Becker's ASC Review

16 GASTROENTEROLOGY The studies shaping GI's future focus By Francesca Mathewes I n a viewpoint published Nov. 10 in Medscape, David Johnson, MD, chief of gastroenterology at Eastern Virginia Medical School and Old Dominion University in Norfolk, outlined four studies presented at the American College of Gastroenterology 2025 Annual Meeting in Phoenix, Ariz. e studies reflect key clinical issues within the specialty and may shape the gastroenterologists' focus moving forward: 1. Higher SSLDR can reduce post-colonoscopy CRC. e first study, conducted by co-authors Joseph Anderson, MD and Douglas Rex, MD, looked at data from the New Hampshire Colonoscopy Registry from 115,585 patients who underwent index colonoscopy, including 177 subsequently diagnosed with colorectal cancer. e searchers evaluated the sessile serrated lesion detection rate as an independent predictor of interval cancer and how higher SSLDRs affected relative risk reduction. In an update published in September 2024, the researchers recommended a "blended" adenoma detection rate of at least 35% and establishing a new performance target of SSLDR of at least 6% across all colonoscopies, including both screening and diagnostic. 2. Colonoscopy prep is still inadequate. Earlier this year, the U.S. Multi-Society Task Force on CRC recommended that endoscopists target at least a 90% adequate bowel prep rate. e task force also recommended that if colonoscopy prep is inadequate, and there are indications for alarm symptoms or discriminants such as positive stool-based tests, the exam should be repeated within one year or as soon as possible. e next study, co-authored by Dr. Johnson himself, used data from the GIQuIC registry to examine the adequacy of bowel prep. It analyzed 16,747,770 colonoscopies performed between 2011 and 2022. Inadequate bowel prep was noted in 920,551 of these cases and only 32% of cases with inadequate prep were revisited within a year, as recommended by professional guidelines. "Alarmingly, 57% didn't come back within five years, suggesting they were lost to follow-up," Dr. Johnson writes. "Even among patients with advanced adenomas or high-risk lesions detected on index exam, only 20% came back within a year, and more than half never returned." 3. Neuromodulation reduces neuropathy in fecal incontinence. e third study was led by Satish Rao, MD, at Augusta (Ga.) University Medical Center. It explored the potential of translumbosacral neuromodulation therapy for reversing neuropathy in patients with fecal incontinence. e trial included 109 patients, 86 of whom were female, who experienced one or more episodes of fecal incontinence per week. Patients received weekly treatments for six weeks of either TNT — with one group received 2400 magnetic stimulation and one group receiving 3600 — or a placebo. TNT involved pacing four magnets at right at le lumbar and sacral. e results were "highly favorable" for TNT, Dr. Johnson writes. Average episodes of fecal incontinence dropped dramatically from 7.7 to 2.8 in the 2400-stimulation group and from 8.3 to 3.5 in the 3600-stimulation group. "e effect here was simply off the chart," Dr. Johnson writes. 4. Novel approach targets advanced fibrosis. e final study looked at resmetirom, a selective thyroid hormone receptor beta agonist that represents a "dramatic" new advancement for treating fatty liver disease. e drug was approved by the FDA in March 2024 for noncirrhotic metabolic dysfunction-associated steatohepatitis with moderate to advanced fibrosis. e study evaluated 122 patients with MASH cirrhosis, who received 80mg of resmetirom for up to two years. At the start, 63% of patients had probable or definitive clinically significant portal hypertension. Aer one year, 20% of patients with clinically significant portal hypertension no longer met diagnostic criteria for this condition, which rose to 28% at two years. Another 35% of patients with stage four fibrosis at baseline transitioned for stage three at two years, which was a "dramatic improvement," Dr. Johnson writes. "However, the results with clinically significant portal hypertension were particularly impressive, suggesting that a meaningful clinical impact can be obtained in patients with advanced liver disease," he said. "Given that resmetirom is already approved, I think these findings are actionable now." n UC San Diego names inaugural liver disease chair By Sophie Eydis U niversity of California in San Diego has appointed Rohit Loomba, MD, as the inaugural holder of the John C. Martin Endowed Chair in Liver Disease. The chair was established through a gift from the John C. Martin Foundation to support research and treatment focused on population-based risk factors in liver disease. Dr. Loomba is chief of the division of gastroenterology and hepatology at UC San Diego Health and director of its metabolic-dysfunction associated steatotic liver disease research center, according to a Nov. 13 system news release. Dr. Loomba is internationally recognized for his work in noninvasive imaging techniques, including MRI-proton density fat fraction, a biomarker now used in over 100 global clinical trials for steatohepatitis. His research has contributed to FDA approvals and the design of late-stage trials. John C. Martin, who died in 2021, was former chairman and CEO of Gilead Sciences and a leader in HIV, hepatitis B and hepatitis C therapy development. The endowed chair honors his legacy in advancing global access to life- saving treatments, according to the release. n

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