Latest news with #DigestiveDiseaseWeek
Medscape
22-05-2025
- Health
- Medscape
Chatbot Helps Users Adopt a Low FODMAP Diet
SAN DIEGO — Low fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) dietary advice has been shown to be effective in easing bloating and abdominal pain, especially in patients with irritable bowel syndrome (IBS), but limited availability of dietitians makes delivering this advice challenging. Researchers from Thailand have successfully enlisted a chatbot to help. In a randomized controlled trial, they found that chatbot-assisted dietary advice with brief guidance effectively reduced high FODMAP intake, bloating severity, and improved dietary knowledge, particularly in patients with bothersome bloating. 'Chatbot-assisted dietary advice for FODMAPs restriction was feasible and applicable in patients with bloating symptoms that had baseline symptoms of moderate severity,' study chief Pochara Somvanapanich, with the Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand, told Medscape Medical News. Somvanapanich, who developed the chatbot algorithm, presented the study results at Digestive Disease Week (DDW) 2025. More Knowledge, Less Bloating The trial enrolled 86 adults with disorders of gut-brain interaction experiencing bloating symptoms for more than 6 months and consuming more than seven high-FODMAPs items per week. Half of them had IBS. At baseline, gastrointestinal (GI) symptoms and the ability to identify FODMAPs were assessed. All participants received a 5-minute consultation on FODMAPs avoidance from a GI fellow and were randomly allocated (stratified by IBS diagnosis and education) into two groups. The chatbot-assisted group received real-time dietary advice via a chatbot which helped them identify high, low, and non-FODMAP foods from a list of more than 300 ingredients/dishes of Thai and western cuisines. The control group received only brief advice on high FODMAPs restriction. Both groups used a diary app to log food intake and postprandial symptoms. Baseline bloating, abdominal pain and global symptoms severity were similar between the two groups. Data on 64 participants (32 in each group) were analyzed. After 4 weeks, significantly more people in the chatbot group than the control group responded — achieving a 30% or greater reduction in daily worst bloating, abdominal pain or global symptoms (19 [59%] vs 10 [31%], P < .05). Responder rates were similar in the IBS and non-IBS subgroups. Subgroup analysis revealed significant differences between groups only for participants with bothersome bloating, not those with mild bloating severity. In those with bothersome bloating severity, the chatbot group had a higher response rate (69.5% vs 36.3%) and fewer bloating symptoms ( P < .05). They also had a greater reduction in high FODMAPs intake (10 vs 23 items/week) and demonstrated improved knowledge in identifying FODMAPs ( P < .05). 'Responders in a chatbot group consistently engaged more with the app, performing significantly more weekly item searches than nonresponders ( P < .05),' the authors noted in their conference abstract. 'Our next step is to develop the chatbot-assisted approach for the reintroduction and personalization phase based on messenger applications (including Facebook Messenger and other messaging platforms),' Somvanapanich told Medscape Medical News . 'Once we've gathered enough data to confirm these are working effectively, we definitely plan to create a one-stop service application for FODMAPs dietary advice,' Somvanapanich added. Lack of Robust Data on Digital GI Health Apps Commenting on this research for Medscape Medical News , Sidhartha R. Sinha, MD, Director of Digital Health and Innovation, Division of Gastroenterology and Hepatology, Stanford University in Stanford, California, noted that there is a 'notable lack of robust data supporting digital health tools in gastroenterology. Despite hundreds of apps available, very few are supported by well-designed trials.' 'The study demonstrated that chatbot-assisted dietary advice significantly improved bloating symptoms, reduced intake of high-FODMAP foods, and enhanced patients' dietary knowledge compared to brief dietary counseling alone, especially in those with bothersome symptoms,' said Sinha, who wasn't involved in the study. 'Patients actively used the chatbot to manage their symptoms, achieving a higher response rate than those in the control arm who received brief counseling on avoiding high-FODMAP food,' he noted. Sinha said in his practice at Stanford, 'in the heart of Silicon Valley,' patients do use digital resources to manage their GI symptoms, including diseases like IBS and inflammatory bowel disease (IBD) — and he believes this is 'increasingly common nationally.' 'However, the need for evidence-based tools is critical and the lack here often prevents many practitioners from regularly recommending them to patients. This study aligns well with clinical practice, and supports the use of this particular app to improve IBS symptoms, particularly when access to dietitians is limited. These results support chatbot-assisted dietary management as a feasible, effective, and scalable approach to patient care,' Sinha told Medscape Medical News .
