Latest news with #DDW2025
Medscape
19-05-2025
- Health
- Medscape
Winning Strategies to Retain Private Practice GIs
SAN DIEGO — With the recently updated recommendations by the US Preventive Services Task Force lowering the age for colorectal cancer screening to 45 instead of 50, an additional 19 million patients now require screening, Asma Khapra, MD, a gastroenterologist at Gastro Health in Fairfax, Virginia, told attendees at Digestive Disease Week (DDW) 2025. That change, coupled with the expected shortage of gastroenterologists, means one thing: The current workforce can't meet patient demand, she said. Private practices in particular face challenges in retaining gastroenterologists, Khapra added. The private practice model is already declining, she said. The fraction of US gastroenterologists in 'fully independent' private practice was about 30% in 2019, Khapra noted. Then, 'COVID really changed the landscape even more.' By 2022, 'that number has shrunk to 13%.' Meanwhile, 67% are employed gastroenterologists (not in private practice), 7% work in large group practices, and 13% are private equity (PE) backed. That makes effective retention strategies crucial for private practices, Khapra said. She first addressed the common attractions of private practices, then the challenges, and finally the winning strategies to retain and keep a viable private practice gastroenterology workforce. The Attractions of Private Practice The reasons for choosing private practice are many, Khapra said, including: Autonomy, Flexibility, Competitive compensation, Ownership mindset, Partnership paths, and Work-life balance including involvement in community and culture. On the other hand, private practices have unique challenges, including: Administrative burdens such as EHR documentation, paperwork, prior authorizations, and staffing issues, Financial pressures, including competition with the employment packages offered by hospitals, as reimbursements continue to drop and staffing costs increase, Burnout, Variety of buy-ins and partnership tracks, Limited career development, and The strains of aging and endoscopy. 'We used to joke in our practice that at any given time, three staff members are in physical therapy due to injuries and disabilities.' Employing the Iceberg Model One strategy, Khapra said, is to follow Edward T. Hall's Iceberg Model of Culture , which focuses on the importance of both visible and invisible elements. 'The key to retention in private practice is to develop a value system where everyone is treated well and respected and compensated fairly,' she said. 'That doesn't mean you split the pie [equally].' 'Visible' elements of the model include the physical environment, policies and practices, symbols and behaviors, she said. While under the surface ('invisible' elements) are shared values, perceptions and attitudes, leadership style, conflict resolution, decision making and unwritten rules. The key, she said, is to provide physicians an actual voice in decision making and to avoid favouritism, thus avoiding comments such as 'Why do the same two people always get the prime scoping blocks?' Financial transparency is also important, Khapra said. And people want flexibility without it being called special treatment. She provided several practical suggestions to accomplish the invisible Iceberg goals. For instance, she suggested paying for activities outside the practice that physicians do, such as serving on committees. If the practice can't afford that, she suggested asking the affiliated hospitals to do so, noting that such an initiative can often build community support. Paying more attention to early associates than is typical can also benefit the practice, Khapra said. 'So much effort is made to recruit them, and then once there, we're on to the next [recruits].' Instead, she suggested, 'pay attention to their needs.' Providing support to physicians who are injured is also crucial and can foster a community culture, she said. For example, one Gastro Health physician was out for 4 weeks due to complications from surgery. 'Everyone jumped in' to help fill the injured physician's shifts, she said, reassuring the physician that the money would be figured out later. 'That's the culture you want to instill.' To prevent burnout, another key to retaining physicians, 'you have to provide support staff.' And offering good benefits, including parental and maternal leave and disability benefits, is also crucial, Khapra said. Consider practices such as having social dinners, another way to build a sense of community. Finally, bring in national and local gastroenterologist organizations for discussions, including advocating for fair reimbursement for private practice. Consider working with the Digestive Health Physicians Alliance, which describes itself as the voice of independent gastroenterology, she suggested. More Perspectives Jami Kinnucan, MD, a gastroenterologist and associate professor of medicine at Mayo Clinic, Jacksonville , Florida, spoke about optimizing recruitment of young gastroenterologists and provided perspective on Khapra's talk. 'I think there's a lot of overlap' with her topic and retaining private practice gastroenterologists, she said in an interview with Medscape Medical News. Most important, she said, is having an efficient system in which the administrative flow is left to digital tools or other staff, not physicians. 'That will also help to reduce burnout,' she said, and allow physicians to do what they most want to do, which is to focus on providing care to patients. 'People want to feel valued for their work,' she agreed. 'People want opportunity for career development, opportunities for growth.' As gastroenterologists age, flexibility is important, as it in in general for all physicians, Kinnucan said. She suggested schedule flexibility as one way. For instance, 'if I tell 10 providers, 'I need you to see 100 patients this week, but you can do it however you want,' that promotes flexibility. They might want to see all of them on Monday and Tuesday, for instance. If you give people choice and autonomy, they are more likely to feel like they are part of the decision.' How do you build a high-functioning team? 'You do it by letting them operate autonomously,' and 'you let people do the things they are really excited about.' And always, as Khapra said, focus on the invisible elements that are so crucial.
