Latest news with #endoscopy
Medscape
22-07-2025
- Health
- Medscape
Pre-Endoscopy GLP-1 RAs Don't Always Cause Gastric Retention
Low rates of retained gastric contents were seen in endoscopy patients on GLP-1 receptor agonists ( RAs), a retrospective multicenter cross-sectional analysis reported in The American Journal of Gastroenterology . Moreover, most instances occurred in patients using the drugs for type 2 diabetes (T2D) rather than for weight loss alone. The findings suggest adopting an individualized approach rather than universal preoperative withholding of GLP-1 RAs before endoscopy, concluded Jennifer Phan, MD, medical director of the Hoag Advanced Endoscopy Center in Newport Beach, California, and colleagues. These agents are associated with slowed gastric emptying, possibly raising the risk for pulmonary aspiration. The study identified comorbid uncontrolled T2D as a risk factor for retained gastric contents. Recommendations from gastroenterological societies and the American Society of Anesthesiologists (ASA) differ regarding pre-endoscopic holding of these ubiquitous agents used for obesity and T2D. 'Many patients undergo routine endoscopic procedures, and there was concern from the anesthesia safety perspective for retained gastric contents,' Phan told Medscape Medical News. 'At first these events were seen in a handful of cases; however, out of precaution this resulted in a statement from the ASA recommending that patients hold their GLP-1 medications for at least 1 week prior to a routine endoscopic procedure.' That guidance resulted in protocol changes within endoscopy units, cancelled procedures, and potential delays in patient care. 'We wanted to study whether this concern was clinically valid and to help identify which subgroup of patients are at highest risk in order to best inform anesthesia and endoscopy practices,' Phan added. The ASA updated its guidance in 2023. The current study aligns with other research showing that rates of clinically relevant retained gastric contents are < 10%, Phan said. For instance, the American Gastroenterological Association (AGA) published a rapid clinical practice update in November 2023 that found insufficient evidence to support patients stopping the medications before endoscopic procedures. AGA guidance suggests an individual approach for each patient on a GLP-1 RA rather than a blanket statement on how to manage all patients taking the medications. 'Our initial hypothesis was that the rates of clinically relevant retained gastric contents in patients on GLP-1 RA medications would be low. This was born out of anecdotal experience of the limited number of aborted procedures we experienced before the ASA statement.' Her group also hypothesized that the indication for which the GLP-1 RA was prescribed would be important, with patients taking GLP-1 RA medications for diabetes potentially having a higher likelihood of retained contents given the concomitant propensity for delayed gastric motility related to uncontrolled hyperglycemia. The Study The investigators identified 815 patients on confirmed GLP-1 RA medications of various types receiving endoscopy from 2021 to 2023 at four centers. Demographics, prescribing practices, and procedure outcomes were captured. GLP-1 RA management of preoperative holding was retroactively classified per ASA guidance. Of the 815 patients (mean age, 67.7 years; 57.7% women; 53.9% White individuals), 70 (8.7%) exhibited retained gastric contents on endoscopy. Of these 65 (93%) had T2D with a median A1c of 6.5%. Among those with retained contents, most had a minimal (10, 14.3%) or moderate (31, 44.3%) amount of food retained, although 29 (41.4%) had a large quantity. Only one patient required unplanned intubation because of a large quantity of residual content, and none had aspiration events. In multivariate analysis, the odds ratio of retention in those with diabetes was 4.1. 