Colonoscopy remains a cornerstone of colorectal cancer prevention, but GI leaders say the procedure’s role, and the business model built around it, is shifting fast.
Here’s what five leaders have told Becker’s about colonoscopy in 2025:
Omar Khokhar, MD. Gastroenterologist at Illinois GastroHealth (Bloomington): Colonoscopy demand in 2025 was a double-edged sword. On one hand, volume stayed high—screening normalization post-pandemic plus aging demographics kept our calendars full. On the other hand, that demand exposed our early choke points. We’ve come to view colonoscopy volume not as a burden but as a demand signal—one that pushes us to modernize, automate, and scale.
Lawrence Kim, MD. President of the American Gastroenterological Association Institute: We are really entering a period of transformation of GI practice. The business model centered around screening colonoscopy has sustained our specialty for several decades, but it’s rapidly evolving. We are seeing screening colonoscopy volumes decreasing across the country, and I’m seeing it in my own practice.
That is because more screening options have become available, and practices are moving into non-invasive screening approaches. Stool-based screening has been around for several years. Now, it is in a period of exponential growth also fueled by payers implementing mass screening programs. On the horizon is also blood-based screening. There are always pros and cons to these approaches, but patients will vote with their feet. Our primary concern is to make sure these approaches are utilized as appropriately as possible. In situations where it’s inappropriate to use these screening methods, we want to make sure patients are directed in an appropriate fashion.
Another trend is the rise of consumer directed care. Increasingly, patients are becoming empowered to take charge of their own care and drive their own clinical services. We see that in the expansion of remote care platforms, and also in the proliferation of complementary and alternative medicine. I think to be successful, GI practices will have to recognize and learn to adapt to both of these trends. I think this may be good for our specialty in many ways. We will always be a procedural specialty, but by becoming less dominated by a single procedure, we can become more patient-centric.
Benjamin Levy, MD. Gastroenterologist at University of Chicago Medicine:
GLP-1 receptor agonists have revolutionized patients’ ability to lose weight and prevent obesity complications. They also help MASLD patients. But they slow gastric emptying and motility, leading to abdominal pain, constipation, diarrhea, nausea, gallstones and even pancreatitis. With prescriptions rising, we’ll see more of these side effects. They also impair colonoscopy prep, so physicians need individualized approaches. Long-term nutritional deficiencies and possible thyroid cancer risk are other concerns, even as evidence remains inconclusive.
Dinesh Madhok, MD. Gastroenterologist CEO of Borland Groover (Jacksonville, Fla.): The first is that a lot of GI care, as you know, revolves around colon cancer — whether it’s screening for it or finding and removing polyps. Colon cancer is the second most common cancer that kills Americans, and I think the screening landscape is shifting because of convenience. We’re seeing more blood-based and stool-based methods, like fecal DNA and RNA testing, coming into the market. These are sometimes sent directly to patients without physician involvement.
I think that’s a disservice to patients and physicians. These tests can give patients a false sense that everything is fine. As we know, polyps lead to colon cancer, and most of these tests don’t pick up polyps; they pick up cancer. Our goal is not to find cancer early, it’s to prevent cancer. Colonoscopy is still the only procedure that can both find and remove polyps, preventing cancer from developing rather than just diagnosing it.
If you already have cancer, yes, you want to catch it early, but in some sense, you’ve already lost the battle. Stool- and blood-based tests have their place, for example, for patients who absolutely refuse colonoscopy, but we need to educate patients about their limitations. Colon cancer screening is an area where we need to make sure both physicians and patients are focused on the best test available, not just the easiest one.
Shaibal Mazumdar, MD. Gastroenterologist in Richfield, Wis.: For ASCs to thrive; we have to create value e.g. best care at the lowest cost with good quality & safety outcomes; those metrics should be measured. They include costs of procedure which includes reimbursements related to anesthesia, path in the form of bundled payments. Should also have metrics related to quality which includes ADR (polyp detection rates); compliance with interval follow up surveillance colonoscopy data and metrics established by the national GI societies.
ASCs are pivotal in delivering efficient, high-quality outpatient care, but their long-term viability hinges on sustainable reimbursement models. As healthcare shifts toward value-based care, ASCs must collaborate with payers to align incentives around delivering the best care at the lowest cost, while maintaining robust quality and safety outcomes. This partnership involves measuring key metrics — encompassing procedural costs through bundled payments and quality indicators like adenoma detection rates and compliance with surveillance colonoscopy intervals established by national gastrointestinal societies. By focusing on these elements, ASCs can foster reimbursement structures that reward value creation, ensuring mutual benefits for providers, payers and patients.