Associated Press
19-05-2025
- Business
- Associated Press
AnX Robotica Unveils NaviCam XS, NaviCam XST, and ESView 3.0 at DDW 2025 to Exceptional Industry Response
PLANO, Texas, May 19, 2025 /PRNewswire/ -- AnX Robotica, a leader in robotic capsule endoscopy and advanced GI diagnostics, proudly announced the successful launch of NaviCam XS, NaviCam XST, and ESView 3.0 during Digestive Disease Week (DDW) 2025. The unveiling drew exceptional interest, with clinicians, researchers, and industry professionals visiting the AnX Robotica booth to witness the next evolution in GI visualization technology. NaviCam XS, the latest addition to the NaviCam platform, introduces a capsule that is 44% smaller by volume than standard small bowel capsules, designed for enhanced patient comfort and easier ingestion without compromising on image quality or diagnostic reliability. This next-generation capsule further advances the possibilities of capsule endoscopy. Alongside NaviCam XS, NaviCam XST made its debut, offering real-time esophageal visualization through a tethered capsule design. With ESView RT Display, clinicians can seamlessly navigate the esophagus without the need for sedation, providing an ideal solution for evaluating conditions such as reflux, and esophageal varices in real-time. AnX Robotica also showcased ESView 3.0, the most advanced version of its software platform to date. With an intuitive interface, enhanced image clarity, and streamlined workflow, ESView 3.0 allows for faster interpretation, real-time annotation, and seamless report generation—enabling physicians to optimize diagnostic efficiency and patient outcomes. 'The response at DDW 2025 has been overwhelmingly positive,' said Stu Wildhorn, Vice President of Marketing and Product Management at AnX Robotica. 'The enthusiasm from clinicians around NaviCam XS, XST, and ESView 3.0 underscores the market's demand for non-invasive, high-resolution GI visualization. These innovations are not just advancing technology; they are setting a new standard for patient care.' The high-traffic booth at DDW served as a launchpad for these technologies, with live demonstrations, hands-on sessions, and presentations that highlighted the precision, ease of use, and clinical impact of the new products. Attendees expressed strong interest in how these solutions can redefine both diagnostic efficiency and patient experience. AnX Robotica remains committed to pushing the boundaries of capsule endoscopy and GI diagnostics, adding to its growing portfolio, which includes NaviCam SB with ProScan™, MotiliCap, NaviCam Colon*, IntraMarX, and VibraBot. *Colon Capsule is not available in the United States View original content to download multimedia: SOURCE AnX Robotica
Medscape
14-05-2025
- Health
- Medscape
Post-Polypectomy Colorectal Cancers Common Before Follow-Up
SAN DIEGO — The majority of colorectal cancers (CRCs) that emerge following a negative colonoscopy and polypectomy occur prior to recommended surveillance exams, and those cases are more likely to be at an advanced stage, according to new research. Of key factors linked to a higher risk for such cases, one stands out — the quality of the baseline colonoscopy procedure. 'A lot of the neoplasia that we see after polypectomy was probably either missed or incompletely resected at baseline,' said Samir Gupta, MD, a professor of medicine in the Division of Gastroenterology, UC San Diego Health, La Jolla, California, in discussing the topic at Digestive Diseases Week (DDW) 2025. 'Therefore, what is key to emphasize is that [colonoscopy] quality is probably the most important factor in post-polypectomy risk,' he said. 'But, advantageously, it's also the most modifiable factor.' Research shows that the risk for CRC incidence following a colonoscopy ranges from just about 3.4 to 5 cases per 10,000 person-years when baseline findings show no adenoma or a low risk; however, higher rates ranging from 13.8 to 20.9 cases per 10,000 person-years are observed for high-risk adenomas or serrated polyps, Gupta reported. 'Compared with those who have normal colonoscopy, the risk [for CRC] with high-risk adenomas is increased by nearly threefold,' Gupta said. In a recent study of US veterans who underwent a colonoscopy with polypectomy between 1999 and 2016 that was labeled negative for cancer, Gupta and his colleagues found that over a median follow-up of 3.9 years, as many as 55% of 396 CRCs that occurred post-polypectomy were detected prior to the recommended surveillance colonoscopy. The study also showed that 40% of post-polypectomy CRC deaths occurred prior to the recommended surveillance exam over a median follow-up of 4.2 years. Cancers detected prior to the recommended surveillance exam were more likely to be diagnosed as stage IV compared with those diagnosed later (16% prior to recommended surveillance vs 2.1% and 8.3% during and after, respectively; P = .003). Importantly, the most prominent reason for the cancers emerging in the interval before follow-up surveillance was missed lesions during the baseline colonoscopy (60%), Gupta said. Colonoscopist Skill and Benchmarks A larger study of 173,288 colonoscopies further underscores colonoscopist skill as a key factor in post-polypectomy CRC, showing that colonoscopists with low vs high performance quality — defined as an adenoma detection rate (ADR) of either < 20% vs ≥ 20% — had higher 10-year cumulative rates of CRC incidence among patients following a negative colonoscopy ( P < .001). Likewise, in another analysis of low-risk vs high-risk polyps, a higher colonoscopist performance status was significantly associated with lower rates of CRCs ( P < .001). 