Issue link: https://beckershealthcare.uberflip.com/i/1208835
38 GASTROENTEROLOGY Gastroenterology in 2030: What the specialty will look like in 10 years By Eric Oliver A s the decade comes to a close in gastroenterology, the spe- cialty has never been at a point of more promise. Colorec- tal cancer incidence and mortality rates are decreasing as screening rates increase; the introduction of machine learning into the specialty is happening at a rapid pace; and the public has never been more aware of the importance of gut health. Here, nine leaders from across the industry share their thoughts on how GI will look in 2030. Note: Responses were edited for style and content. Question: What will gastroenterology look like in 2030? Purna Kashyap, MBBS, AGA Center for Gut Microbiome Re- search and Education Scientific Advisory Board; Mayo Clinic (Rochester, Minn.): GI is evolving rapidly, making it a really excit- ing time for clinicians managing patients with digestive disorders. [ese] four developments have promise to transform [GI] over the next decade: Advances in sequencing technologies. e declining cost of DNA sequencing and smaller size of sequencers has brought next-gener- ation sequencing closer to clinical applications. Pharmacogenomic panels have already been introduced to the clinic, and I expect to see epigenetic and microbiome-based applications in the near future. e next decade will see a sharper focus on the mechanistic role of gut bacteria, and we can expect both diagnostics as well as data- driven therapeutics targeting the gut microbiome. Artificial intelligence. e rapid accumulation of clinical, imaging and multiomics data has lured AI into GI, laying the path for preci- sion medicine. [AI has already used] deep learning [to detect] polyps and GI bleeding [in real-world settings]. As we integrate clinical, imaging and -omics data, we will begin to see widespread applica- tion of AI-based models aimed at improving diagnosis and outcomes of complex GI diseases, such as cirrhosis and inflammatory bowel disease, as well as early detection of GI cancers. Endo-robotics. Interventional endoscopy is already seeing a transformation with the emergence of endo-bariatrics. e current innovative pipeline will pave the way for endo-robotics for com- plex organ-sparing endoscopic surgery, nonthermal ablation and regenerative [biologics] therapies for chronic GI diseases, endoscopic therapies for diabetes and nonalcoholic fatty liver disease, and expan- sion of third-space endoscopy procedures over the next decade. Home testing. Finally, the breakthrough in DNA-based testing allowing for in-home screening of CRC has opened a new avenue, making care accessible to larger populations. We can expect a continued push for point-of-care testing using miniaturized devices and digital technology for detection and monitoring of chronic GI conditions and cancers over the next decade. While the list above is by no means comprehensive, it gives a snap- shot of where our field is moving. I am excited to see what the next decade brings for GIs and our patients. Vivek Kaul, MD, University of Rochester (N.Y.) Medical Center: Change is the only constant. In the last two decades, GI has under- gone rapid and significant evolution. is fast-paced transformation is expected to continue over the next decade. EHRs will continue to evolve and communicate better across health- care systems regionally and nationally. Data acquisition and sharing, outcome and quality-based reimbursement and value-based purchas- ing will be cornerstones of future clinical practices. Health systems will continue to consolidate, enabling efficiencies of scale. Service-line based multidisciplinary care delivery will be more widely established. e concept of GI hospitalists will take root more widely; advanced practice providers will assume greater responsi- bilities in most practice settings; and new technology — like voice recognition and phone-based apps — will penetrate daily practices more routinely. Technological sophistication will also enable mean- ingful telemedicine and remote consultation initiatives. Whereas disruptive technologies, particularly genetic and molecular- based testing, may make a dent in routine endoscopic procedures, newer procedures and technologies, like motorized enteroscopy, nonendoscopic diagnostic tests, will become available to fill the gap for the general GIs. For the therapeutic endoscopist, advanced resection platforms and robotic endoscopy would have come of age and be firmly established by 2030, thereby transforming third-space endoscopy and the entire endo-surgery field. Endoscopic ultrasound interventions will continue to expand and bridge the gap between surgery and endoscopy. Defect closure and bleeding control devices will evolve to help conquer more complex endoscopic challenges and will be simpler to use in emergency situations. Disposable endoscopes will have found several niche ap- plications, especially in high-risk procedures and clinical scenarios. AI platforms would have matured by 2030 with specific applications aimed to improve yield of endoscopy and diagnostic testing. Bariatric endoscopic practice will have evolved into more of a metabolic endoscopy approach, from mechanical to increasingly physiologically oriented interventions. Personalized cancer medi- cine and immunotherapy will be the norm for GI-cancer manage- ment. Similarly, immune-modulators and biologics will continue to transform IBD care, particularly for severe patients. Increased global connectivity and networking will result in greater opportunities for teaching, training and research collaboration worldwide. Ten years from now, the world and the GI space will be quite differ- ent. ose of us who can adapt and evolve accordingly will be most successful. Despite all the changes and advancements, our ultimate goal will and always should be to provide the highest quality patient care possible. Michael Kochman, MD, AGA Governing Board Councilor for Development and Growth; University of Pennsylvania Perelman School of Medicine (Philadelphia): GI will change due to both iterative and disruptive innovation; some changes will be predictable and some completely unanticipated. We will see an increasing move toward molecular diagnostics and patient selection for therapies based upon predicted responses and outcomes.