BOWEL DISEASESMALL BOWEL ENTEROSCOPY

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