Citations

Abstract Background Large language models (LLMs) offer promise for systematic review data extraction, but performance in complex multidisciplinary domains and utility for clinical statement generation remain insufficiently described. Objectives To evaluate Google NotebookLM for AI-assisted data extraction and RAND/UCLA consensus statement generation in a systematic review of IBD, obesity, and cardiometabolic comorbidities. Methods Studies were organized into domain-specific notebooks; structured prompts generated standardized evidence tables. Two independent reviewers validated outputs against full-text articles using a four-category error classification. Cell-level accuracy and critical accuracy (cells free of major factual errors) were the primary metrics; workflow time was compared against a published conventional extraction benchmark. Concordance between AI-generated and expert-finalized statements was assessed. Results Across 57 articles, 1,710 data cells were extracted; 151 (8.83%) were flagged, yielding 91.17% cell-level accuracy. Major factual errors occurred in only 4 cells (0.23%), for a critical accuracy of 99.77%. Most errors were minor omissions (59.6%) or incomplete extractions (30.5%); domain error rates ranged from 7.08% to 11.33%. The pipeline required 17.7 versus a projected 165.1 person-hours (89.3% reduction). PICO-structured prompting generated 70 candidate statements; 58 of 112 finalized panel statements (51.8%) were AI-derived, and 85.7% were retained in the finalized set. Conclusion Google NotebookLM demonstrates feasibility as a primary extraction and synthesis tool in a multidisciplinary systematic review, with extractive incompleteness as the principal limitation and substantial time savings over conventional approaches. Its novel application to RAND/UCLA consensus statement generation extends AI-assisted evidence synthesis to clinical consensus generation workflow.

Introduction Obesity and related cardiometabolic comorbidities, including hypertension, dyslipidaemia, diabetes, metabolic dysfunction-associated steatotic liver disease and atherosclerotic cardiovascular disease, are increasingly prevalent among individuals with inflammatory bowel disease (IBD). These conditions influence disease activity, therapeutic response, surgical outcomes and overall quality of life, yet evidence remains fragmented. The M odulate O besity and relate D metabolic compl I cations F or Y ielding improvements in IBD outcomes (MODIFY-IBD) initiative aims to synthesise evidence and generate consensus recommendations to guide practice and future research in this area. This study describes a protocol for a structured evidence synthesis and Research ANd Development/University of California, Los Angeles (RAND/UCLA) Appropriateness Method (RUAM) consensus process. Methods and analysis We will conduct three systematic reviews and a structured evidence synthesis organised into three domains: (1) the impact of obesity on IBD outcomes, (2) the burden of cardiometabolic complications in IBD and (3) the management of overweight, obesity and cardiometabolic comorbidities in IBD. A multidisciplinary international panel of gastroenterologists, surgeons, endocrinologists, hepatologists, cardiologists and dietitians will assess each statement using the RAND/UCLA appropriateness method. Panellists will rate the appropriateness of each statement (only those that fall within their area of expertise) on a 1–9 scale (1–3=inappropriate, 4–6=uncertain and 7–9=appropriate), with medians rounded up (eg, 6.5=appropriate). Agreement will be assessed using the RAND Disagreement Index (DI<1.0=agreement). Ethics and dissemination This study will not involve direct patient participation, as it is based on evidence synthesis and expert consensus; therefore, formal research ethics committee approval will not be required. Patient representatives will contribute to the consensus process to provide contextual perspectives but no identifiable data will be collected. Findings will be disseminated through publication in peer-reviewed journals, presentation at major gastroenterology and IBD conferences and communication with professional societies. A lay summary and patient-friendly infographic will also be developed to facilitate translation of recommendations into clinical practice. PROSPERO registration numbers CRD420251178843: a systematic review of the impact of obesity on inflammatory bowel disease outcomes. CRD420251178799: a systematic review of cardiometabolic complications in inflammatory bowel disease. CRD420251174653: management of overweight, obesity and cardiometabolic comorbidities in inflammatory bowel disease: a systematic review.

Background and Aims: Upadacitinib, a selective janus kinase 1 (JAK1) inhibitor, and ustekinumab, an interleukin-12/23 inhibitor, are approved for the treatment of moderate-to-severe ulcerative colitis (UC). However, real-world data in patients with anti-tumor necrosis factor (TNF)-exposure are limited. Methods: We performed a retrospective cohort study in TriNetX US Collaborative Network. Adult patients with UC and prior anti-TNF exposure were identified. Patients who received upadacitinib or ustekinumab between April 2022 and August 2024 were stratified into two cohorts. Patients with Crohn’s disease, rheumatoid arthritis, psoriasis and ankylosing spondylitis were excluded. Propensity-score matching was performed to balance comorbidities, medications, and labs between the two cohorts. Study outcomes included rates of corticosteroid use, colectomies, change of therapy, hospital admissions or emergency department visit, and all-cause mortality. Results: A total of 724 patients in the upadacitinib cohort and 909 in the ustekinumab cohort met the inclusion criteria. After matching, 633 patients remained in each cohort, with balanced baseline characteristics. At 1-year follow-up, the rates of corticosteroid use were 40.1% in the upadacitinib group and 48.5% in the ustekinumab group (aOR= 0.71, 95% CI: 0.69-0.89), mainly driven by differences in oral corticosteroid use (aOR= 0.73, 95% CI: 0.58-0.91). All other outcomes were comparable between the two study groups. Conclusion: In patients with ulcerative colitis and prior anti-TNF exposure, upadacitinib was associated with lower oral corticosteroid use than ustekinumab over 1 year, with no significant differences in rates of colectomy, ED visits or hospitalizations. These findings suggest a potanial higher effectiveness of upadacitinib compared with ustekinumab and may help inform treatment selection in this population.