'Higher colonoscopist performance was associated with a lower cumulative colorectal cancer risk within each [polyp risk] group, such that the cumulative risk after high-risk adenoma removal by a higher performing colonoscopist is similar to that in patients who had a low-risk adenoma removed by a lower performer,' Gupta explained. 'So, this has nothing to do with the type of polyp that was removed — it really has to do with the quality of the colonoscopist,' he said. The American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy Quality Task Force recently updated recommended benchmarks for colonoscopists for detecting polyps, said Aasma Shaukat, MD, director of GI Outcomes Research at NYU Grossman School of Medicine, New York City, in further discussing the issue in the session. They recommend an ADR of 35% overall, with the recommended benchmark being ≥ 40% for men aged 45 years or older and ≥ 30% for women aged 45 years or older, with a rate of 50% for patients aged 45 years or older with an abnormal stool test, Shaukat explained. And 'these are minimum benchmarks,' she said. 'Multiple studies suggest that, in fact, the reported rates are much higher.' Among key strategies for detecting elusive adenomas is the need to slow down withdrawal time during the colonoscopy in order to take as close a look as possible, Shaukat emphasized. She noted research that her team has published showing that physicians' shorter withdrawal times were in fact inversely associated with an increased risk for cancers occurring prior to the recommended surveillance ( P < .0001). 'Multiple studies have shown it isn't just the time but the technique with withdrawal,' she added, underscoring the need to flatten as much of the mucosa and folds as possible during the withdrawal. 'It's important to perfect our technique.' Sessile serrated lesions, with often subtle and indistinct borders, can be among the most difficult polyps to remove, Shaukat noted. Studies have shown that as many as 31% of sessile serrated lesions are incompletely resected, compared with about 7% of tubular adenomas. Patient Compliance Can't Be Counted On In addition to physician-related factors, patients themselves can also play a role in post-polypectomy cancer risk — specifically in not complying with surveillance recommendations, with reasons ranging from cost to the invasiveness and burden of undergoing a surveillance colonoscopy. 'Colonoscopies are expensive, and participation is suboptimal,' Gupta said. One study of high-risk patients with adenoma shows that only 64% received surveillance, and many who did receive surveillance received it late, he noted. This underscores the need for better prevention as well as follow-up strategies, he added. Recommendations for surveillance exams from the World Endoscopy Organization range from every 3 to 10 years for patients with polyps, depending on the number, size, and type of polyps, to every 10 years for those with normal colonoscopies and no polyps. A key potential solution to improve patient monitoring within those periods is the use of fecal immunochemical tests (FITs), which are noninvasive, substantially less burdensome alternatives to colonoscopies, which check for blood in the stool, Gupta said. While the tests can't replace the gold standard of colonoscopies, the tests nevertheless can play an important role in monitoring patients, he said. Evidence supporting their benefits includes a recent important study of 2226 patients who underwent either post-polypectomy colonoscopy, FIT (either with FOB Gold or OC-Sensor), or FIT-fecal DNA (Cologuard) test, he noted. The results showed that the OC-Sensor FIT had a 71% sensitivity, and FIT-fecal DNA had a sensitivity of 86% in the detection of CRC. Importantly, the study found that a positive FIT result prior to the recommended surveillance colonoscopy reduced the time-to-diagnosis for CRC and advanced adenoma by a median of 30 and 20 months, respectively. FIT Tests Potentially a 'Major Advantage' 'The predictive models and these noninvasive tests are likely better than current guidelines for predicting who has metachronous advanced neoplasia or colon cancer,' Gupta said. 'For this reason, I really think that these alternatives have a potentially major advantage in reducing colonoscopy burdens. These alternatives are worthwhile of studying, and we really do need to consider them,' he said. More broadly, the collective evidence points to factors that can and should be addressed with a proactive diligence, Gupta noted. 'We need to be able to shift from using guidelines that are just based on the number, size, and histology of polyps to a scenario where we're doing very high-quality colonoscopies with excellent ADR rates and complete polyp excision,' Gupta said. Furthermore, 'the use of tools for more precise risk stratification could result in a big, low-risk group that could just require 10-year colonoscopy surveillance or maybe even periodic noninvasive surveillance, and a much smaller high-risk group that we could really focus our attention on, doing surveillance colonoscopy every 3-5 years or maybe even intense noninvasive surveillance.'
