Assessing ChatGPT vs. Standard Medical Resources for Endoscopic Sleeve Gastroplasty Education: A Medical Professional Evaluation Study.

BACKGROUND AND AIMS: The Chat Generative Pre-Trained Transformer (ChatGPT) represents a significant advancement in artificial intelligence (AI) chatbot technology. While ChatGPT offers promising capabilities, concerns remain about its reliability and accuracy. This study aims to evaluate ChatGPT's responses to patients' frequently asked questions about Endoscopic Sleeve Gastroplasty (ESG). METHODS: Expert Gastroenterologists and Bariatric Surgeons, with experience in ESG, were invited to evaluate ChatGPT-generated answers to eight ESG-related questions, and answers sourced from hospital websites. The evaluation criteria included ease of understanding, scientific accuracy, and overall answer satisfaction. They were also tasked with discerning whether each response was AI generated or not. RESULTS: Twelve medical professionals with expertise in ESG participated, 83.3% of whom had experience performing the procedure independently. The entire cohort possessed substantial knowledge about ESG. ChatGPT's utility among participants, rated on a scale of one to five, averaged 2.75. The raters demonstrated a 54% accuracy rate in distinguishing AI-generated responses, with a sensitivity of 39% and specificity of 60%, resulting in an average of 17.6 correct identifications out of a possible 31. Overall, there were no significant differences between AI-generated and non-AI responses in terms of scientific accuracy, understandability, and satisfaction, with one notable exception. For the question defining ESG, the AI-generated definition scored higher in scientific accuracy (4.33 vs. 3.61, p = 0.007) and satisfaction (4.33 vs. 3.58, p = 0.009) compared to the non-AI versions. CONCLUSIONS: This study underscores ChatGPT's efficacy in providing medical information on ESG, demonstrating its comparability to traditional sources in scientific accuracy.

Post-bariatric Surgery Changes in Secondary Esophageal Motility and Distensibility Parameters.

INTRODUCTION: Despite the increasing number of bariatric procedures over the recent years, the physiological changes in secondary esophageal motility and distensibility parameters after surgery remain unknown. METHODS: This is a retrospective, single-center cohort study comparing esophageal planimetry and gastroesophageal junction (GEJ) distensibility in post-bariatric surgery patients (Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and conversion/revisional patients (DH)) and native-anatomy patients with obesity (NAC). Distensibility refers to the area achieved with a certain amount of pressure, and secondary peristalsis represents the esophageal response to an intended obstruction. Patients with pre-surgical dysmotility symptoms were excluded from the study. RESULTS: From November 2018 to January 2023, 167 patients were evaluated and eligible for this study (RYGB = 87, SG = 33, NAC = 22, DH = 25). In NAC cohort, 17/22 (77%) patients presented normal motility patterns compared to 35/87 (40%) RYGB, 12/33 (36%) SG, and 5/25 (20%) DH (p < 0.05 for all comparisons). The most common abnormal motility pattern for all three bariatric cohorts was absent contractions. DH patients generally had the highest mean maximum distensibility index averages, followed by SG, RYGB, and NAC. CONCLUSION: Bariatric surgery affects esophageal and GEJ physiology, and it is associated with higher rates of secondary dysmotility. DH patients have even higher rates of dysmotility. Further studies assessing clinical data and their correlation with manometric and pH-metric findings are needed.

Tubularization of the gastric pouch helps sustain weight loss after transoral outlet reduction for post-Roux-en-Y gastric bypass weight recurrence.

Background and study aims Traditional transoral outlet reduction (TORe) is a minimally invasive endoscopic approach focused on reducing the aperture of the gastrojejunal (GJ) anastomosis, while the tubular transoral outlet reduction (tTORe) consists of tabularization of the distal pouch utilizing an O-shape gastroplasty suturing pattern. The primary aim of this study was to compare short-term weight loss between TORe and tTORe. Patients and methods Retrospective analysis of a prospectively maintained database was conducted at a tertiary care bariatric center of excellence. The study included patients with history of Roux-en-Y gastric bypass (RYGB) who had an endoscopic revision by TORe or tTORe and had follow-up data in their electronic medical record. The primary outcome was percent total body weight loss (%TBWL). Results A total of 128 patients were included (tTORe=85, TORe=43). At 3 and 6 months, the tTORe and TORe cohorts presented similar %TBWL (3 months: 8.5±4.9 vs. 7.3±6.0, P = 0.27 and 6 months: 8.1±7.4 vs. 6.8±5.6, P = 0.44). At 9 months, there was a trend toward greater weight loss in the tTORe cohort (9.7±8.6% vs. 5.1±6.8%, P = 0.053). At 12 months, the %TBWL was significantly higher in the tubularization group compared to the standard group (8.2±10.8 vs. 2.3±7.3%, P = 0.01). Procedure time was significantly different between both groups (60.5 vs. 53.4 minutes, P = 0.03). The adverse events rate was similar between groups (8.2% vs. 7.0% for tTORe and TORe, respectively, P = 0.61). Conclusions The tTORe enhances efficacy and durability of the standard procedure without adding significant procedure-related risks.

Pitfalls of EUS-guided gastrojejunostomy in a patient with history of Roux-en-Y gastric bypass and a frozen abdomen.

Video 1Case of EUS-guided gastrojejunostomy in a patient with a history of Roux-en-Y gastric bypass and a frozen abdomen.

Management of a refractory marginal ulcer following Roux-en-Y gastric bypass with EUS-guided Roux-en-Y gastric bypass reversal.

Video 1EUS-guided Roux-en-Y gastric bypass reversal procedure to treat a refractory marginal ulcer following Roux-en-Y gastric bypass.

Diabetes Mellitus Remission in Patients with BMI > 50 kg/m2 after Bariatric Surgeries: A Real-World Multi-Centered Study.

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a common comorbidity associated with obesity, particularly in patients with body mass index (BMI) ≥ 50 kg/m2. We aim to study real-world T2DM long-term remission in patients with BMI ≥ 50 kg/m2 following Roux-En-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). METHODS: This was a retrospective study of the electronic medical records of all patients with BMI ≥ 50 kg/m2, T2DM, and have undergone RYGB or SG at three tertiary referral centers in the United States. We assessed the change in T2DM outcomes after bariatric surgery using a matched paired t-test for continuous variables and Bowker and Pearson test for categorical variables. We performed a multivariate logistic regression to determine predictors of remission. RESULTS: A total of 279 patients with T2DM (65% females, mean age 51.0 ± 11.7 years, 89% white, BMI 56.6 ± 5.9 kg/m2) were analyzed. Long-term T2DM remission (≥ 5 years) was demonstrated in 47% of patients. The duration of T2DM (p < 0.0001), number of T2DM medications (p = 0.003) and weight loss (p = 0.048) were the only independent factors for long-term T2DM remission. CONCLUSIONS: In this cohort of patients with BMI ≥ 50 kg/m2, RYGB and SG demonstrated significant and similar long-term T2DM remission rates and weight loss outcomes.