Medscape
21-05-2025
- Health
- Medscape
Blood Test May Predict Crohn's Disease 2 Years Before Onset
SAN DIEGO — Crohn's disease (CD) has become more common in the United States, and an estimated 1 million Americans have the condition. Still, much is unknown about how to evaluate the individual risk for the disease. 'It's pretty much accepted that Crohn's disease does not begin at diagnosis,' said Ryan Ungaro, MD, associate professor of medicine at the Icahn School of Medicine at Mount Sinai, New York City, speaking at Digestive Disease Week (DDW) 2025. Although individual blood markers have been associated with the future risk for CD, what's needed, he said, is to understand which combination of biomarkers are most predictive. Now, Ungaro and his team have developed a risk score they found accurate in predicting CD onset within 2 years before its onset. It's an early version that will likely be further improved and needs additional validation, Ungaro told Medscape Medical News . 'Once we can accurately identify individuals at risk for developing Crohn's disease, we can then imagine a number of potential interventions,' Ungaro said. Approaches would vary depending on how far away the onset is estimated to be. For people who likely wouldn't develop disease for many years, one intervention might be close monitoring to enable diagnosis in the earliest stages, when treatment works best, he said. Someone at a high risk of developing CD in the next 2 or 3 years, on the other hand, might be offered a pharmaceutical intervention. Developing and Testing the Risk Score To develop the risk score, Ungaro and colleagues analyzed data of 200 patients with CD and 100 healthy control participants from PREDICTS, a nested case-controlled study of active US military service members. The study is within the larger Department of Defense Serum Repository, which began in 1985 and has more than 62.5 million samples, all stored at −30 °C. The researchers collected serum samples at four timepoints up to 6 or more years before the diagnosis. They assayed antimicrobial antibodies using the Prometheus Laboratories platform, proteomic markers using the Olink inflammation panel, and anti–granulocyte macrophage colony-stimulating factor autoantibodies using enzyme-linked immunosorbent assay. Participants (median age, 33 years for both groups) were randomly divided into equally sized training and testing sets. In both the group, 83% of patients were White and about 90% were men. Time-varying trajectories of marker abundance were estimated for each biomarker. Then, logistic regression modeled disease status as a function of each marker for different timepoints and multivariate modeling was performed via logistic LASSO regression. A risk score to predict CD onset within 2 years was developed. Prediction models were fit on the testing set and predictive performance evaluated using receiver operating characteristic curves and area under the curve (AUC). Blood proteins and antibodies have differing associations with CD depending on the time before diagnosis, the researchers found. The integrative model to predict CD onset within 2 years incorporated 10 biomarkers associated significantly with CD onset. The AUC for the model was 0.87 (considered good, with 1 indicating perfect discrimination). It produced a specificity of 99% and a positive predictive value of 84%. The researchers stratified the model scores into quartiles and found the CD incidence within 2 years increased from 2% in the first quartile to 57.7% in the fourth. The relative risk of developing CD in the top quartile individuals vs lower quartile individuals was 10.4. The serologic and proteomic markers show dynamic changes years before the diagnosis, Ungaro said. A Strong Start The research represents 'an ambitious and exciting frontier for the future of IBD [inflammatory bowel disease] care,' said Victor G. Chedid, MD, MS, consultant and assistant professor of medicine at Mayo Clinic, Rochester, Minnesota, who reviewed the findings but was not involved in the study. Currently, physicians treat IBD once it manifests, and it's difficult to predict who will get CD, he said. The integrative model's AUC of 0.87 is impressive, and its specificity and positive predictive value levels show it is highly accurate in predicting the onset of CD within 2 years, Chedid added. Further validation in larger and more diverse population is needed, Chedid said, but he sees the potential for the model to be practical in clinical practice. 'Additionally, the use of blood-based biomarkers makes the model relatively noninvasive and easy to implement in a clinical setting,' he said. Now, the research goal is to understand the best biomarkers for characterizing the different preclinical phases of CD and to test different interventions in prevention trials, Ungaro told Medscape Medical News . A few trials are planned or ongoing, he noted. The trial PIONIR trial will look at the impact of a specific diet on the risk of developing CD, and the INTERCEPT trial aims to develop a blood-based risk score that can identify individuals with a high risk of developing CD within 5 years after initial evaluation. Ungaro reported being on the advisory board of and/or receiving speaker or consulting fees from AbbVie, Bristol Myer Squibb, Celltrion, ECM Therapeutics, Genentech, Jansen, Eli Lilly, Pfizer, Roivant, Sanofi, and Takeda. Chedid reported having no relevant disclosures.