Medscape
09-05-2025
- Health
- Medscape
Endoscopic Procedure Shows Promise in Type 2 Diabetes Care
A novel investigational endoscopic procedure targeting the duodenum appears beneficial in improving glycemic parameters in people with type 2 diabetes (T2D). In a new dose-finding study, the re-cellularization via electroporation therapy (ReCET, Endogenex) improved insulin sensitivity, beta-cell function, and other glycemic parameters at 12 and 48 weeks in 51 individuals with T2D. 'The findings suggest that duodenal mucosal and submucosal recellularization are key therapeutic targets in type 2 diabetes management,' said Barham Abu Dayyeh, MD, director of Interventional Gastroenterology at Cedar-Sinai Hospital, Los Angeles, in a presentation at Digestive Disease Week (DDW) 2025. The outpatient technique is based on pulsed electrical fields, or electroporation, which do not use heat. 'It's nonthermal regeneration, not just ablation. It's regeneration of the duodenum as a treatment target that could potentially modify type 2 diabetes,' Abu Dayyeh told Medscape Medical News . Separately at DDW, Abu Dayyeh presented results from an artificial intelligence–based analysis of duodenal biopsies from 111 individuals with T2D and 120 control individuals without diabetes, demonstrating distinct mucosal features associated with metabolic disease, significant inflammation in the deep mucosa and submucosa with increased fibrosis, and gut-barrier dysfunction. The authors termed this set of abnormalities 'diabetic duodenopathy.' Abu Dayyeh likened the duodenum to a 'conductor' of the 'dysfunctional orchestra' of metabolic disease that includes T2D. 'It's tasked with integrating signals from the food that we eat and from our microbiome and communicates that metabolic response to downstream organs like the pancreas, liver, and adipose tissue.' Currently, he said, 'We use treatments that work downstream on components of this dysfunctional orchestra. So we work on the violinist and the flute player, but we do not go upstream to say maybe there's an opportunity to put the orchestra conductor back in synch…We manage blood glycemia by lowering it, rather than looking at upstream disease-modifying targets that could reverse the course so you require less insulin and less medication.' Abu Dayyeh envisions the ReCET procedure as an option for people struggling to control T2D with standard medications, or for early use to avoid or delay medications, particularly insulin. But it won't replace medications. 'On the contrary, I see it as enhancing and complementing medications,' he said. Asked to comment, Ali Aminian, MD, professor of surgery and director of the Bariatric and Metabolic Institute at the Cleveland Clinic, Cleveland, told Medscape Medical News , 'Diabetes is a heterogeneous disease complex with numerous pathophysiological derangements. Although diabetic duodenopathy can be seen in some patients with diabetes, that wouldn't explain the entire story behind diabetes pathogenesis in all people with diabetes. In a subgroup of people with duodenal involvement in their disease process, endoscopic procedures targeting the duodenum may play a role in the future.' Glycemic Parameters Improve Following ReCET Procedure The new study, called REGENT-1, was a multicenter, open-label, single-arm dose escalation of three levels of energy delivery in patients