'Given the predominance of diabetes in those with retained gastric contents, we highlight the potential to risk-stratify patients who require further preprocedural consideration,' the authors wrote. Those with GLP-1 RA held per ASA guidance (406, 49.8%) were less likely to have retained contents (4.4% vs 12.7%; P < .001), but no significant differences for intubation (0% vs 2%; P = .53) or aborting procedure rates (28% vs 18%; P = .40) due to gastric retention were observed. On multivariable analysis, the likelihood of food retention increased by 36% (95% CI, 1.15-1.60) for every 1% increase in glycosylated hemoglobin after adjusting for GLP-1 RA type and preoperative medication hold. 'Our study can help to differentiate which patients can be at largest risk for retained gastric contents,' Phan said, noting the impact of increasing percentages of A1C. 'There's a 36% increased likelihood of food retention in patients on GLP-1 medications, so a blanket policy to hold GLP-1s in patients who are nondiabetic and taking the medication for obesity may not be the best approach. But if patients have uncontrolled hyperglycemia, then an approach of caution is clinically valid.' In that context, holding the GLP-1 RA injection or lengthening the preoperative clear-liquid diet policy should be considered. She noted that the study results are generalizable because the study was conducted across multiple types of hospital systems, both university and county, and included all types of GLP-1 RA. Offering an anesthesiologist's perspective on the study, Paul Potnuru, MD, an assistant professor in the Department of Anesthesiology, Critical Care, and Pain Medicine at UTHealth Houston and not involved in the study, called the findings 'somewhat reassuring' but said the risk for aspiration was still a consideration. A recent review, however, reported that the risk for GLP-1 RA-associated pulmonary aspiration was low. Potnuru acknowledged that the original ASA guidance on preoperative GLP-1 RA cessation led to some confusion. 'There were not a lot of data on the issue, but some studies found that even with stopping GLP-1s 2 weeks preoperatively some patients still retained gastric content,' he told Medscape Medical News . A study at his center recently reported that 56% of GLP-1 RA users had increased pre-anesthesia residual gastric content compared with 19% of nonusers. From the anesthesiologist's clinical vantage point, the margin of safety is an issue even if aspiration risk is low. 'If there's a 1 in 1000 chance or even a 1 in 3000 chance, that can be considered too high,' Potnuru said. He further noted that the current study included only 815 patients, not nearly enough for definitive data. In addition, a retrospective study based on medical records can't really capture all the real-world procedural changes made in the operating room. 'It's common for anesthesiologists not to document all cases of intubation, for example,' he said. While the ideal is a completely empty stomach, he agreed that a practical alternative to stopping GLP-1 RA therapy, especially that prescribed for diabetes, would be a 24-hour liquid diet, which would clear the stomach quickly. 'If you stop these drugs in patients taking them for diabetes, you get a worsening of their glycemic control,' he said. He noted that patients have different risk tolerances, with some willing to go ahead even if ultrasound shows gastric retention, while some opt to cancel. Prospective studies are needed, Potnuru added, 'because you find more if you know what you're looking for.' His center is starting a clinical trial in 150 patients to assess the impact of a 24-hour, liquids-only diet on gastric retention. According to Phan, other research is following GLP-1 RA users undergoing colonoscopy. 'Future studies can look at the added value of point-of-care abdominal ultrasound to see if it increases precision preoperative management in these patients on GLP-1 medications.' Other groups are examining the safety of these agents in the general context of sedation. 'It's worth noting that the studies are being done on currently available medications and may not apply to future medications such as triple agonists or anti-amylins that may come on the market in the near future,' Phan said. This study received no financial support.
Globe and Mail
10-07-2025
- Business
- Globe and Mail
Is it Worth Adding Boston Scientific Stock to Your Portfolio Now?
