Evaluating the Role of Artificial Intelligence in Making Clinical Decisions for Treating Acute Pancreatitis

<b>Background/Objectives:</b> Acute pancreatitis (AP) is an illness that requires prompt diagnosis and treatment since it has the potential to become life-threatening. The American College of Gastroenterology 2024 (ACG24) guidelines offer a framework for diagnosis, severity, and treatment criteria. To assess Google Gemini application of ACG24 guidelines to Medical Information Mart for Intensive Care-III AP cases for risk, nutrition, and complication management. <b>Methods:</b> This observational cross-sectional study was based on 512 patients with AP who were treated in the Medical Information Mart for Intensive Care-III database from 2001 to 2012. The study compared the efficiency of Gemini in relation to the ACG24 guidelines in the three main areas of risk stratification, enteral nutrition timing, and necrotizing pancreatitis management. Enteral nutrition, according to the ACG24 guidelines, should be started within 48 h for patients who are capable, and antibiotics should only be used for confirmed infected necrosis. <b>Results:</b> The study included 512 patients who were divided into two groups: 213 patients with mild pancreatitis (41.6%) and 299 patients with severe pancreatitis (58.4%). The model achieved 85% accuracy for mild cases and 82% accuracy for severe cases of pancreatitis. The Acute Physiology and Chronic Health Evaluation II and Ranson scores matched the predictions of Gemini for both mild cases (<i>p</i> = 0.28 and <i>p</i> = 0.33, respectively) and severe cases (<i>p</i> = 0.31 and <i>p</i> = 0.27, respectively). The recommendations for early enteral nutrition and delayed feeding in mild cases were correct for 78% of patients, but the system suggested oral intake prematurely in 8% of severe cases. The antibiotic guideline compliance reached 82% among 156 patients with necrotizing pancreatitis, and the procedure for draining infected necrosis was correct 85% of the time. <b>Conclusions:</b> The Gemini model achieved 78-85% accuracy in determining pancreatitis severity and adherence to treatment guidelines but showed lower accuracy in nutrition timing compared to other parameters. Core Tip: This study evaluated the Google Gemini model in applying the American College of Gastroenterology 2024 guidelines for acute pancreatitis across 512 Medical Information Mart for Intensive Care-III cases. Results demonstrated 85% accuracy in severity classification, precise prediction of Acute Physiology and Chronic Health Evaluation II and Ranson scores, and 78-85% compliance with nutritional and necrotizing pancreatitis management guidelines. These findings suggest that artificial intelligence-based clinical decision support systems can provide rapid, consistent, and guideline-concordant recommendations, which are particularly valuable in settings with limited specialist expertise.