Diseases of the Colon & Rectum最新文献

Background: The Ventral Rectopexy International Expert Panel recently published a consensus update on ventral rectopexy. The ability of large language models to synthesize the literature on ventral rectopexy without an explicit knowledge base was studied prior to publication of the consensus.

Objective: To compare different large language models' responses and citations on ventral rectopexy using the expert panel consensus as a reference standard.

Design: ChatGPT-4o, Gemini 1.5 Pro, and OpenEvidence were compared on content appropriateness (1-inappropriate to 5-appropriate), readability (Flesch reading ease), response length, citation fabrication, and citation quality per Oxford Levels of Evidence. The most content-appropriate chatbot response selected by the expert panel was de-identified and presented alongside the consensus text to 15 colorectal surgeons who attempted to identify the chatbot-generated text.

Setting: Questions were submitted on September 18-19, 2024. Analysis was performed prior to the consensus's publication online on January 30, 2025.

Main outcome measures: Content appropriateness, fabricated citation rate, citation quality, accuracy of identifying human vs. chatbot text by colorectal surgeons.

Results: OpenEvidence ranked highest for content appropriateness (mean 3.5/5), above Gemini (3.0/5) and ChatGPT (2.8/5) (p<0.001). ChatGPT was most verbose with the highest readability scores (p=0.021). ChatGPT fabricated 53% of citations; Gemini fabricated 12%; OpenEvidence fabricated 0% (p<0.001). All OpenEvidence citations were peer-reviewed with 40/117 (34%) citing Level I-III studies vs. 46/94 (49%) of the references cited in the consensus (p=0.043). Chatbot-generated responses were identified with 28/51 (55%) accuracy.

Limitations: Reproducibility due to nature of large language models and availability of consensus post-publication.

Conclusions: OpenEvidence outperformed Gemini 1.5 Pro and ChatGPT-4o on content appropriateness and peer-reviewed citation quantity and quality. Chatbot-generated text was indistinguishable from expert-authored consensus to subject matter experts. Large language models as an early-stage research tool may be viable for future consensus working groups, provided transparent disclosure and rigorous oversight. See Video Abstract.

Background: Low anterior resection syndrome describes chronic debilitating bowel dysfunction following rectal cancer surgery and is associated with poor quality of life. Conservative self-management strategies are the first-line treatment for low anterior resection syndrome.

Design: Qualitative analysis of text data generated by participants through an online Informational and Peer Support App, which was successfully tested through a multicenter randomized controlled trial.

Patients: Forum posts were generated by study participants, peer mentors and healthcare providers.

Setting: Data analyzed from the App included forum posts, chat night transcripts and video comments.

Main outcome measures: Using an affinity diagram approach, 2 reviewers independently identified and organized themes from the compiled texts.

Objective: To explore the lived experience of using self-management for low anterior resection syndrome among rectal cancer survivors who have actively participated on the App.

Results: In total, there were 45 participants and 2,363 App logins over 6 months. Of the 786 posts exchanged through the App, 112 (14.2%) were made by healthcare providers, and the rest by participants and peer mentors. Thematic analysis revealed 7 themes and 27 subthemes, which included: 1) diet: use and benefit of food diaries, trigger foods and probiotics, fiber supplements, and personalized dietary guide with the help of a nutritionist; 2) coping strategies: sense of humor, finding peace with acceptance of 'new normal' and managing expectations and recognition of the toll LARS can have on mental health; 3) transanal irrigation: initial reluctance to try it, learning to perform transanal irrigation from peers online, leading to significant improvement in bowel function; 4)Benefits of peer support: sharing of knowledge and sense of community found through peer support are empowering and provide hope.

Limitations: Small sample size, selection bias.

Conclusion: This qualitative analysis highlighted the lived experience and unmet needs of rectal cancer survivors pursuing self-management strategies for low anterior resection syndrome. See Video Abstract.

Background: Chronic anal fissures are a painful condition characterized by a tear in the anal mucosa. Botulinum toxin injection is a minimally invasive treatment option, but long-term effectiveness in recurrent or persistent cases remain unclear.

Objective: Evaluate long-term outcomes of botulinum toxin injections for the treatment of fissures.

Design: Retrospective review.

Settings: Tertiary academic center.

Patients: Adults with chronic fissures treated with botulinum toxin between 2018-2023.

Main outcome measures: Short and long-term healing, recurrence, or persistence after botulinum toxin injection. Persistent or recurrent fissure(s) were followed for outcomes after subsequent repeat injections or surgery (lateral internal sphincterotomy or fissurectomy).

Results: Among 161 patients, 45.3% (n = 73) experienced short-term healing following botulinum toxin as firstline therapy, but only 26% (n = 42) had sustained healing. Subsequent treatment patterns were similar for recurrent (n = 31) or persistent (n = 88) fissures: 35% vs 31% no further intervention, 55% vs 42% multiple subsequent injections, 10% vs 23% surgery, respectively. Sustained healing was achieved in 63% (n = 10/16) of patients who underwent surgery compared to 37% (n=14/38) who had repeat botulinum toxin injections (p = 0.06). Only 49% achieved sustained healing after either a single injection, multiple injections, or injection(s) with surgery. Complications included 5 episodes of mild fecal incontinence in the botulinum toxin group, and two instances of surgical site infection in the surgery group.

Limitations: Single institution, retrospective study, and loss to follow up.

Conclusion: Botulinum toxin remains a valuable therapy for chronic anal fissures. Many patients have persistent or recurrent fissures after botulinum toxin injection and undergo additional interventions. Despite multiple interventions, only half of patients achieved sustained healing, regardless of treatment pattern. These data do not support the use of botulinum toxin over surgery for treatment of chronic fissures, are helpful for counseling patients about the safety profile of each and sets expectations regarding the need for multiple interventions. See Video Abstract.