Validation of AI-ENDO System in Endoscopic Submucosal Dissection

NCT07392268 | Recruiting

• 1 other identifier: CRE-2025.198
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

This study is a pilot trial designed to evaluate the feasibility and safety of Al-ENDO assisted ESD in patients with gastrointestinal superficial lesions. Patients with gastrointestinal superficial lesions are scheduled for conventional ESD will be screened for eligibility. The study consists of a few stages:

1. 1.In the first phase, the Al-ENDO system will be tested in the background of the ESD procedure prospectively, but without interfering the endoscopists. The Al-ENDO system would be installed in the Endoscopy Centre in Prince of Wales Hospital. Real-time video analysis would be conducted in the background without interference of the endoscopists' performance. A total of 30 clinical ESD procedures would be analysed, with the goal of achieving good accuracy of the system. The data obtained from this group of patients would also serve as control group for comparison with the subsequent procedures with Al-ENDO support.
2. 2.The second phase of the study would comprise of a the prospective pilot study which Al-ENDO system would be connected to the endoscopy tower with the auxiliary output monitor placing side-by-side with the endoscopy main monitor. The GUI would be displayed in the auxiliary monitor. This phase aims to demonstrate device and patients' safety throughout the procedure, and a total of 10 patients would be recruited, with the target of ensuring smooth dissection procedure without system interruption of failure. In this phase of the study, only expert endoscopist would be involved in performing the procedure.
3. 3.The third phase of the study comprises of a continuation of the initial pilot study with additional of 20 more patients, so that total of 30 procedures would be performed to compare the clinical outcomes with the control group collected previously.

Conditions

Superficial Esophageal, Gastric or Colorectal Lesions

Keywords

Al-ENDO SYSTEM; ENDOSCOPIC SUBMUCOSAL DISSECTION; ESD

Outcome Measures

Primary Outcomes (1)

• Technical success rate

  Defined as the rate of procedure with successful en-bloc, without major intra-operative adverse event. Unit of measure: % of procedures

  1 day

Secondary Outcomes (20)

• Clinical success rate

  30 days

• Total procedure time

  1 day

• Resected lesion size

  1 day

• Lesion location

  1 day

• Lesion histological type

  30 days

Study Arms (2)

AI-ENDO assisted ESD

EXPERIMENTAL

ESD performed with AI-ENDO assistance

Device: AI-ENDO system; Procedure: Conventional ESD

Conventional ESD

ACTIVE COMPARATOR

ESD performed as in usual clinical practice

Procedure: Conventional ESD

Interventions

AI-ENDO system DEVICE

During procedure of AI-ENDO assisted ESD, the AI-ENDO system will be connected to the video output system of the main endoscopy processor, so that real-time video data could be fed to the AI-ENDO system for AI analysis. In ESD procedures with AI-ENDO assistance, an auxiliary monitor would be placed side-by-side to the main endoscopy output monitor. This enables endoscopist to simultaneously take reference to the AI interpreted videos.

AI-ENDO assisted ESD

Conventional ESD PROCEDURE

The ESD procedure would be performed in the same manner as in usual clinical practice. In brief, after identification of the target lesion, submucosal injection will be performed to elevate the submucosal layer from the muscularis propria. Mucosal incision followed by submucosal dissection will be performed using dedicated ESD knives. Countertraction method could be utilized based on the endoscopists' personal preference. After successful resection and ensuring adequate haemostasis, the specimen would be retrieved for pathological evaluation.

AI-ENDO assisted ESD; Conventional ESD

Eligibility Criteria

• Age: 18 Years - 85 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patient with superficial esophageal, gastric or colorectal lesions, scheduled for endoscopic submucosal dissection (ESD).
• Age between 18 and 85.

You may not qualify if:

• Patient who refused to participate.
• Other cases deemed by the examining physician as unsuitable for safe treatment.