Medscape
19-05-2025
- Health
- Medscape
Blood Detection Capsule May Help in Upper GI Bleeding
SAN DIEGO — A real-time, blood-sensing capsule (PillSense) is a safe and effective diagnostic tool for patients with suspected upper gastrointestinal (GI) bleeding that can aid patient triage, reduce unnecessary procedures, and optimize resource use, a study found. Notably, patients with negative capsule results had shorter hospital stays and lower acuity markers, and in more than one third of cases, an esophagogastroduodenoscopy (EGD) was avoided altogether without any observed adverse events or readmissions, the study team found. 'Our study shows that this novel capsule that detects blood in the upper GI tract (PillSense) was highly sensitive and specific (> 90%) for detecting recent or active upper GI blood, influenced clinical management in 80% of cases and allowed about one third of patients to be safely discharged from the emergency department, with close outpatient follow-up,' Linda Lee, MD, medical director of endoscopy, Brigham and Women's Hospital and associate professor of medicine, Harvard Medical School, Boston, told Medscape Medical News . The study was presented at Digestive Disease Week (DDW) 2025. Real-World Insights EGD is the gold standard for diagnosing suspected upper GI bleeding, but limited access to timely EGD complicates diagnosis and resource allocation. Approved by the US Food and Drug Administration, PillSense (EnteraSense) is an ingestible capsule with a reusable receiver that provides a rapid, noninvasive method for detecting upper GI bleeding. The capsule analyzes light absorption to identify blood and transmits the result within 10 minutes. Lee and colleagues evaluated the real-world impact of this point-of-care device on clinical triage and resource allocation, while assessing its safety profile. They analyzed data on 43 patients (mean age 60 years; 72% men) with clinical suspicion of upper GI bleeding in whom the device was used. The most common symptoms were symptomatic anemia (70%), melena (67%), and hematemesis (33%). Sixteen PillSense studies (37%) were positive for blood detection, and 27 (63%) were negative. Compared to patients with a positive capsule results, those without blood detected by the capsule had shorter hospital stays (mean, 3.8 vs 13.4 days, P = .02), lower GBS scores (mean, 7.93 vs 12.81; P = .005), and fewer units of blood transfused (mean, 1.19 vs 10.94; P = .01) and were less apt to be hemodynamically unstable (5 vs 8 patients; P = .03). Capsule results influenced clinical management in 80% of cases, leading to avoidance of EGD in 37% and prioritization of urgent EGD in 18% (all had active bleeding on EGD). Capsule use improved resource allocation in 51% of cases. This included 12 patients who were discharged from the ED, six who were assigned an inpatient bed early, and four who underwent expedited colonoscopy as upper GI bleeding was ruled out, they noted. Among the eight patients who did not undergo EGD, there were no readmissions within 30 days and no adverse events. There were no capsule-related adverse events. 'Clinicians should consider using this novel capsule PillSense as another data point in the management of suspected upper GI bleed,' Lee told Medscape Medical News . 'This could include in helping to triage patients for safe discharge from the ED or to more urgent endoscopy, to differentiate between upper vs lower GI bleed and to manage ICU patients with possible rebleeding,' Lee said. Important Real-World Evidence Reached for comment, Shahin Ayazi, MD, esophageal surgeon, Director, Allegheny Health Network Chevalier Jackson Esophageal Research Center, Pittsburgh, Pennsylvania, said this study is important for several reasons. 'Prior investigations have established that PillSense possesses a high negative predictive value for detecting upper GI bleeding and have speculated on its utility in triage, decision-making, and potentially avoiding unnecessary endoscopy. This study is important because it substantiates that speculation with clinical data,' Ayazi, who wasn't involved in the study, told Medscape Medical News . 'These findings support the capsule's practical application in patient stratification and clinical workflow, particularly when diagnostic uncertainty is high and endoscopic resources are limited,' Ayazi noted. In his experience, PillSense is 'highly useful as a triage adjunct in the evaluation of suspected upper GI bleeding. It provides direct and objective evidence as to whether blood is currently present in the stomach,' he said. 'In patients whose presentation is ambiguous or whose clinical scores fall into an intermediate risk zone, this binary result can provide clarity that subjective assessment alone may not achieve. This is particularly relevant in settings where the goal is to perform endoscopy within 24 hours, but the volume of consults exceeds procedural capacity,' Ayazi explained. 