Artificial intelligence detection of endoscopic moderate-to-severe ulcerative colitis: a novel tool to enhance clinical trial recruitment

Background and Aims Artificial intelligence (AI) may detect endoscopically active ulcerative colitis (UC) and streamline clinical trial enrollment. Here, we investigate the performance of a commercially available AI model, autoinflammatory bowel disease (AutoIBD)-UC (Virgo Surgical Video Solutions, Inc, San Francisco, Calif, USA), to detect moderate-to-severe UC in colonoscopy videos collected as part of routine clinical practice. Methods AutoIBD-UC was applied to consecutive endoscopy videos between August 30, 2024, and October 17, 2024. Each video received an AutoIBD score (0-1); videos with scores above a predefined confidence threshold were flagged as possible moderate-to-severe UC. Flagged videos and medical records were reviewed to confirm UC diagnosis and grade Mayo endoscopic subscore (MES). Concurrently, research staff retrospectively reviewed all endoscopy reports to identify 3 cohorts: (1) 20 MES ≥2, (2) 20 non-UC inflammation, and (3) 20 screening colonoscopies. Sensitivity and specificity were calculated for all videos screened by AI. Median AutoIBD scores were compared by MES and disease extent. Results AutoIBD-UC was applied to 2273 endoscopy videos. Twenty-one videos were flagged, 10 of which had MES ≥2. AutoIBD-UC flagged 9 of 20 videos in cohort 1 and all MES 3 videos. More procedures with extensive (4 of 8) or left-sided disease (5 of 7) were flagged compared with those with proctitis (0 of 5). Median AutoIBD-UC scores differed between MES 2 (0.437; interquartile range [IQR], 0.270-0.571) and MES 3 (0.690; IQR, 0.607-0.765; P = .006), and by disease extent: proctitis (0.224; IQR, 0.193-0.270), left-sided (0.571; IQR, 0.554-0.603), and extensive (0.506; IQR, 0.408-0.598; P = .021). The sensitivity of AutoIBD-UC was 0.47, and the specificity was 0.99. Conclusions AutoIBD-UC accurately detects moderate-to-severe UC with moderate sensitivity and high specificity. Larger studies are necessary to evaluate AutoIBD-UC's utility as a recruitment aid compared to standard practice.