Sponsors & Collaborators

• Chinese University of Hong Kong: lead

Study Sites (1)

Department of Surgery, Faculty of Medicine, the Chinese University of Hong Kong

Hong Kong, Hong Kong

RECRUITING

Related Publications (18)

• Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4.

  PMID: 33538338 BACKGROUND

• Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, Nordlinger B, van de Velde CJ, Balmana J, Regula J, Nagtegaal ID, Beets-Tan RG, Arnold D, Ciardiello F, Hoff P, Kerr D, Kohne CH, Labianca R, Price T, Scheithauer W, Sobrero A, Tabernero J, Aderka D, Barroso S, Bodoky G, Douillard JY, El Ghazaly H, Gallardo J, Garin A, Glynne-Jones R, Jordan K, Meshcheryakov A, Papamichail D, Pfeiffer P, Souglakos I, Turhal S, Cervantes A. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making. Ann Oncol. 2012 Oct;23(10):2479-2516. doi: 10.1093/annonc/mds236.

  PMID: 23012255 BACKGROUND

• Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet. 2020 Aug 29;396(10251):635-648. doi: 10.1016/S0140-6736(20)31288-5.

  PMID: 32861308 BACKGROUND

• Nivatvongs S. Surgical management of early colorectal cancer. World J Surg. 2000 Sep;24(9):1052-5. doi: 10.1007/s002680010148.

  PMID: 11036281 BACKGROUND

• Hasuike N, Ono H, Boku N, Mizusawa J, Takizawa K, Fukuda H, Oda I, Doyama H, Kaneko K, Hori S, Iishi H, Kurokawa Y, Muto M; Gastrointestinal Endoscopy Group of Japan Clinical Oncology Group (JCOG-GIESG). A non-randomized confirmatory trial of an expanded indication for endoscopic submucosal dissection for intestinal-type gastric cancer (cT1a): the Japan Clinical Oncology Group study (JCOG0607). Gastric Cancer. 2018 Jan;21(1):114-123. doi: 10.1007/s10120-017-0704-y. Epub 2017 Feb 21.

  PMID: 28224238 BACKGROUND

• Chiu PW, Teoh AY, To KF, Wong SK, Liu SY, Lam CC, Yung MY, Chan FK, Lau JY, Ng EK. Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia: a retrospective cohort study. Surg Endosc. 2012 Dec;26(12):3584-91. doi: 10.1007/s00464-012-2371-8. Epub 2012 Jun 8.

  PMID: 22678176 BACKGROUND

• ASGE TECHNOLOGY COMMITTEE; Kantsevoy SV, Adler DG, Conway JD, Diehl DL, Farraye FA, Kwon R, Mamula P, Rodriguez S, Shah RJ, Wong Kee Song LM, Tierney WM. Endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc. 2008 Jul;68(1):11-8. doi: 10.1016/j.gie.2008.01.037. No abstract available.

  PMID: 18577472 BACKGROUND

• Teoh AY, Chiu PW, Wong SK, Sung JJ, Lau JY, Ng EK. Difficulties and outcomes in starting endoscopic submucosal dissection. Surg Endosc. 2010 May;24(5):1049-54. doi: 10.1007/s00464-009-0724-8. Epub 2009 Nov 13.

  PMID: 19911227 BACKGROUND

• Zhang X, Ly EK, Nithyanand S, Modayil RJ, Khodorskiy DO, Neppala S, Bhumi S, DeMaria M, Widmer JL, Friedel DM, Grendell JH, Stavropoulos SN. Learning Curve for Endoscopic Submucosal Dissection With an Untutored, Prevalence-Based Approach in the United States. Clin Gastroenterol Hepatol. 2020 Mar;18(3):580-588.e1. doi: 10.1016/j.cgh.2019.06.008. Epub 2019 Jun 18.

