Introduction

Large rectal adenomas often spread to the upper part of the anal canal. In this study were retrospectively analyzed 13 of 40 rectal lesions, operated by endoscopic submucosal dissections in 2018-2025, which were localized in lower rectum. 7 lesions have spread on anal canal and 6 lesions were localized in lower rectum without spreading on anal canal. The study compared the risk of intraprocedural bleeding, completeness of removal, duration of dissection, pain syndrome, and red blood cell indicators based on the size and location of the lesions.

Aims & Methods

A retrospective analysis was conducted on 40 Endoscopic Submucosal Dissections (ESD) of rectal lesions, all performed by a single operator at a single center. Two cases of NETs treated by ESD, two cases of synchronous colorectal locations resected in a single procedure, three ESD cases of recurrent adenomas following endoscopic or surgical treatment, two cases with deeply invasive carcinomas, and eighteen cases with rectal tumors without involvement of the lower rectum and anal canal were excluded. Seven ESD cases of anorectal lesions ranging from 20 to 170 mm in size, and six lower rectal lesions ranging from 30 to 80 cm were compared. Information about duration, location and size was taken from protocol of the operation and reviewed by photo and video fixation of procedures. Medical documentation was checked for red blood indicators and treatment of pain syndrome. Additionally, a follow-up phone call for all patients will be conducted two weeks after ESD.

Results

All lesions were removed in a single block. Only one tumor was fragmentated during the extraction. Coagulation forceps was needed in 5 of 7 cases in anorectal ESD group and 4 of 6 cases between lower rectal lesions. Forceps were needed in all cases over 70 mm in size. Two cases of massive bleeding were documented in anorectal group: one intraprocedural bleeding and one delayed bleeding. All patients in the low rectal group were discharged the day after ESD. In the anorectal group, four patients were discharged on the second, third, fourth, and fifth day following the procedure. Patients in the anorectal group reported symptoms within two weeks after dissection, including pain, episodes of fever, and increased hair loss (in cases involving significant intraprocedural bleeding).

Conclusion

Endoscopic submucosal dissection in lower rectum and anal canal is an effective modality for treatment of large benign tumors. But such operation, especially in cases on anorectal lesions has high risk of massive intraprocedural and delayed bleeding, longer hospital staying and longer recovery after treatment.

Introduction

Gallstone disease affects approximately 6% of the global population. Adequate knowledge about gallstone disease among the public can facilitate early medical consultation and enable them to navigate healthcare pathways effectively. In the digital age, patients increasingly turn to the internet for health-related information, with over half of the global population relying on it for access to knowledge.

Aims & Methods

This study aimed to evaluate the quality, readability, usability, and reliability of patient-oriented websites providing information on gallstone disease, using validated assessment tools. The three most widely used search engines, Google, Yahoo, and Bing were searched employing keywords related to gallstone disease. The first 50 search results per keyword per engine were screened. Applying the inclusion and exclusion criteria, 52 websites were selected for detailed analysis. The information was assessed for readability using the Flesch Reading Ease Score (FRES), for usability and reliability using the LIDA tool, and for overall quality using the DISCERN instrument. Statistical analysis was performed using SPSS (v27), with significance set at p < 0.05.

Results

Among the 52 websites analyzed, only sixteen (30.8%) sites had obtained Health on the Net (HON) code certification. The median FRES score of the included websites was 60.5 out of 100 (range: 33-79.6), indicating readability appropriate for readers aged 13–15 years. The median LIDA usability and reliability scores were 40 out of 54 (range: 31–54) and 24.5 out of 51 (range: 10–51), respectively. The median DISCERN score was 69.8 out of 80 (range: 30-80) with 5.8% (n=3) of websites scoring below 50%. A low DISCERN score (≤ 50%) was found in three (5.8%) websites. The DISCERN score was found to be significantly associated with LIDA reliability and LIDA overall scores (p < 0.001), government run websites (p= 0.028) and HON code certification (p = 0.01). However, no significant association was found between DISCERN scores and LIDA usability or FRES. Most websites (86.5%) provided accurate clinical information, but only 76.9% discussed treatment complications.

