Using deep learning to assess the function of gastroesophageal flap valve according to the Hill classification system

BACKGROUND: The endoscopic Hill classification of the gastroesophageal flap valve (GEFV) is of great importance for understanding the functional status of the esophagogastric junction (EGJ). Deep learning (DL) methods have been extensively employed in the area of digestive endoscopy. To improve the efficiency and accuracy of the endoscopist’s Hill classification and assist in incorporating it into routine endoscopy reports and GERD assessment examinations, this study first employed DL to establish a four-category model based on the Hill classification. MATERIALS AND METHODS: A dataset consisting of 3256 GEFV endoscopic images has been constructed for training and evaluation. Furthermore, a new attention mechanism module has been provided to improve the performance of the DL model. Combined with the attention mechanism module, numerous experiments were conducted on the GEFV endoscopic image dataset, and 12 mainstream DL models were tested and evaluated. The classification accuracy of the DL model and endoscopists with different experience levels was compared. RESULTS: 12 mainstream backbone networks were trained and tested, and four outstanding feature extraction backbone networks (ResNet-50, VGG-16, VGG-19, and Xception) were selected for further DL model development. The ResNet-50 showed the best Hill classification performance; its area under the curve (AUC) reached 0.989, and the classification accuracy (93.39%) was significantly higher than that of junior (74.83%) and senior (78.00%) endoscopists. CONCLUSIONS: The DL model combined with the attention mechanism module in this paper demonstrated outstanding classification performance based on the Hill grading and has great potential for improving the accuracy of the Hill classification by endoscopists.