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BACKGROUND AIMS Barrett’s epithelium measurement using widely accepted Prague C&M classification is highly operator dependent. We propose a novel methodology for measuring this risk score automatically. The method also enables quantification of the area of Barrett’s epithelium (BEA) and islands which was not possible before. Furthermore, it allows 3D reconstruction of the esophageal surface enabling interactive 3D visualization. We aim to assess the accuracy of the proposed AI system both on phantom and endoscopic patient data. METHODS Utilizing advanced deep learning, a depth estimator network is used to predict endoscope camera distance from the gastric folds. By segmenting BEA and gastro-esophageal junction and projecting them to the estimated mm distances, we measure C&M scores including the BEA. The derived endoscopy AI system is tested on a purpose-built 3D printed esophagus phantom with varying BEA and on 194 high-definition videos from 131 patients with C&M values scored by expert endoscopists. RESULTS Endoscopic phantom video data demonstrated a 97.2 % accuracy with a marginal ± 0.9 mm average deviation for C&M and island measurements, while for BEA we achieved 98.4 % accuracy with only ± 0.4 cm2 average deviation compared to ground-truth. On patient data, the C&M measurements provided by our system concord with expert scores with marginal overall relative error (mean difference) of 8 % (3.6 mm) and 7 % (2.8 mm) for C and M scores, respectively. CONCLUSIONS The proposed methodology automatically extracts Prague C&M scores with high accuracy. Quantification and 3D-reconstruction of the entire Barrett’s area provides new opportunities for risk stratification and assessment of therapy response.

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