  PMID: 31220645 BACKGROUND

• ASGE Standards of Practice Committee; Storm AC, Fishman DS, Buxbaum JL, Coelho-Prabhu N, Al-Haddad MA, Amateau SK, Calderwood AH, DiMaio CJ, Elhanafi SE, Forbes N, Fujii-Lau LL, Jue TL, Kohli DR, Kwon RS, Law JK, Pawa S, Thosani NC, Wani S, Qumseya BJ. American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures. Gastrointest Endosc. 2022 Feb;95(2):207-215.e2. doi: 10.1016/j.gie.2021.10.022. Epub 2022 Jan 5.

  PMID: 34998575 BACKGROUND

• Pimentel-Nunes P, Libanio D, Bastiaansen BAJ, Bhandari P, Bisschops R, Bourke MJ, Esposito G, Lemmers A, Maselli R, Messmann H, Pech O, Pioche M, Vieth M, Weusten BLAM, van Hooft JE, Deprez PH, Dinis-Ribeiro M. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy. 2022 Jun;54(6):591-622. doi: 10.1055/a-1811-7025. Epub 2022 May 6.

  PMID: 35523224 BACKGROUND

• Weingart SN, Iezzoni LI. Looking for medical injuries where the light is bright. JAMA. 2003 Oct 8;290(14):1917-9. doi: 10.1001/jama.290.14.1917. No abstract available.

  PMID: 14532322 BACKGROUND

• Cuschieri A. Nature of human error: implications for surgical practice. Ann Surg. 2006 Nov;244(5):642-8. doi: 10.1097/01.sla.0000243601.36582.18.

  PMID: 17060751 BACKGROUND

• Chiu PWY, Yip HC, Xia XF, Chan SM, Ng EKW, Lau JYW. How I do it: Flexible 3-D endoscope for endoscopic submucosal dissection. Dig Endosc. 2019 May;31(3):323-328. doi: 10.1111/den.13315. Epub 2019 Mar 21.

  PMID: 30550632 BACKGROUND

• Kim ES, Cho KB, Park KS, Lee KI, Jang BK, Chung WJ, Hwang JS. Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors. Endoscopy. 2011 Jul;43(7):573-8. doi: 10.1055/s-0030-1256339. Epub 2011 Mar 29.

  PMID: 21448852 BACKGROUND

• Mizushima T, Kato M, Iwanaga I, Sato F, Kubo K, Ehira N, Uebayashi M, Ono S, Nakagawa M, Mabe K, Shimizu Y, Sakamoto N. Technical difficulty according to location, and risk factors for perforation, in endoscopic submucosal dissection of colorectal tumors. Surg Endosc. 2015 Jan;29(1):133-9. doi: 10.1007/s00464-014-3665-9. Epub 2014 Jul 4.

  PMID: 24993172 BACKGROUND

• Cao J, Yip HC, Chen Y, Scheppach M, Luo X, Yang H, Cheng MK, Long Y, Jin Y, Chiu PW, Yam Y, Meng HM, Dou Q. Intelligent surgical workflow recognition for endoscopic submucosal dissection with real-time animal study. Nat Commun. 2023 Oct 21;14(1):6676. doi: 10.1038/s41467-023-42451-8.

  PMID: 37865629 BACKGROUND

• Scheppach MW, Yip HC, Chen Y, Yang H, Cao J, Chua T, Dou Q, Meng HML, Yam Y, Chiu PW. Feasibility of real-time artificial intelligence-assisted anatomical structure recognition during endoscopic submucosal dissection. Endosc Int Open. 2025 Jun 17;13:a26158008. doi: 10.1055/a-2615-8008. eCollection 2025.

  PMID: 40611836 BACKGROUND

Central Study Contacts

Hon Chi Yip

CONTACT

+852 3505 2956; hcyip@surgery.cuhk.edu.hk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: January 28, 2026
• First Posted: February 6, 2026
• Study Start: May 1, 2025
• Primary Completion (Estimated): June 30, 2027
• Study Completion (Estimated): December 31, 2027
• Last Updated: February 6, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

HK (1)