who had T2D for 10 years or less with A1c levels 7.5%-11% despite the use of one or more noninsulin glucose-lowering medications. Procedural success, defined as treatment of at least 6 cm of duodenum, was achieved in 100% of participants. From a baseline A1c of 8.6%, there were dose-response drops at weeks 12 and 48 by energy delivery, with significant reductions at week 48 of 1.00 and 1.70 percentage points, respectively, among the 18 who received the middle dose and the 21 given the highest dose. Body weight also dropped in all three groups in a dose-response way, from 1.2% with the lowest to 6.2% with the highest energy delivery. In mixed-meal tolerance testing, glucose area under the curve, homeostatic model assessment for insulin resistance, sensitivity index, beta-cell function, and disposition index (a measure of beta-cell response to insulin resistance) were all reduced from baseline at 48 weeks after ReCET, reaching statistical significance with the highest energy dose. There were no device- or procedure-related serious adverse events. Based on a literature search, Abu Dayyeh found that modern glucagon like peptide-1 receptor agonist medications have a stronger effect than ReCET or Roux-en-Y gastric bypass (RYGB) on beta-cell function (increases by 239% with semaglutide and 314% with tirzepatide vs 50% with ReCET and 74% for RYGB). However, ReCET procedure produced superior results for both insulin sensitivity (+487% for ReCET and +326% for bypass vs 30% and 62%, respectively for semaglutide and tirzepatide) and disposition index (+1032% for ReCET, +667% with tirzepatide, +642% for RYGB, and +367% for semaglutide). Aminian commented, 'The findings of this single arm clinical trial are promising. The next step is to incorporate a blinded control group who undergoes an endoscopy without any therapeutic intervention.' In fact, such a study is underway. Results of 'a multicenter, randomized, double-blind, sham-controlled study for assessing the safety and effectiveness of endoscopic intestinal re-cellularization therapy in individuals with type 2 diabetes (ReCET)' are expected in late 2026. In the meantime, Amanian said about the current findings, 'I'd argue that the observed improvement in diabetes parameters can be related to more intensive medical therapy during follow-up in this single arm study.' In the trials, the procedure takes 30 minutes to an hour to perform. However, as the technology improves, 'the vision of this is to be a 20-minute outpatient procedure eventually,' Abu Dayyeh said. He envisions that eventually the procedure will become as accessible as colonoscopy is now, and that primary care physicians and endocrinologists would similarly refer patients to a gastroenterologist or surgeon to have it done. 'They do the procedure and send your patient back, hopefully with a less complex management strategy, so you could manage them more efficiently without escalating care.' Abu Dayyeh is a co-inventor of the ReCET procedure, with the technology licensed by the Mayo Clinic. He is a consultant for and/or reported receiving research support from Boston Scientific, Olympus, Medtronic, Metamodix, BFKW, Apollo Endosurgery, USGI, Endogastric Solutions, Spatz, and Cairn. Aminian had received grants and personal fees from Medtronic and Ethicon. He serves as a consultant for Medtronic, Ethicon, and Eli Lilly.
