Real-time automated assessment of histological disease activity in patients with ulcerative colitis using single-wavelength endoscopy technology

Abstract Single-wavelength endoscopy (SWE) has shown promising results in assessing histological disease activity in ulcerative colitis. Our objective was to validate the real-time performance of a bedside prototype of SWE computer-aided diagnosis (CAD) as proof of concept. A bedside module for real-time use evaluated histological disease activity when endoscopy was performed in the rectum and sigmoid based on white-light endoscopy and SWE (410 nm monochromatic light). Biopsies were taken for reference and scored using the Geboes score (GBS). SWE-CAD displayed a blue or red indicator, corresponding to histological remission or non-remission, respectively. Simultaneous scoring using the Mayo Endoscopic Score was performed by the endoscopist. In 36 patients, histological disease activity was automatically scored using SWE-CAD. At the section level, SWE-CAD showed an accuracy of 96.4%, sensitivity of 96.1%, and specificity of 85.5%. When differentiating disease activity into mild, moderate, and severe, accuracy was 97.7%, 62.8%, and 95.0%, respectively. At the per-patient level, overall diagnostic accuracy remained high at 94.4%, with only 2/36 underestimations compared with GBS. A novel SWE-CAD system demonstrated clinical accuracy of 94.4% at the per-patient level, potentially aiding physicians in interpreting subtle endoscopic abnormalities and paving the way to more individualized patient management.