Boston Scientific 's BSX robust MedSurg segment, driven by endoscopy, neuromodulation and urology businesses, is poised for further growth in the upcoming quarters. The long-term prospects of the WATCHMAN devices are also encouraging. The company's impressive strategic acquisitions provide a favorable opportunity for growth. Meanwhile, headwinds like currency fluctuations are concerning for its operations. In the past year, this Zacks Rank #2 (Buy) company's shares have rallied 33.6% compared with the industry and the S&P 500 composite's growth of 11.7% and 10.1%, respectively. The renowned manufacturer of medical devices and products has a market capitalization of $153.61 billion. BSX beat on earnings in each of the trailing four quarters, delivering an average surprise of 8.79%. Let us delve deeper. Upsides for BSX Stock MedSurg's Impressive Market Share Gain: Boston Scientific is consistently gaining market share within its MedSurg segment. The Endoscopy business within MedSurg is gaining from strong growth in endoluminal surgery and single-use imaging franchises, along with sustained growth of the AXIOS platform, where the company is reinvesting to drive expanded indications. Within Urology, Boston Scientific continues to expand market share globally. The company's Stone management and prostheticurology franchises are growing well, led by key launches with the TENACIO pump for the AMS 700 and continued success with the expanding LithoVue portfolio. Within Neuromodulation, Boston Scientific's pain and brain businesses are gaining traction. Within deep brain stimulation, the company expects to see improved growth in 2025, backed by the recent FDA and CE Mark approvals of the Cartesia X and HX leads. WATCHMAN, a Long-Term Growth Driver: Boston Scientific's structural heart programs are fast building momentum on the back of strong performance of the WATCHMAN left atrial appendage closure device. WATCHMAN is the first device to offer a non-pharmacologic alternative to oral anti-coagulants that has been studied in a randomized clinical trial and is the leading device in percutaneous LAAC globally. The next generation WATCHMAN FLX and FLX Pro are capturing the global market. In the first quarter of 2025, WATCHMAN sales increased 24% year over year, with a strong contribution from the rise in concomitant procedures enabled by the new DRG, which became effective in October. Impressive Value-Adding Acquisitions: Boston Scientific's recent acquisitions have added numerous products with immense potential. The company's recently completed strategic buyouts include Bolt Medical. Earlier, BSX had acquired Cortex, an advanced AF mapping solution. The company also acquired Silk Road to broaden in the field of vascular medicine. Boston Scientific also completed the acquisition of Axonics in the fourth quarter of 2024. Sales from closed acquisitions contributed 400 basis points in the first quarter, resulting in 18.2% organic revenue growth for Boston Scientific. The company is currently looking forward to close the acquisitions of SoniVie and Intera Oncology. Downside for BSX Stock Exposure to Currency Movement: With Boston Scientific recording 40% of its sales from the international market, it remains highly exposed to currency fluctuations. Unfavorable currency movements have been a major dampener over the past few quarters, as in the case of other important MedTech players. For 2025, the company expects a 50-basis point headwind from foreign exchange on revenues. BSX Stock's Estimate Trend The Zacks Consensus Estimate for 2025 earnings per share has remained unchanged at $2.91 in the past 30 days. The Zacks Consensus Estimate for 2025 revenues is pegged at $19.50 billion, indicating a 16.4% rise from the year-ago reported number. Other Key Picks Some other top-ranked stocks in the broader medical space are Align Technology ALGN, Abbott Laboratories ABT and Cencora COR. Align Technology has an estimated long-term earnings growth rate of 11.2% compared with the industry's 9.9%. Its earnings surpassed the Zacks Consensus Estimate in each of the trailing four quarters, the average surprise being 3.4%. Its shares have lost 27.7% compared with the industry's 3.3% decline in the past year. ALGN carries a Zacks Rank #2 at present. You can see the complete list of today's Zacks #1 Rank (Strong Buy) stocks here. Abbott, currently carrying a Zacks Rank #2, has an earnings yield of 3.8% compared with the industry's 0.6%. Shares of the company have surged 129.7% compared with the industry's 35.9% gain. ABT's earnings surpassed estimates in each of the trailing four quarters, the average surprise being 1.6%. Cencora, carrying a Zacks Rank #2 at present, has an earnings yield of 5.4% compared with the industry's 3.8%. Shares of the company have rallied 25.9% against the industry's 14.4% decline. COR's earnings surpassed estimates in each of the trailing four quarters, the average surprise being 6%. Higher. Faster. Sooner. Buy These Stocks Now A small number of stocks are primed for a breakout, and you have a chance to get in before they take off. At any given time, there are only 220 Zacks Rank #1 Strong Buys. On average, this list more than doubles the S&P 500. We've combed through the latest Strong Buys and selected 7 compelling companies likely to jump sooner and climb higher than any other stock you could buy this month. You'll learn everything you need to know about these exciting trades in our brand-new Special Report, 7 Best Stocks for the Next 30 Days. Download the report free now >> Want the latest recommendations from Zacks Investment Research? Today, you can download 7 Best Stocks for the Next 30 Days. Click to get this free report Abbott Laboratories (ABT): Free Stock Analysis Report Boston Scientific Corporation (BSX): Free Stock Analysis Report Align Technology, Inc. (ALGN): Free Stock Analysis Report Cencora, Inc. (COR): Free Stock Analysis Report
The Sun
08-07-2025
- Health
- The Sun
Ten-minute NHS cancer test to be offered to Brits in high street pharmacies – are you eligible?
