Artificial Intelligence Versus Conventional Scoring for Assessing Small Bowel Capsule Endoscopy Cleanliness in Crohn's Disease.

Abstract / Summary

Evaluation of cleanliness in capsule endoscopy is essential to validate the exam. However, reliable evaluation of bowel cleanliness remains challenging. The validated KODA score provides robust assessment but is time-consuming and impractical in routine practice. We aimed to evaluate the performance of an AI-based tool (AXAROlite, Augmented Endoscopy) compared with the KODA score for assessing small bowel cleanliness in CD patients. This was a post hoc analysis of a multicenter randomized controlled trial (NCT05117996) including 142 CD patients undergoing SBCE after either a standard PEG-based or simplified clear liquid preparation. All videos were evaluated for cleanliness using the KODA score by trained readers. The same videos were analyzed using the AI-based AXAROlite tool. Correlation, agreement, and diagnostic performance of AXAROlite were compared with the KODA score. Clinical factors influencing AI-assessed cleanliness were also investigated. AXAROlite and KODA showed strong correlation for whole small bowel (ρ = 0.61; p < 0.001). AXAROlite demonstrated excellent diagnostic accuracy for detecting adequate cleanliness defined as KODA > 2.25 (AUROC = 0.85, 95% CI 0.79-0.92), with an optimal threshold of 72% clean frames (sensitivity 86%, specificity 72%). Mean cleanliness decreased progressively from proximal to distal small bowel with both methods (p = 0.001). The AXROlite score was independently reduced in patients with active disease and a longer small bowel transit time. AXAROlite provides a rapid, fully automated, and accurate evaluation of small bowel cleanliness in CD, comparable to the validated KODA score. Its integration into routine workflows may streamline reporting and reduce inter-observer variability.

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