Lay Summary This meta-analysis of 8 randomized controlled trials compares the effectiveness of using high-definition scopes with virtual chromoendoscopy vs dye chromoendoscopy for detecting dysplasia in inflammatory bowel disease patients. Overall, the odds of dysplasia detection were not significantly different between dye chromoendoscopy and virtual chromoendoscopy.

Background and aims Percutaneous endoscopic gastrostomy (PEG) is an essential procedure for patients who require long-term enteral nutrition but are unable to eat orally. However, it carries a risk of bleeding, particularly in patients on anticoagulation or dual antiplatelet therapy (DAPT). This study aimed to assess the bleeding risk associated with continuing anticoagulation or DAPT during PEG placement. Methods Using the TriNetX US Collaborative Network Database, we analyzed four cohorts: patients on anticoagulants, patients not on anticoagulants, patients on DAPT, and patients on aspirin (ASP), focusing on gastrostomy-related bleeding within 7 and 30 days, along with secondary outcomes such as mortality and the need for blood transfusion or endoscopic reintervention. Results Our analysis showed no statistically significant difference in the 7-day bleeding risk between the anticoagulant and no anticoagulant groups. However, a higher 30-day bleeding risk was observed in the anticoagulant group (0.9 vs. 0.4%, P = 0.007). There was no significant difference in the incidence of severe bleeding events requiring endoscopic intervention or blood transfusion. In addition, the difference in the bleeding risk between the DAPT and ASP groups was not statistically significant within 7 and 30 days. Conclusion These findings suggest that while anticoagulant use increases the risk of minor post-PEG bleeding, it does not lead to a higher incidence of severe bleeding. Additionally, the continuation of DAPT was not associated with statistically significant increase in bleeding risk. This study provides valuable insights into the management of antithrombotic therapy in patients undergoing PEG.

Abstract Background Studies evaluating the risk of post-polypectomy bleeding (PPB) after colorectal endoscopic mucosal resection (EMR) in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) are limited. Methods This retrospective cohort study utilized the U.S. Collaborative Network to assess the risk of PPB after colorectal EMR in patients with CKD compared to controls. Using one-to-one propensity score matching (PSM), the primary outcome measured was PPB within 30 days after colorectal EMR. The PPB risk was further stratified by CKD severity: non-advanced CKD and advanced CKD. Results After PSM, each cohort included 7,460 patients. Overall, CKD was associated with increased risk of PPB following colorectal EMR (5.5% vs. 4%, odds ratio [OR] 1.38, 95% confidence interval [CI] 1.19–1.61, p < 0.001). The PPB risk was significantly higher in patients with advanced CKD (8.1% vs, 4.6%, OR 1.83, 95% CI 1.43–2.34, p < 0.001), while those with non-advanced CKD showed modest increase in risk of PPB (4.7% vs. 3.9%, OR 1.21, 95% CI 1.001–1.46, p = 0.049). Conclusion Patients with CKD had higher risk of PPB than patients without CKD, but absolute risk remained low. The PPB risk was notably increased in patients with advanced CKD. Optimizing patients with CKD, especially advanced CKD, before colorectal EMR and monitoring for post-procedure bleeding remains important.

INTRODUCTION: The impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on colonoscopy bowel preparation is unclear. METHODS: We searched multiple databases for studies comparing bowel preparation quality between GLP-1RA users and the control group. Using a random-effects model, we calculated pooled odds ratios and mean differences with 95% confidence intervals (CIs). Inadequate bowel preparation (IBP) rate was the primary outcome, and Boston Bowel Preparation Scale mean score was the secondary outcome. RESULTS: Five studies with 10,833 patients (n = 5,434 GLP-1RAs vs n = 5,399 control) were included. The IBP rate was higher in the GLP-1RAs group compared with the control group (odds ratios 2.10, 95% CI 1.41–3.13, P = 0.0003). Furthermore, the mean Boston Bowel Preparation Scale score was lower in the GLP1-RAs group compared with the control group (mean differences −0.34; 95% CI −0.51, −0.17; P = 0.0001). DISCUSSION: Our findings suggest that using GLP-1RA increases the risk of IBP.

INTRODUCTION: Data on the risk of post-polypectomy bleeding after endoscopic mucosal resection (EMR) in patients with cirrhosis are limited. METHODS: This retrospective cohort study used the US Collaborative Network to assess post-polypectomy bleeding risk after colorectal EMR in patients with cirrhosis compared with controls. Using one-to-one propensity score matching, the primary outcome measured was bleeding within 30 days post-EMR. The bleeding risk was further stratified by cirrhosis severity (compensated and decompensated). RESULTS: After propensity score matching, each cohort included 2,381 patients. Patients with cirrhosis had a higher risk of post-polypectomy bleeding (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.05–1.82, P = 0.02). However, endoscopic reinterventions for hemostasis were similar between cirrhosis and control cohorts (OR 1.20, 95% CI 0.71–2.05, P = 0.50). The post-polypectomy bleeding risk was significantly higher in patients with decompensated cirrhosis (OR 1.65, 95% CI 1.12–2.42, P = 0.01), while those with compensated cirrhosis showed no increased risk of post-polypectomy bleeding (OR 1.15, 95% CI 0.85–1.54, P = 0.37). DISCUSSION: The post-polypectomy bleeding risk was higher in patients with decompensated cirrhosis, while the bleeding risk was not increased in those with compensated disease. Optimizing patients with cirrhosis, especially with decompensated disease, before colorectal EMR and monitoring for post-procedure bleeding remain important. A conservative, supportive approach to managing bleeding in patients with cirrhosis may be as effective as in those without cirrhosis.