Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
Medicine
Performance of DeepSeek V3 and ChatGPT-4o in answering esophageal cancer-related questions
Esophageal cancer remains a significant global health issue. ChatGPT-4o and DeepSeek V3 can provide the public with health-related knowledge about esophageal cancer. This study aimed to evaluate the accuracy of DeepSeek V3 and ChatGPT-4o in responding to health knowledge questions related to esophageal cancer. Fifty-two questions related to esophageal cancer were classified into themes of basic knowledge, diagnosis and molecular biology, management of local and locoregional diseases, management of advanced and metastatic diseases, clinical case analysis and patient frequently asked questions (FAQs). These questions were entered into DeepSeek V3 and ChatGPT-4o to obtain responses, and 2 experienced gastroenterologists independently evaluated the accuracy and temporal stability of each response. Overall, the scores of DeepSeek V3 and ChatGPT-4o on all questions were 4 (3-4), and there was no statistically significant difference between the 2 groups. The final scores of DeepSeek V3 in basic knowledge, diagnosis and molecular biology, management of local and locoregional diseases, management of advanced and metastatic diseases, clinical case analysis, and FAQs were 4 (3-4), 4 (3-4), 4 (3-4), 3 (3-4), 4 (4-4), and 4 (4-4), respectively, while the scores of ChatGPT-4o were 4 (3-4), 3 (2-4), 4 (3-4), 3 (3-4), 4 (4-4), and 4 (4-4), respectively. For temporal stability across 2 independent test runs, DeepSeek V3 presented inconsistent responses on 2 questions, and ChatGPT-4o on 1 question; no statistically significant differences were found in overall and subgroup scores between the 2 runs for both models (all P > .05). ChatGPT-4o and DeepSeek V3 showed favorable accuracy and comprehensive responses to most of the 52 esophageal cancer-related questions in this study, but our findings do not confirm their general reliability for esophageal cancer health information in routine clinical or public use.
27 July 2026
Read appraisal →BMJ open
Comparative diagnostic accuracy of image-enhanced endoscopy modalities and artificial intelligence-assisted endoscopy for gastric intestinal metaplasia and gastric dysplasia: protocol for a systematic review and diagnostic test network meta-analysis.
INTRODUCTION: Gastric intestinal metaplasia (GIM) and gastric dysplasia are critical precursors in the Correa cascade of gastric carcinogenesis. Although multiple image-enhanced endoscopy (IEE) modalities and artificial intelligence (AI)-assisted systems have been developed to improve their detection, the comparative diagnostic accuracy of these technologies remains unclear. Direct comparative studies are limited and conventional pairwise meta-analyses do not provide a coherent framework for comparing multiple diagnostic technologies. METHODS AND ANALYSIS: This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and PRISMA-Network Meta-Analysis guidelines. We will search MEDLINE (Ovid), Embase (Ovid), the Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Library/Wiley), Web of Science Core Collection (Clarivate), Scopus (Elsevier), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform from inception, without date or language restrictions. Eligible studies will be diagnostic accuracy studies evaluating IEE modalities (including narrow-band imaging with or without magnification, blue laser imaging, linked colour imaging and iScan) or AI-assisted endoscopy against histology. Comparative studies will form the primary evidence base for the diagnostic test network meta-analysis; single-arm studies will be summarised separately and will not contribute to the primary network estimates. The coprimary diagnostic parameters will be sensitivity and specificity for GIM and dysplasia. These will be analysed jointly using a hierarchical bivariate diagnostic test network meta-analysis with binomial likelihoods and correlated random effects. Diagnostic OR and area under the receiver operating characteristic curve will be treated as secondary summary measures. Two reviewers will independently screen, extract data and apply Quality Assessment of Diagnostic Accuracy Studies 2. Heterogeneity, transitivity and inconsistency will be assessed using prespecified clinical and methodological effect modifiers, model-based diagnostics and sensitivity analyses. The certainty of evidence will be assessed using Confidence in Network Meta-Analysis, with interpretation adapted to diagnostic accuracy outcomes. ETHICS AND DISSEMINATION: This study does not require ethical approval as it relies on secondary analysis of published literature. Findings will be disseminated through peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER: CRD420261363078.
29 June 2026
Read appraisal →Medicine
Clinical outcome of revisional gastrectomy postgastric banding failure: A systematic review.
BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) has been widely used for obesity management; however, its long-term failure, due to complications such as band erosion, slippage, and inadequate weight loss, has necessitated revisional bariatric procedures. Revisional laparoscopic sleeve gastrectomy has emerged as a common alternative, yet its safety and efficacy remain debated. METHODS: A systematic review was conducted in accordance with PRISMA guidelines; this review was prospectively registered with Prospective Register of Systematic Reviews (CRD42024568094). A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane databases was performed up to July 19, 2024. Studies published in English that reported postoperative outcomes following revisional laparoscopic sleeve gastrectomy after failed LAGB were included. Data were extracted independently by 2 reviewers, focusing on patient demographics, complication rates (including leaks, bleeding, and infections), and nutritional outcomes. Quality assessment was performed using a standardized tool for observational studies, cohort and cross-sectional studies. RESULTS: Fifty studies involving a total of 16,192 patients were analyzed. Patients had a mean age between 30 and 50 years and a revision body mass index ranging from 33 to 52 kg/m2. Infection was reported in 9 studies, though incidence was low. Bleeding was examined in 30 studies, with mostly isolated cases; thrombosis was reported in only 1 study. Leak rates were reported in 39 studies, ranging from 0% to 8.1%, with stage-specific rates between 2.8% and 5.8%. Four studies noted nutritional deficiencies, including increased ferritin deficiency and some cases contributing to readmission. Overall complication rates were reported in 22 studies, averaging 9.95% and ranging from 0% to 37.5%. CONCLUSION: Revisional laparoscopic sleeve gastrectomy following failed LAGB appears to offer a safe and effective alternative, with acceptable complication rates and favorable weight loss outcomes. However, heterogeneity in study designs and patient characteristics underscores the need for standardized reporting and further research to optimize clinical protocols.
28 June 2026
Read appraisal →Journal of robotic surgery
Outcomes in laparoscopic versus robotic-assisted surgery for median arcuate ligament syndrome: a systematic review and meta-analysis
Median Arcuate Ligament Syndrome (MALS) is a rare condition caused by external compression of the coeliac artery by the median arcuate ligament (MAL), leading to postprandial abdominal pain, nausea, vomiting, and weight loss. This study aims to compare outcomes of robotic (RMALR) and laparoscopic (LMALR) MAL release. A systematic search of PubMed/MEDLINE, Scopus, and Embase databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to compare perioperative and postoperative outcomes of LMALR versus RMALR. Comparative studies including adult patients undergoing either approach were included. Outcomes assessed were conversion to open surgery, resolution of pain, length of admission, postoperative complications, symptom recurrence and time to recurrence. Five retrospective comparative studies comprising 158 patients were included. No differences were found between laparoscopic and robotic approaches in conversion to open, resolution of pain, postoperative complications, length of admission, or overall time to recurrence. However, RMALR showed a significantly longer time to symptom recurrence (9.04 months, 95% CI 4.18-13.89; p = 0.0003). Both LMALR and RMALR are safe and effective for MALS, with comparable perioperative and postoperative outcomes. The longer symptom-free interval after robotic surgery may reflect greater precision in dissection around the coeliac axis. However, further prospective studies with standardised follow-up are needed to validate these findings.
20 June 2026
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