准确确定恶性胆道狭窄(MBSs)对于早期治疗至关重要。该研究旨在开发一个实时解释人工智能(AI)系统，在数字单操作员胆管镜下预测MBSs。开发了一个新颖的可解释AI系统MBSDeiT，由两个模型组成，首先识别合格的图像，然后实时预测MBS。在内部、外部、前瞻性测试数据集和亚组分析中，以及在前瞻性数据集上通过视频级别验证了MBSDeiT的整体效率，并与内镜医师进行比较。评估了AI预测与内镜特征之间的关联，以提高可解释性。 MBSDeiT可以首先自动选择符合要求的DSOC图像，在内部测试数据集上的AUC为0.904，在外部测试数据集上的AUC为0.921-0.927，并在内部测试数据集上识别MBS，外部测试数据集上的AUC为0.978-0.999，在前瞻性测试数据集上的AUC为0.976。 MBSDeiT在前瞻性测试视频中准确识别了92.3%的MBS。亚组分析证实了MBSDeiT的稳定性和鲁棒性。MBSDeiT的性能优于专家和新手内镜医师。AI预测与内镜特征之间存在显著关联(nodular mass;friability;raised intraductal lesion;and abnormal vessels; P < 0.05)，这与内镜医师的预测相一致。 研究结果表明，MBSDeiT可能是在DSOC下准确诊断MBS的一种有前途的方法。版权所有©2023年美国胃肠内镜学会。由Elsevier Inc.发表。保留所有权利。

It is crucial to accurately determine malignant biliary strictures (MBSs) for early curative treatment. The study aimed to develop a real-time interpretable artificial intelligent (AI) system to predict MBSs under digital single-operator cholangioscopy (DSOC).A novel interpretable AI system called MBSDeiT was developed, consisting of two models to identify qualified images and then predict MBS in real time. The overall efficiency of MBSDeiT was validated at the image level on internal, external, prospective testing datasets and subgroups analyses, and at the video level on the prospective datasets, and compared with that of endoscopists. The association between AI predictions and endoscopic features was evaluated to increase the interpretability.MBSDeiT can first automatically select qualified DSOC images with an AUC of 0.904 and 0.921-0.927 on the internal testing dataset and the external testing datasets, and then identify MBSs with an AUC of 0.971 on the internal testing dataset, an AUC of 0.978-0.999 on the external testing datasets, and an AUC of 0.976 on the prospective testing dataset, respectively. MBSDeiT accurately identified 92.3% MBS in prospective testing videos. Subgroups analyses confirmed the stability and robustness of MBSDeiT. MBSDeiT achieved superior performance to that of expert and novice endoscopists. The AI predictions were significantly associated with four endoscopic features (nodular mass; friability; raised intraductal lesion; and abnormal vessels; P < 0.05) under DSOC, which is consistent with the endoscopists' predictions.The findings suggest that MBSDeiT could be a promising approach for the accurate diagnosis of MBS under DSOC.Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.