Gastroenterology (GI) cancer surveillance scheduling relies on extracting structured data from unstructured clinical texts, such as endoscopy and pathology reports. Traditional Natural Language Processing (NLP) models have been employed for this task, but recent advancements in Large Language Models (LLMs) present a new opportunity for automation without requiring extensive labeled datasets. In this study, we propose an LLM-based entity extraction and rule-based decision support framework for Barrett’s Oesophagus (BO) surveillance timing prediction. Our approach processes endoscopy and pathology reports to extract clinically relevant information and structures it into a standardised format, which is then used to determine appropriate surveillance intervals. We evaluate multiple state-of-the-art LLMs on real-world clinical datasets from two hospitals, assessing their performance in accuracy and running time cost. The results demonstrate that LLMs, particularly Phi-4 and (DeepSeek distilled) Qwen-2.5, can effectively automate the extraction of BO surveillance-related information with high accuracy, while Phi-4 is also efficient during inference. We also compared the trade-offs between LLMs and fine-tuned non-LLMs. Our findings indicate that LLM extraction based methods can support clinical decision-making by providing justifications from report extractions, reducing manual workload, and improving guideline adherence in BO surveillance scheduling.

The development of NLP models in the healthcare sector faces important challenges due to the limited availability of patient data, mainly driven by privacy concerns. This study proposes the generation of synthetic free-text medical reports, specifically focusing on the gastroenterology domain, to address the scarcity of specialised datasets, while preserving patient privacy. We fine-tune BioGPT on over 90 000 endoscopy reports and integrate Differential Privacy (DP) into the training process. 10 000 DP-private synthetic reports are generated by this model. The generated synthetic data is evaluated through multiple dimensions: similarity to real datasets, language quality, and utility in both supervised and semi-supervised NLP tasks. Results suggest that while DP integration impacts text quality, it offers a promising balance between data utility and privacy, improving the performance of a real-world downstream task. Our study underscores the potential of synthetic data to facilitate model development in the healthcare domain without compromising patient privacy.