'In such scenarios, PillSense enables physicians to stratify patients based on objective evidence of active bleeding, helping to prioritize those who require urgent endoscopy and defer or even avoid endoscopic evaluation in those who do not. The result is a more efficient allocation of endoscopic resources without compromising patient safety,' he added. Ayazi cautioned that the PillSense capsule should not be used as a replacement for clinical evaluation or established risk stratification protocols. 'It is intended for hemodynamically stable patients and has not been validated in cases of active or massive bleeding. Its diagnostic yield depends on the presence of blood in the stomach at the time of capsule transit; intermittent or proximal bleeding that has ceased may not be detected, introducing the potential for false-negative results,' Ayazi told Medscape Medical News. 'However, in prior studies, the negative predictive value was high, and in the present study, no adverse outcomes were observed in patients who did not undergo endoscopy following a negative PillSense result,' Ayazi noted. 'It must also be understood that PillSense does not localize the source of bleeding or replace endoscopy in patients with a high likelihood of active hemorrhage. It is not designed to detect bleeding from the lower GI tract or distal small bowel. Rather, it serves as an adjunct that can provide immediate clarity when the need for endoscopy is uncertain, and should be interpreted within the broader context of clinical findings, laboratory data, and established risk stratification tools,' he added.
The Star
17-05-2025
- Health
- The Star
Sabah doctor wins award at World Cup of Endoscopy
Malaysian pride: Dr Emmanuel presenting a video of his award-winning endoscopic procedure for the World Cup of Endoscopy in San Diego, California. KOTA KINABALU: When Dr James Emmanuel took centre stage at the World Cup of Endoscopy during the Digestive Disease Week in San Diego, California, he achieved many firsts for Malaysia. A consultant gastroenterologist and hepatologist from Sabah's Queen Elizabeth Hospital (QEH), he is the first Malaysian to represent the country for the event and took home the coveted Best of the Best Award for his medical method. The video of his award-winning case featured a scarless, minimally-invasive procedure to remove gastrointestinal tumours without open surgery – a first-of-its-kind approach performed at QEH in August last year. 'We had no precedent for this. It was uncharted territory. But it worked. 'We submitted the video not just to share knowledge but also to offer hope for patients worldwide,' he said. The 41-year-old Kuala Lumpur-born stood out not only for his groundbreaking submission but also for wearing traditional Kadazandusun attire. It was an homage to Sabah and its rich cultural heritage in front of more than 20,000 leading medical professionals. The medical technique was born from a collaborative effort between Dr Emmanuel, a hepatobiliary surgeon, and an interventional radiologist, showcasing the power of interdisciplinary teamwork within Sabah's public healthcare system. 'This win is not mine alone. It is for every Malaysian, every Sabahan and every patient who inspires us to keep pushing the limits of medicine,' he said. The World Cup of Endoscopy featured eight of the best global submissions in diagnostic and therapeutic endoscopy. While the top award went to a doctor from India for another scarless gastric tumour removal technique, and the Mel Shapiro Award was won by Johns Hopkins Hospital, Dr Emmanuel's entry stood out for its clinical innovation and spirit of collaboration. 'Several delegates told us they were amazed by how smoothly our gastroenterology, surgery and radiology teams worked together. 'One doctor from the Cleveland Clinic even said such synergy would be hard to replicate elsewhere. That really affirmed the value of what we've built here,' he said. Though winning was a proud moment, Dr Emmanuel said the real reward was hearing how their work inspired others around the world. 'It reminded me of my mum's words: with heart and teamwork, you can achieve more than you ever thought possible,' he said. Dr Emmanuel's choice of traditional attire was also a personal tribute, coinciding with Sabah's month-long Harvest Festival. 'It was my way of saying thank you. 'After more than a decade working in Sabah, I wanted to honour our cultural heritage and bring a piece of home with me to the world stage,' he said. The proudest moment, however, came when Dr Emmanuel dedicated his award to his late mother, Maria Elizabeth Fernandez, who passed away just two months ago. 'She would have turned 80 this June. She was more than a mother. She was a teacher, a giver, a pillar of strength. 'She offered free education to underprivileged children and was a voice for the voiceless. 'She changed lives through kindness,' he said. Fernandez taught at La Salle Sentul School for many years and helped raise not just her own children but also nieces and nephews, providing them with love and opportunity. 'My mother's passing left a profound void. But her spirit, generosity and legacy live on. I dedicate this award to her, this Mother's Day and always,' said Dr Emmanuel.
