P0236 - Enhancing Diagnosis of Indeterminate Biliary Strictures: A Case Series Using AI–Enhanced Cholangioscopy

Miguel Martins, MD¹, Mariano Gonzalez Haba, MD², Francisco Mendes, MD¹, Pedro Cardoso, MD¹, Maria João Almeida, MD³, Joana Mota, MD¹, Pedro Pereira, MD, PhD³, Jessica Widmer, DO⁴, Tiago Ribeiro, MD¹, Belen Agudo, MD², Filipe Vilas Boas, MD, PhD³, João Ferreira, PhD⁵, Miguel Mascarenhas Saraiva, MD, PhD¹
1Centro Hospitalar Universitário São João, Porto, Porto, Portugal; 2Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Madrid, Spain; 3Centro Hospitalar Universitário de São João, Porto, Porto, Portugal; 4NYU Langone Health, Mineola, NY; 5Faculdade de Engenharia da Universidade do Porto, Porto, Porto, Portugal

Introduction: The evaluation of indeterminate biliary strictures (BSs) remains clinically challenging due to innacurate visual assessment, high interobserver variability and suboptimal biopsy yield during digital single-operator cholangioscopy (DSOC).

Artificial intelligence (AI), particularly convolutional neural networks (CNNs), offers a promising support real-time diagnostic accuracy in this setting.

This case series aims to describe examples of how a previously published AI-based tool can be integrated during DSOC for real-time characterization of BSs across global high-volume centers and case types. Predictions were generated over 30-second intervals and interpreted alongside visual findings and histology. AI results were not used to guide clinical decisions at the time of care.

Case Description/

Methods: In Case 1, a 71-year-old male with hilar thickening showed high AI-predicted malignancy ( >85%), corroborated by biopsy-confirmed cholangiocarcinoma. In Case 2, a 75-year-old male with choledocholithiasis and distal duct inflammation had a low malignancy prediction (< 5%) and benign histology, with no recurrence after 12 months. In Case 3, a 72-year-old man with obstructive jaundice, presented a nodular lesion with neovascularity; AI output showed >90% malignancy probability, confirmed as adenocarcinoma. In Case 4, a 69-year-old woman with autoimmune background and ambiguous DSOC appearance had a benign AI prediction, later supported by steroid-responsive IgG4-related cholangitis. In Case 5 involved a 64-year-old male with primary sclerosing cholangitis. AI yielded intermediate malignancy risk (~55%) in a dominant stricture. Surgical resection revealed early cholangiocarcinoma.

Discussion: This cases series from multiple centers demonstrated how integrating AI in real-time during cholangioscopy could enhance diagnostic performance, particularly when diagnoses are uncertain or high-risk cases. Although AI-assisted DSOC is not intended to replace histologic confirmation, it can aid in clinical decision-making by reducing ambiguity in interpretation and enhancing detection of lesions at earlier phases, although further prospective validation studies are still pending.


Figure: Examples of an Al-based tool can be integrated during DSOC

Disclosures:
Miguel Martins indicated no relevant financial relationships.
Mariano Gonzalez Haba indicated no relevant financial relationships.
Francisco Mendes indicated no relevant financial relationships.
Pedro Cardoso indicated no relevant financial relationships.
Maria João Almeida indicated no relevant financial relationships.
Joana Mota indicated no relevant financial relationships.
Pedro Pereira indicated no relevant financial relationships.
Jessica Widmer indicated no relevant financial relationships.
Tiago Ribeiro indicated no relevant financial relationships.
Belen Agudo indicated no relevant financial relationships.
Filipe Vilas Boas indicated no relevant financial relationships.
João Ferreira indicated no relevant financial relationships.
Miguel Mascarenhas Saraiva indicated no relevant financial relationships.

Miguel Martins, MD¹, Mariano Gonzalez Haba, MD², Francisco Mendes, MD¹, Pedro Cardoso, MD¹, Maria João Almeida, MD³, Joana Mota, MD¹, Pedro Pereira, MD, PhD³, Jessica Widmer, DO⁴, Tiago Ribeiro, MD¹, Belen Agudo, MD², Filipe Vilas Boas, MD, PhD³, João Ferreira, PhD⁵, Miguel Mascarenhas Saraiva, MD, PhD¹. P0236 - Enhancing Diagnosis of Indeterminate Biliary Strictures: A Case Series Using AI–Enhanced Cholangioscopy, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.