The Artificial Intelligence (AI) developed by IECED stands out among thousands of contestants from around the world and obtains the highest award of the most important European medical day in the digestive endoscopic area (ESGE DAYS 2021)

Technology and research, two of the pillars on which the Ecuadorian Institute of Digestive Diseases (IECED) has been strengthening over the years, continues to outsand in the world of medicine. On this occasion, with the highest recognition from the European Society of Gastrointestinal Endoscopy (ESGE), which in the framework of its International Congress “ESGE Days 2021”, will be held Online between March 25 and 27, and it will reward the Ecuadorian medical team with the award for the TECHNOLOGICAL INNOVATION OF THE YEAR 2021, in the category “Best Procedural Innovation”, once again representing Ecuador at the highest level.

Among thousands of medical-scientific papers presented, surpassing their peers from the US, Europe, Asia and the rest of the world, the study called “Application of Artificial Intelligence for real-time anatomical recognition during Endoscopic Ultrasound Evaluation: A pilot study” is awarded with the highest recognition of the day.

Besides this achievement there are seven other research papers that were also accepted for oral presentations and poster presentations, and two of them stand out for being world pioneers in the use of Artificial Intelligence (AI) in Ecoendoscopy and in Cholangioscopy respectively.


The future of endoscopic ultrasound

The use of Artificial Intelligence (AI) in endoscopic ultrasound is already a reality that will revolutionize the world of digestive medicine, thanks to the futuristic vision of Dr. Carlos Robles-Medranda, director of the IECED, who has been promoting it for some years, managing to position Ecuador as the first country in the world to develop this advanced technology.

The proposal was well received in the European medical field, obtaining the highest award mentioned above where a study will be presented with the details of the experience of IECED with the use of AI in endoscopic ultrasound, to recognize anatomical structures of the patient in real time during the procedure.

But what is the importance of recognizing these structures more easily? The expert explains that “endoscopic ultrasound is a study that requires exhaustive training, both for the mechanical endoscopic way and for the interpretation of endosonographic images with special emphasis on it”.

Normally the professional training of physicians requires an ideal minimum time of 6 months (or more), especially in Latin American countries, regions of Asia and Africa, where there are no centers available (or there are very few such as IECED in Ecuador) to train in endoscopic ultrasound. “So, if one does not have specialized centers where to prepare, you cannot have an endoscopic ultrasound available for the number of patients who need this test …”, explains Dr. Carlos Robles-Medranda, former president of the Ecuadorian Society of Gastroenterology.

Given this reality, the idea arises of developing the Artificial Intelligence (AI) system that is incorporated into the echoendoscope, so that it recognizes organs such as the spleen, pancreas, aorta, liver, spine, gallbladder, azygos vein, among others, in an easier and faster way improving the learning process of experts in much less time; and, therefore, help more people access this advanced technology for the detection of pre-malignant or malignant diseases.

For this, the system was fed with more than 10,000 samples of endoscopic ultrasound videos, made by 2 expert IECED echoendoscopists, so that the software learns to recognize the structures well with an accuracy of 85% (with a view to increasing the percentage, because it is in the development stage and constantly updating).


Malignant lesions exposed with AI

The second work, explains Dr. Roberto Oleas, member of the IECED research staff, is a pilot study that serves to determine and characterize malignant lesions in the bile ducts automatically and in real time. “With the help of Artificial Intelligence the computer recognizes characteristics of the lesions, trains itself and can give a more accurate interpretation, which helps the doctor to make a faster and more accurate diagnosis of the disease.”

Currently, for viewing bile duct injuries there are commonly many criteria and inter-observer variability that disagree on diagnostic accuracy. Meanwhile, when using a computer with an AI-trained neural network, to recognize the malignancy criteria, the diagnostic accuracy increases significantly by up to 95%, with a view of increasing the percentage because this new technology continues to be constant in development and improvement.

In the ESGE-awarded study, around 1900 cholangioscopy samples were taken from patients with malignancy (with cholangiocarcinoma / cancer) and without malignancy (without cholangiocarcinoma / cancer), and suggestive patterns of malignancy and biopsies were evaluated, which were reviewed and analyzed by two cholangioscopists from IECED, to confirm that the information is correct.

“With these videos the software was fed to detect them automatically. This will serve to more effectively train professionals in the area and to help medical centers that do not have experts in cholangioscopy, to detect malignancies in their patients, and thus they can provide them with a faster and more timely treatment ”, says Dr. Robles-Medranda, who will present the work within the framework of the European event.


Fast and safe detection of Hepatic Cirrhosis

Another of the technological innovations implemented by IECED, and which is also recognized in the European medical conference “ESGE Days 2021”, was the measurement and prediction of Liver Cirrhosis by endoscopic ultrasound. Undoubtedly a great advantage for specialists but especially for patients, who would no longer have to undergo a liver biopsy (standard method) to detect the disease and therefore avoid adverse events such as bleeding and infections, among other possible complications that usually occur.

“With the study of endoscopic ultrasound, the aim is to diagnose in an easier, less invasive and more precise way Hepatic Cirrhosis, thus obtaining a high margin of safety that allows evaluating the elasticity of the liver and taking a measurement that determines whether the patient does have or does not have the disease ”, explains Dr. Carlos Robles-Medranda, director of IECED.

This is achieved thanks to the use of a new technology, unique in the world, called share-waves (Hitachi) which is incorporated into the echoendoscope.

To verify its effectiveness, a prospective case-control study was carried out between cirrhotic and non-cirrhotic patients. “In these preliminary studies it was shown that the share-wave echoendoscopy of the right hepatic lobe obtains a sensitivity of 100%, with a specificity of 93%, while in the left lobe it obtains 93% in sensitivity and specificity… reaching a diagnosis 98% accurate, ”says Robles-Medranda.

Encouraging figures that could prevent patients from being biopsied and therefore avoid greater risks to their health.


Other recognitions

And more scientific studies were awarded, ranging from “the creation of new controls and more effective protocols for the reopening of IECED endoscopy rooms in times of Covid-19”, through “the use of endoscopic ultrasound to drain the bile duct”, following for “the use of confocal endomicroscopy technology in the colon to detect the risk of developing future complications due to diverticular disease in patients”, continuing with “the implementation of a new method for the detection of colon cancer” and ending with “the comparison of two technologies to better diagnose dyspepsia (abominal pain)”, which make IECED the creditor of 8 well deserved recognitions that surely puts Ecuador at the highest level in the world.

To learn more about each of the studies carried out and to see the exhibitions during the ESGE Days 2021, you can go to


Text written by: Christian Colombo Cordero.

Sources: IECED, ESGE.