AN NHS 'sponge-on-a-string' cancer test will be rolled out in high street pharmacies for the first time. Taking just ten minutes, the test will help spot oesophageal cancer in its early stages. Dozens of Boots pharmacies in England will test patients who regularly use over-the-counter medications to ease heartburn or acid reflux. The 'heartburn health checks' will be trialled from early next year, NHS England announced. The sponge test can help spot if heartburn is a sign of a more serious problem called Barrett's oesophagus, a precursor to oesophageal cancer. The test involves patients swallowing a small pill on a thread, which expands into a penny-sized sponge when it reaches the stomach. After a few minutes, it's safely pulled out to collect cells from the lining of the oesophagus, which are tested for pre-cancerous changes in the lab. Cells lining the food pipe are normally flat, but they become more like the column-shaped cells in the lining of the stomach and bowel when Barrett's oesophagus develops. If pre-cancerous cells are found, people can have the cells removed through endoscopy or a procedure known as radiofrequency ablation. The sponge test is already used in hospitals and community diagnostic centres in place of invasive endoscopies - where a thin, flexible tube with a camera is inserted into the oesophagus. The NHS is now trialling rollout in dozens of Boots pharmacies in the hopes of making early diagnosis more convenient and accessible to patients. Patients can choose to be tested for the cancer while they shop, NHSE suggested, after pharmacists approach patients who often buy heartburn or acid reflux medications but haven't come forward to their GP. Check your risk of one of the most common cancers in the UK with a simple 45-second test Around 1,500 people in London and the East Midlands will be offered the test in a pharmacy or be referred to a clinic in their area. Health officials say offering the test in pharmacies could help shift care from hospitals to the community - a major tenet of the Government's 10-Year Health Plan published earlier this month. Prof Peter Johnson, NHS national cancer director said: "This new pilot brings a convenient test to where people shop, making it easier than ever for patients to check signs and symptoms that might be worrying them. "For the majority of people with persistent reflux, these quick and easy heartburn health checks will provide peace of mind that you aren't at increased risk of cancer. "For those who do find out they have Barret's oesophagus, regular follow-up checks will be put in place so any further cell changes can be spotted early.' Minister for public health and prevention Ashley Dalton, added: "With more than 8,000 people diagnosed with late-stage oesophageal cancer each year, being able to spot the warning signs using a 10-minute test in a local pharmacy — before cancer has even taken hold — will be a game-changer." The pilot will run for two years, followed by an independent evaluation that will decide whether to make the test more widely available. The test is made by diagnostics company Cyted Health. OESOPHAGEAL cancer is a cancer of the food pipe. It affects 9,400 people in the UK every year, and most people are over the age of 60. Smoking increases your risk of the disease, as does being overweight, drinking alcohol and having conditions like Barrett's oesophagus, where the cells lining your oesophagus have become abnormal. Only 12 per cent of patients survive for 10 or more years after being diagnosed. There are around 8,000 oesophageal cancer deaths in the UK every year - or 22 every day. Early diagnosis is key, so recognising the symptoms is vital. The most common include: Difficulty swallowing Unexplained weight loss Indigestion or heartburn that doesn't go away Pain in the throat or behind the breastbone But some people also experience a cough, hoarseness, dark poo, tiredness and food coming back up after swallowing. Source: Cancer Research UK 8 Can heartburn be a sign of cancer? Acid reflux affects around two in ten people, so it's pretty common. It can be brought on by spicy and fatty foods, coffee and booze, as well as smoking and some medicines. It's also more common if you're overweight, stressed or anxious, or pregnant. Persistent symptoms can be a sign of the pre-cancerous Barrett's oesophagus. Eddie, 77, from Suffolk credits the sponge on a string test with potentially saving his life after suffering from heartburn for most of his life. 8 'It used to wake me up at night, but I always thought it was just one of those things," he said. "To think that something as simple as swallowing a capsule could uncover a hidden risk is truly remarkable. "I am now able to get targeted treatment to stop my condition progressing to cancer, rather than finding out when it's too late. "This never would have been caught if it wasn't for capsule sponge testing. "This test gave me peace of mind and access to early treatment and could mean the difference between life and death for so many others.' 'Brutal disease' There are almost 10,000 patients diagnosed with oesophageal cancer in the UK each year, but 80 per cent are diagnosed at a late stage. Only 20 per cent of patients survive the year, so the key to saving lives is early diagnosis. Cancer of the oesophagus is more common in older people and men. Smoking, drinking alcohol and obesity can increase that risk. Mimi McCord, founder and chairman of Heartburn Cancer UK said: "Oesophageal cancer can be a brutal disease. "It hides in plain sight and when it takes hold, it doesn't hang around before it kills. "Catching it early - or when it's a pre-cancerous condition – is the best chance people have of survival. "People who regularly self-medicate often fall below the radar of the GP system. "Lives will be saved by more people being made aware of the signs and symptoms to look out for and having quick, simple and easily accessible tests in pharmacies."
