This study assessed the effectiveness of large language models (LLMs) in generating lay summaries for patient education on the management of precancerous lesions and early neoplasia in the stomach. In this pilot study, we used a two-period, crossover, blinded design to compare a ChatGPT-4o summary versus a Digestive Cancers Europe (DiCE) summary. Two panels rated the materials: expert physicians and DiCE Patient Advisory Committee members. Experts scored accuracy, completeness, comprehensibility, and satisfaction (across five sections); patients rated overall completeness, comprehensibility, and satisfaction. Paired comparisons used mixed-effects estimates. Readability was assessed with Flesch-Kincaid grade level (FKGL) and SMOG index. Median expert ratings were similar between materials across metrics. For the overall summary, median (range; IQR) scores were: accuracy 5 (4-6; 1) for ChatGPT-4o vs. 5 (3-6; 1) for DiCE (P = 0.10); completeness 4 (3-5; 1) vs. 4 (2-5; 1; P = 0.27); comprehensibility 4 (3-5; 1) vs. 4 (2-5; 1; P = 0.33); and satisfaction 4 (2-5; 1) vs. 3 (1-5; 2; P = 0.53). Patient ratings mirrored experts, with very similar results. Readability failed to meet guideline recommendations for both summaries on both FKGL and SMOG scores. ChatGPT-4o produced patient materials comparable to DiCE, but both require readability optimization; a human-in-the-loop workflow and future tests across prompts and models are warranted.

Double-balloon endoscopy-assisted bile duct biopsy with a long, tapered delivery system Advances in chemotherapy have prolonged survival in cholangiocarcinoma, making postoperative biliary recurrence increasingly common; re-resec- Fig. 3 A contrast-enhanced CT image demonstrating a biliary stricture at the hepaticoje- junostomy site (arrowheads), with upstream dilatation of the left bile duct.CT, computed tomography.

Fig. 4 a A giant mass at the bulb-descending junction with a smooth surface, focally coarse mucosa, and erythematous, eroded mucosa at the head; the tumor prolapses into the descending duodenum.b Complete resection of the lesion via full-thickness resection.c Hemostatic forceps applied to vessel stumps at the wound site; the defect was closed using a combination of the through-the-scope twin clip and clips.d The gross specimen of the resected lesion, measuring approximately 9.0 cm 3.5 cm. Fig. 5 H&E staining (10 4) of the duo- denal Brunner gland hamartoma.H&E, hematoxylin and eosin. These authors contributed equally.

Single-operator esophageal endoscopic submucosal dissection using an endoscope-tethered adjustable knife Fig. 2 Procedure of single-operator ESD. a Marking around the lesion.