Medscape
16-05-2025
- Health
- Medscape
Colorectal Cancer Screening Choices: Is Compliance Key?
SAN DIEGO — In the ever-expanding options for colorectal cancer (CRC) screening, blood tests using precision medicine are becoming more advanced and convenient than ever; however, caveats abound, and when it comes to potentially life-saving screening measures, picking the optimal screening tool is critical. Regarding tests, 'perfect is not possible,' said William M. Grady, MD, of the Fred Hutchinson Cancer Center, University of Washington School of Medicine, in Seattle, who took part in a debate on the pros and cons of key screening options at Digestive Disease Week (DDW) 2025. 'We have to remember that that's the reality of colorectal cancer screening, and we need to meet our patients where they live,' said Grady, who argued on behalf of blood-based tests, including cell-free (cf) DNA (Shield, Guardant Health) and cfDNA plus protein biomarkers (Freenome). A big point in their favor is their convenience and higher patient compliance — better tests that don't get done do not work, he stressed. He cited data that showed suboptimal compliance rates with standard colonoscopy: Rates range from about 70% among non-Hispanic White individuals to 67% among Black individuals, 51% among Hispanic individuals, and the low rate of just 26% among patients aged between 45 and 50 years. With troubling increases in CRC incidence among younger patients, 'that's a group we're particularly concerned about,' Grady said. Meanwhile, studies show compliance rates with blood-based tests are ≥ 80%, with similar rates seen among those racial and ethnic groups, with lower rates for conventional colonoscopy, he noted. Importantly, in terms of performance in detecting CRC, blood-based tests stand up to other modalities, as demonstrated in a real-world study conducted by Grady and his colleagues showing a sensitivity of 83% for the cfDNA test, 74% for the fecal immunochemical test (FIT) stool test, and 92% for a multitarget stool DNA test compared with 95% for colonoscopy. 'What we can see is that the sensitivity of blood-based tests looks favorable and comparable to other tests,' he said. Among the four options, cfDNA had a highest patient adherence rate (85%-86%) compared with colonoscopy (28%-42%), FIT (43%-65%), and multitarget stool DNA (48%-60%). 'The bottom line is that these tests decrease CRC mortality and incidence, and we know there's a potential to improve compliance with colorectal cancer screening if we offer blood-based tests for average-risk people who refuse colonoscopy,' Grady said. Blood-Based Tests: Caveats, Harms? Arguing against blood-based tests in the debate, Robert E. Schoen, MD, MPH, professor of medicine and epidemiology, Division of Gastroenterology, Hepatology and Nutrition, at the University of Pittsburgh, Pittsburgh, checked off some of the key caveats. While the overall sensitivity of blood-based tests may look favorable, these tests don't detect early CRC well,' said Schoen. The sensitivity rates for stage 1 CRC are 64.7% with Guardant Health and 57.1% with Freenome. Furthermore, their rates of detecting advanced adenomas are very low; the rate with Guardant Health is only about 13%, and with Freenome is even lower at 12.5%, he reported. These rates are 'similar to the false positive rate, with poor discrimination and accuracy for advanced adenomas,' Schoen said. 'Without substantial detection of advanced adenomas, blood-based testing is inferior [to other options].' Importantly, the low advanced adenoma rate translates to a lack of CRC prevention, which is key to reducing CRC mortality, he noted. Essential to success with blood-based biopsies, as well as with stool tests, is the need for a follow-up colonoscopy if results are positive, but Schoen pointed out that this may or may not happen. He cited research from FIT data showing that among 33,000 patients with abnormal stool tests, the rate of follow-up colonoscopy within a year, despite the concerning results, was a dismal 56%. 'We have a long way to go to make sure that people who get positive noninvasive tests get followed up,' he said. In terms of the argument that blood-based screening is better than no screening at all, Schoen cited recent research that projected reductions in the risk for CRC incidence and mortality among 100,000 patients with each of the screening modalities. Starting with standard colonoscopy performed every 10 years, the reductions in incidence and mortality would be 79% and 81%, respectively, followed by annual FIT, at 72% and 76%; multitarget DNA every 3 years, at 68% and 73%; and cfDNA (Shield), at 45% and 55%. Based on those rates, if patients originally opting for FIT were to shift to blood-based tests, 'the rate of CRC deaths would increase,' Schoen noted. The findings underscore that 'blood testing is unfavorable as a 'substitution test,'' he added. 