Medscape
01-07-2025
- Health
- Medscape
Gastric Procedure Alleviates GERD Symptoms in Obesity
TOPLINE: In patients with obesity, endoscopic gastric remodeling (EGR) — a minimally invasive procedure — is safe and effective in relieving both typical and atypical gastroesophageal reflux disease (GERD) symptoms at 12 months post-procedure, while also reducing proton pump inhibitor (PPI) use. METHODOLOGY: EGR is a minimally invasive alternative to bariatric surgery that reduces gastric volume by approximately 70%, though its effect on GERD symptoms remains unclear. Researchers conducted a prospective cohort study at a tertiary referral bariatric center to examine EGR's effect on GERD symptoms in patients with at least one obesity-related comorbidity. Patients completed GERD and health-related assessments before and 12 months after the procedure. TAKEAWAY: Researchers included 50 patients (mean age, 41 years; mean BMI at baseline, 38.4; 95.8% women; 44% with GERD) who underwent EGR using either endoscopic suturing (16%) or plication (84%). All patients successfully underwent EGR without any serious adverse events. Between baseline and 12 months post-procedure, the mean Reflux Symptom Index score decreased from 5.1 to 3.8 (P = .007) and PPI use from 38% to 20% (P = .047). The presence of a hiatal hernia predicted a greater alleviation of GERD symptoms. IN PRACTICE: 'EGR may be considered a preferred option to co-manage both obesity and GERD, particularly in the lower obesity class,' the authors wrote. SOURCE: This study was led by Pichamol Jirapinyo, MD, MPH, Brigham and Women's Hospital, Boston, and published online in Clinical and Translational Gastroenterology. LIMITATIONS: This study did not include esophageal pH monitoring before or after EGR. Most participants were non-Hispanic women, which may have limited generalizability. Factors such as dietary modifications and medication use were not assessed. DISCLOSURES: The study received no external funding. Several authors reported being consultants; receiving research support, grants, or royalties; and having other ties with pharmaceutical companies. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Yahoo
24-06-2025
- Health
- Yahoo
Cosmo to Unveil First-of-its-Kind Clinical Study on the Use of GI Genius(TM) with Apple Vision Pro at Rush University Medical Center
Dublin, Ireland--(Newsfile Corp. - June 24, 2025) - Cosmo Pharmaceuticals N.V. ('Cosmo') today announced that in July 2025, it will initiate their first usability study of a medical device software application connecting the Medtronic GI Genius™ intelligent endoscopy module, an AI-powered platform for gastrointestinal endoscopy, with Apple Vision Pro. The study, to be conducted at Rush University Medical Center in Chicago under the leadership of Irving Waxman, MD, James R. Lowenstine Professor and Chief, Division of Digestive Diseases & Nutrition, and will evaluate the real-time use of this innovative technology during live colonoscopy procedures. The software application – designed by Cosmo for use with Apple Vision Pro – will enable physicians to visualize AI-generated insights from the GI Genius™ module directly through Apple Vision Pro, enabling physicians to view important information without looking away from the operative screen. This innovative, spatial experience is being investigated for the first time in GI endoscopy and is believed to set the foundation for a new standard in procedural medicine. The GI Genius™ system uses artificial intelligence to increase the adenoma detection rate (ADR) of colorectal polyps by as much as 14.4%. This innovation was made possible through extensive development work with spatial computing technology, utilizing Apple Vision Pro's software architecture, input, and high-resolution display system. Cosmo's teams engineered the software application to operate natively on Apple Vision Pro, unlocking a fusion of clinical AI experiences and spatial computing visualization never before seen in endoscopy. The upcoming usability study – the first of its kind and conducted on patients undergoing routine colonoscopy – will serve as a key component of Cosmo's planned FDA submission, expected shortly after the study concludes. 