Tyler Berzin MD, FASGE Profile picture
Jan 27, 2022 9 tweets 4 min read Read on X
1/ Why automated quality metrics may be the key to unlocking adoption of new polyp detection technologies for #colorectalcancer screening, a brief 🧵
2/ A common refrain is that cost barriers have been the central reason for slow uptake of evidence-based polyp detection technologies (mucosal exposure caps, wide angle colo, & perhaps #AI).
3/ I think that's not the whole story. This pattern also exposes the near absence of user-friendly, automated endoscopy quality analytics tools.
4/ Presently, when a GI team trials a polyp detection technology, in most cases the final purchase decision comes down to only two things: A) a 'back of the envelope' economic analysis and B) the 'gut' feeling of users after a few month trial re: whether the tech 'felt' helpful.
5/ This is not how critical decisions regarding quality improvement initiatives should be made and exposes a fundamental flaw and *key technology gap* in GI practice. For majority of U.S. GI groups, it's not yet possible to get automated, button-click analytics re: ADR and APC.
6/ Imagine running a sports team without live data re: athlete performance, & no way to tell from game to game whether strategic changes had altered player or team stats. NFL, NBA etc all already use cloud-based AI to generate a vast range of simple and complex performance data.
7/ Most GI groups are stuck where sports were in the 1960s, with no *live* access to analytics. Data is often stuck in outdated EHRs and/or siloed between path, hospital, endo center etc.
8/ @GoogleHealth and others have tried to begin chipping away at this data silo issue. Several rockstar GI colleagues across U.S. medical centers have solved these issues locally, often using #NLP as a tool, but the solutions have not yet been scalable.
9/ The 'dawn of AI' for GI can't really happen without the dawn of automated analytics. If we *can* solve this in a scalable way for gastroenterology, analytics tools will be rocket fuel for an unapparelled wave of innovation.

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More from @tberzin

Jul 17, 2020
1/ Great question and thx for highlighting this @TheLancet RCT re: #ERCP for gallstone pancreatitis @JBortinger! A few reactions below, and I hope that others on #GItwitter will add their thoughts as well..
2/ Historically, urgent ERCP for gallstone pancreatitis has been recommended in only 2 subgroups of patients:
➡️ pts w/ cholangitis (💯) or
➡️ w/ 'predicted severe pancreatitis' (🤔)
3/ That 'predicted severe pancreatitis' concept was supported in this 1988 Lancet study (the typesetting looks like it's actually from 1938..). Idea was that a persistent/obstructing stone could worsen pancreatitis outcome...so.. ERCP.
Read 9 tweets
Feb 4, 2020
1/9 Quick synopsis of our recent double-blind randomized study on computer-aided polyp detection in @LancetGastroHep, which can be found here: thelancet.com/journals/langa…
2/9 Previous work by our team and others have shown that #AI polyp detection can improve ADR. A major question has been whether use of on-screen computer-aided detection merely increases the vigilance of the endoscopist (vs. specifically helping find more polyps).
3/9 We enrolled 1046 pts. We tried to address operational bias by blinding the endoscopist to whether or not CADe was being used. Blinding is hard. This required development of a 'sham' CADe system by @WisionAI that alerted only to 'polyp-like' findings (bubbles, folds etc).
Read 9 tweets
Aug 29, 2019
1/4: Why is a thin nasal feeding tube often called a ‘Dobhoff’? The original thin-caliber, weighted feeding tube was invented in 1975 by Dr. Robert Dobbie and Dr. James Hoffmeister. They joined their names for ‘Dobhoff’ (and also used the spelling ‘Dobbhoff’ interchangeably).
2/4: Dobbie was a surgical attending @utmedicalcenter focused on nutrition for lung & esophageal CA pts & Hoffmeister was a surgical resident. Until the Dobhoff tube, typical feeding tubes were 18 French (or larger) red rubber tubes, that usually only reached the stomach.
3/4 The original ‘Dobhoff’ tube was a ~7-8 French tube (0.095” diameter) made of silastic and PVC, and with a mercury-filled tip.
Read 5 tweets

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