Medscape
09-05-2025
- Health
- Medscape
No Benefit to ERCP With Sphincterotomy in Pancreas Divisum
SAN DIEGO — In treating pancreas divisum, the common use of endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy showed no significant benefit over a sham procedure, suggesting that patients can be spared the intervention, which can carry risks of its own. 'This is a topic that has been debated for decades,' said first author Gregory A. Coté, MD, Division Head, professor of medicine, Division of Gastroenterology & Hepatology, Oregon Health & Science University, in Portland, Oregon. 'Many doctors believe the procedure helps and offer it because we have limited options to help our patients, whereas others believe the procedure is harmful and doesn't help,' he explained in a press briefing for the late-breaking study, presented at Digestive Disease Week (DDW) 2025. The study's findings supported the latter argument. 'Patients who underwent ERCP with sphincterotomy were just as likely as those who did not have this procedure to develop acute pancreatitis again,' Coté reported. While clinical guidelines currently recommend ERCP as treatment for pancreas divisum, 'these guidelines are likely to change based on this study,' he said. Pancreas divisum, occurring in about 7%-10% of people, is an anatomic variation that can represent an obstructive risk factor for acute recurrent pancreatitis. The common use of ERCP with minor papilla endoscopic sphincterotomy to treat the condition is based on prior retrospective studies showing that in patients who did develop acute pancreatitis, up to 70% with the treatment never developed acute pancreatitis again. However, there have been no studies comparing the use of the treatment with a control group. Coté and colleagues conducted the multicenter SHARP trial, in which 148 patients with pancreas divisum were enrolled between September 2018 and August 2024 and randomized to receive either ERCP with minor papilla endoscopic sphincterotomy (n = 75) or a sham treatment (n = 73). The patients, who had a median age of 51 years, had a median of 3 acute pancreatitis episodes prior to randomization. With a median follow-up of 33.5 months (range, 6-48 months), 34.7% of patients in the ERCP arm experienced an acute pancreatitis incident compared with 43.8% in the sham arm, for a hazard ratio of 0.83 after adjusting for duct size and the number of episodes, which was not a statistically significant difference ( P = .27). A subgroup analysis further showed no indication of a treatment effect based on factors including age, diabetes status, sex, alcohol or tobacco use, or other factors. 'Compared with a sham ERCP group, we found that minor papillotomy did not reduce the risk of acute pancreatitis, incident chronic pancreatitis, endocrine pancreatic insufficiency or diabetes, or pancreas-related pain events,' Coté said. The findings are particularly important because the treatment itself is associated with some risks, he added. 'Ironically, the problem with this procedure is that it can cause acute pancreatitis in 10%-20% of patients and may instigate other issues later,' such as the development of scarring of the pancreas related to incisions in the procedure. 'No one wants to offer an expensive procedure that has its own risks if it doesn't help,' Coté said. Based on the findings, 'pancreas divisum anatomy should no longer be considered an indication for ERCP, even for idiopathic acute pancreatitis,' he concluded.