'In fact, widespread adoption of blood testing could increase CRC morbidity.' 'Is it better than nothing?' he asked. 'Yes, but only if performance of a colonoscopy after a positive test is accomplished.' What About FIT? Arguing that stool-based testing, or FIT, is the ideal choice as a first-line CRC test Jill Tinmouth, MD, PhD, a professor at the University of Toronto, Ontario, Canada, pointed to its prominent role in organized screening programs, including regions where resources may limit the widespread utilization of routine first-line colonoscopy screening. In addition, it narrows colonoscopies to those that are already prescreened as being at risk. Data from one such program, reported by Kaiser Permanente of Northern California, showed that participation in CRC screening doubled from 40% to 80% over 10 years after initiating FIT screening. CRC mortality over the same period decreased by 50% from baseline, and incidence fell by as much as 75%. In follow-up colonoscopies, Tinmouth noted that collective research from studies reflecting real-world participation and adherence to FIT in populations in the United Kingdom, the Netherlands, Taiwan, and California show follow-up colonoscopy rates of 88%, 85%, 70%, and 78%, respectively. Meanwhile, a recent large comparison of biennial FIT (n = 26,719) vs one-time colonoscopy (n = 26,332) screening, the first study to directly compare the two, showed noninferiority, with nearly identical rates of CRC mortality at 10 years (0.22% colonoscopy vs 0.24% FIT) as well as CRC incidence (1.13% vs 1.22%, respectively). 'This study shows that in the context of organized screening, the benefits of FIT are the same as colonoscopy in the most important outcome of CRC — mortality,' Tinmouth said. Furthermore, as noted with blood-based screening, the higher participation with FIT shows a much more even racial/ethnic participation than that observed with colonoscopy. 'FIT has clear and compelling advantages over colonoscopy,' she said. As well as better compliance among all groups, 'it is less costly and also better for the environment [by using fewer resources],' she added. Colonoscopy: 'Best for First-Line Screening' Making the case that standard colonoscopy should in fact be the first-line test, Swati G. Patel, MD, director of the Gastrointestinal Cancer Risk and Prevention Center at the University of Colorado Anschutz Medical Center, Aurora, Colorado, emphasized the robust, large population studies showing its benefits. Among them is a landmark national policy study showing a significant reduction in CRC incidence and mortality associated with first-line colonoscopy and adenoma removal. A multitude of other studies in different settings have also shown similar benefits across large populations, Patel added. In terms of its key advantages over FIT, the once-a-decade screening requirement for average-risk patients is seen as highly favorable by many, as evidenced in clinical trial data showing that individuals highly value tests that are accurate and do not need to be completed frequently, she said. Research from various other trials of organized screening programs further showed patients crossing over from FIT to colonoscopy, including one study of more than 3500 patients comparing colonoscopy and FIT, which had approximately 40% adherence with FIT vs nearly 90% with colonoscopy. Notably, as many as 25% of the patients in the FIT arm in that study crossed over to colonoscopy, presumably due to preference for the once-a-decade regimen, Patel said. 'Colonoscopy had a substantial and impressive long-term protective benefit both in terms of developing colon cancer and dying from colon cancer,' she said. Regarding the head-to-head FIT and colonoscopy comparison that Tinmouth described, Patel noted that a supplemental table in the study's appendix of patients who completed screening does reveal increasing separation between the two approaches, favoring colonoscopy, in terms of longer-term CRC incidence and mortality. The collective findings underscore that 'colonoscopy as a standalone test is uniquely cost-effective,' in the face of costs related to colon cancer treatment. Instead of relying on biennial tests with FIT, colonoscopy allows clinicians to immediately risk-stratify those individuals who can benefit from closer surveillance and really relax surveillance for those who are determined to be low risk, she said.
