Roundtables

GI Centers of the Future 6 in use for colorectal cancer screening, including fecal immunochemical test- ing, CT colonography and fecal DNA has been demonstrated in randomized trials to be as effective as colonoscopy in reduc- ing both the frequency and the mortality rate of colorectal cancer. Notwithstanding the above, howev- er, I believe that optical colonoscopy will be challenged by other screening modalities when more data examin- ing the cost effectiveness of various testing strategies are available. For example, a large [Veterans Affairs] cooperative study is currently under way comparing colonoscopy with FIT. While the results of this study will not be available for many years, there are some individuals who feel that FIT may come out on top when both effectiveness and cost are factored into the equation. Approximately 60 percent of eligi- ble Americans have now undergone some form of screening for colorectal cancer. is number is up at least 10 percent in the last decade, due to increased efforts to educate the public about the im- portance of colorectal cancer screening and improved meth- ods of sedation that have increased patient compliance with screening rec- ommendations. Q: Do you think that the Gi physi- cian workforce will also increase? Colleen M. Schmitt, MD, Presi- dent-Elect of the American Society for Gas- trointestinal Endoscopy, Galen Medical Group, Chattanooga, Tenn.: A number of factors contribute to the increased demand for colonos- copies, such as the aging and growth of our population. However, it has been pro- jected that there will be a shortfall of GI physicians by 2020. Q: how will you adapt your practice as colonoscopy volume shis? Are there any preemptive measures you are planning to take? Dr. Deas: We have added new phy- sicians to our practice over the past few years. is is part of the adapta- tion. e ambulatory surgery center is co-located with our office so that improves our time efficiency and we also have nurse practitioners to help with seeing patients in the office, scheduling and preparing patients for colonoscopy. Some practices provide open access colonoscopy, which means that the pa- tient is not evaluated in the GI endos- copist's office before the colonoscopy. Patients are referred directly from their primary care provider for the proce- dure only, eliminating the office visit time. Q: Where do you see the biggest op- portunities for gastroenter- ologists focused on colonoscopy? Dr. Deas: e most important thing we can do is work to improve the quality of the colonoscopy. at includes spending more time exam- ining the colon and improving bowel preparation, to improve the quality of the exam. ese are two main issues that the endoscopists can focus on to make the colonos- copy more effective at reducing cancer rates and interval cancers. e ASGE Institute for Training and Technology also has a lot of hands- on training options for physicians to improve their skills and to learn more ad- vanced techniques in polyp removal as well as other endoscopic techniques. Dr. Stern: Just to streamline the care, GI physicians should try and get block time at surgery centers so doing the procedure becomes more efficient. We are also recognizing genetic or famil- ial reasons that might lead to colon cancer and as we are getting better about that, we can screen patients at a younger age. Dr. Schmitt: Within GI industry, we understand the importance of quality measures such as the adenoma detec- tion rate. We need to make sure that all quality measures translate into val- ue for our patients and make sure that our patients and referring physicians understand that value. When they look for an endoscopist, they should ask about those quality measures. e other area where we have oppor- tunity is augmenting our basic skill set. We have GI physicians who want to expand their skills and the ASGE has an assessment-based certificate program to help endoscopists do that. Dr. Cohen: Once again, the core prin- ciples are efficacy and efficiency. In other words, we need to do what we're doing well and at a cost that is com- petitive with other modalities. n "I believe that demand for optical colonoscopy will continue to increase during the next five years. This belief is based upon evidence that supports the efficacy of colonoscopy in the prevention of colorectal cancer." -Dr. Lawrence B. Cohen

• Cover