Endoscopic ultrasonography in the differential diagnosis of obstructive pathology of the major duodenal papilla using fuzzy diagnostic models

Objective: to improve the quality of endoscopic ultrasonography (EUS) in the diagnosis of obstructive pathology of the major duodenal papilla (MDP) using fuzzy diagnostic models. Materials and methods. The study included 189 patients treated at the Kursk Regional Multidisciplinary Clinical Hospital in 2013-2023. 134 people (70.9%) were diagnosed with MDP stenosis, 24 (12.7%) had single benign papillary neoplasms, 31 (16.4%) patients had malignant MDP tumors. Based on the analysis of treatment results, the possibility of differential diagnosis of duodenal papilla pathology according to endoscopic ultrasonography using fuzzy diagnostic models was studied. Differentiation was carried out using the methodology of synthesis of hybrid fuzzy decision rules, in which the lack of statistical data is filled with the clinical knowledge of experts, which determines the possibility of constructing a function of belonging to a differentiable pathology. Results. Within the framework of the methodology, informative echographic criteria for the diagnosis of various pathology of MDP have been developed based on endosonography data, systematized and presented in the form of reference endosonograms and reference schemes that fully reflect the characteristics of the diagnostic object. According to the expert assessment, the coefficients of confidence in the decisions made, which are the basis of the diagnostic algorithm, are determined. The results of mathematical modeling showed confidence in the correct diagnosis of pathological changes using synthesized fuzzy algorithms over 0.85, which is an acceptable result for clinical use. Conclusion. The use of the developed fuzzy model in combination with visual examination of the papillary zone (which provides the EUS method), brings the diagnostic accuracy of differential diagnosis to the maximum values.

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