'We are thrilled to be the first in the world to evaluate this technology in the endoscopy suite,' said Prof. Irving Waxman. 'What Cosmo has built by connecting the GI Genius™ module with Apple Vision Pro is extraordinary. It has the potential to revolutionize how we practice – by giving us AI-powered insights exactly when and where we need them. This is not just an incremental improvement – it's a complete reimagining of procedural medicine, and I'm proud that Rush is leading the way.' 'This is a historic moment for Cosmo and for the field of endoscopy,' added Giovanni Di Napoli, CEO of Cosmo. 'By integrating the GI Genius™ module with Apple Vision Pro, we will be delivering an entirely new experience – intelligent, and intuitive. Developing this application for Apple Vision Pro has been an extraordinary journey, and the result will be a fusion of clinical AI experiences and spatial computing. This is what the future of medicine looks like: real-time AI, embedded naturally into the physician's workflow by blending digital content with the physical world. We're proud to be at the forefront of this transformation – and excited about what's possible when world-class technology and medical innovation come together.' The GI Genius™ module is commercialized globally through Cosmo's strategic partnership with Medtronic, which has served as the exclusive distributor since 2019. About Cosmo Cosmo Pharmaceuticals N.V. is committed to revolutionizing healthcare and transforming people's lives by researching and developing innovative products that tackle unfulfilled healthcare demands. As a pharmaceutical company, Cosmo is active in the areas of Healthtech/AI, dermatology, gastroenterology and contract manufacturing & development. For the commercialization and distribution of its products, Cosmo collaborates with leading partners worldwide, including Medtronic and Sun Pharma. Founded in 1997, Cosmo is headquartered in Dublin (Ireland) and has offices also in San Diego (USA), and Lainate/Rome/Catania (Italy). The Company has approximately 330 employees at the end of 2024, all dedicated to making a significant impact in the field of healthcare. For more information, please visit About Rush Rush is a nonprofit health system that includes Rush University Medical Center, Rush University, Rush Copley Medical Center and Rush Oak Park Hospital, as well as an extensive provider network and numerous outpatient care facilities. Rush University Medical Center is ranked among the top hospitals in the nation by U.S. News & World Report and consistently is named among the top academic medical centers for excellence in patient care by Vizient Inc. and a Top Teaching Hospital by The Leapfrog Group. Rush University comprises three colleges: Rush Medical College, the College of Nursing and the College of Health Sciences. Financial calendar Investor Day, Zurich July 1, 2025 2025 Half-Year Results and Report July 23, 2025 For further information, please contact: Cosmo Pharmaceuticals Investor Relations, DisclaimerSome of the statements in this press release may be forward-looking statements or statements of future expectations based on currently available information. Such statements are naturally subject to risks and uncertainties. Factors such as the development of general economic conditions, future market conditions, unusual catastrophic loss events, changes in the capital markets and other circumstances may cause the actual events or results to be materially different from those anticipated by such statements. Cosmo does not make any representation or warranty, express or implied, as to the accuracy, completeness or updated status of such statements. Therefore, in no case whatsoever will Cosmo and its affiliate companies be liable to anyone for any decision made or action taken in conjunction with the information and/or statements in this press release or for any related damages. Attachments PDF - English To view the source version of this press release, please visit Sign in to access your portfolio