Conclusion

The quality of online patient information on gallstone disease varied considerably, with only a minority meeting optimal standards for readability and certification. While clinical accuracy was generally satisfactory, gaps remain in presenting treatment risks and maintaining content currency. These findings emphasize the need for improved oversight and standardization of online health content to support patient education and informed decision-making.

References

1. Internet World Stats. Internet world stats: Usage and population statistics, http://www.internetworldstats.com/stats.htm (2013, accessed 16 June 2023).
2. Lee JS, Seo HS, Hong TH. YouTube as a source of patient information on gallstone disease. World J Gastroenterol 2014; 20: 4066–4070.
3. Raptis DA, Sinanyan M, Ghani S, et al. Quality assessment of patient information on the management of gallstone disease in the internet. HPB 2019; 21: 1632–1640.
4. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 2016; 65: 146–181.

Disclosure

There is no conflict of interest

Introduction

Interest in large language models (LLMs) across multiple medical specialities has grown rapidly as a source of patient‑facing advice., No systematic review has appraised the accuracy and readability of LLM‑generated responses for gastrointestinal (GI) procedures, resulting in a lack of current evidence on the reliability of these tools.

Aims & Methods

We aimed to quantify the accuracy and readability of LLM responses to both patient‑ and clinician‑facing questions on GI investigations and interventions, and to identify limitations hindering clinical use. We searched PubMed, Ovid MEDLINE, Ovid Embase, and Google Scholar for peer‑reviewed studies published from 2023 to 2025 that evaluated text-based answers from any LLM on at least one GI diagnostic or therapeutic procedure (colonoscopy, endoscopy, EGD, ERCP, EUS, PEG, GI surgery and others). Inclusion criteria were English language, full‑text primary studies reporting at least one accuracy or readability metric; exclusion criteria included studies with a non-GI focus, image-only tasks, reviews, abstracts, or missing data.. Multiple reviewers independently screened records and extracted data, resolving disagreements by consensus. Risk of bias was appraised using the NIH Quality Assessment Tool (NIH‑QAT) for observational cross‑sectional studies [1]. Accuracy was quantified using a binary (accurate/inaccurate), three-point (accurate, partially accurate, inaccurate), or numerical 1-5 point scales. Readability was assessed using a five‑point Likert scale.

Results

Of the 409 records screened, 45 full‑text articles were reviewed, and 14 met the inclusion criteria, covering seven LLMs. Accuracy varied across models: on the binary scale, Google Bard performed best (82 %, n = 11), followed by Microsoft Copilot (60 %, n = 10). On the three‑point scale, Claude performed best (2.44 / 3, n = 124), with ChatGPT second (2.15 / 3, n = 124). On the five‑point scale, ChatGPT ranked first (3.6 / 5, n = 308), and Claude next (3.04 / 5, n = 16).

By procedure, colonoscopy scored highest on binary (73 %, n = 30) and three‑point (2.73 / 3, n = 14) scales, whereas endoscopy topped the five‑point scale (4.01 / 5, n = 32). Surgery showed mixed performance — binary 59 % (n = 141), three‑point 1.93 / 3 (n = 105), and five‑point 3.54 / 5 (n = 244). ERCP, EUS, PEG, and EGD were represented by smaller samples, giving variable three‑point scores (ERCP 2.66, EUS 2.56, EGD 2.22, PEG 1.83).

Conclusion

LLMs can provide readable answers on GI procedures, but none reach the ≥ 95 % accuracy typically expected for clinical use, with performance still inconsistent across procedures. Standardised benchmarking, balanced prompt libraries, and updated model evaluations are needed before LLMs can be safely used in clinical gastroenterology.

References

[1] National Heart, Lung, and Blood Institute. Study Quality Assessment Tools [https://www. nhlbi. nih. gov/health-topics/study-quality-assessment-tools].