Gastrointestinal procedures continue to dominate the ASC landscape in 2025, driven by increased screening demand, younger-onset colorectal cancer and ongoing migration of cases out of hospitals. All the while, the specialty is navigating significant pressures, from reimbursement cuts and prior authorization hurdles to workforce shortages and rising supply costs, even as new technology and expanding ASC networks reshape how GI care is delivered.
Here are 10 things to know about GI procedures in ASCs:
- GI procedures remain the dominant specialty in ASCs: GI procedures accounted for nearly 28.3% of all Medicare ASC procedure volume in 2023, making gastrointestinal care one of the largest procedural categories in the outpatient surgery space.
While cataract surgeries remain the single most common procedure, GI services collectively represent a dominant share of ASC volume.
- Demand is accelerating due to earlier screening guidelines: Lowering the recommended screening age from 50 to 45 added roughly 19 million Americans to the screening pool, significantly boosting demand for outpatient colonoscopies. p
- Earlier-onset colorectal cancer brings higher-acuity cases to ASCs: Separate from screening-age changes, ASCs are seeing more patients under 55 referred for diagnostic colonoscopies as colorectal cancer continues to rise in younger adults. In turn, centers must prepare for higher-acuity needs, more complex prep considerations and faster workups for symptomatic patients.
- Reimbursement pressures continue to strain: Many physicians worry that declining payments, compounded by rising supply and labor costs, could worsen access challenges and contribute to delayed diagnoses, especially as nationwide GI wait times grow longer. Reimbursement for advanced GI procedures has not kept pace with their complexity or clinical value, leaders have also noted.
“Reducing reimbursement puts additional pressure on clinician practices which may lead to delayed care and diagnoses,” Omar Khokhar, MD, gastroenterologist at Illinois GastroHealth in Bloomington, told Becker’s.
- The prior authorization process creates a major bottleneck: GI specialists say that prior authorization and advanced notification requirements for common endoscopic procedures delay care, increase administrative burden and slow down ASC throughput. These policies can contribute to postponed screenings and reduced access for high-risk patients.
“ASCs need to choose tighter payer alignment, saying no to low-performing contracts and yes to deeper partnerships that reward value,” Dr. Khokhar said.
- Inflation rises costs: GI practices and ASCs continue to face rising operational costs, including anesthesia drugs, disposable devices and endoscopy equipment, even as reimbursement remains flat or declines. Leaders warn that the widening gap between expenses and payments is straining margins and making it harder for centers to keep pace with growing demand.
Decreasing professional reimbursement amid rising expenses is becoming “an ongoing issue that will become more pressing as it continues to fester,” particularly as physicians are expected to do more while receiving less, Linda Lee, MD, medical director of endoscopy at Boston-based Brigham and Women’s Hospital and Brigham & Women’s Faulkner Hospital, told Becker’s.
- Workforce shortages limit ASC capacity for colonoscopy and endoscopy: The U.S. is projected to face a shortage of more than 1,600 gastroenterologists by the end of 2025, a gap that directly affects how many colonoscopies, upper endoscopies and inflammatory bowel disease surveillance procedures ASCs can schedule each day. In high-demand markets, the shortage is already contributing to longer wait times and reduced procedural access.
- New technologies improve accuracy, efficiency and minimally invasive GI procedures: A wave of emerging technologies is reshaping how ASCs perform endoscopic procedures.
AI-enhanced endoscopy is helping gastroenterologists detect polyps and other abnormalities with greater accuracy and speed, while advanced imaging tools such as multi-contrast laser endoscopy and confocal laser endomicroscopy offer clearer visualization of precancerous tissue during colonoscopy and EGD.
Endoscopic-ultrasound–guided techniques are also expanding minimally invasive options for patients who previously required surgery.
- New evidence reinforces when colonoscopy is needed after noninvasive tests: Four studies highlighted at the 2025 ACG Annual Meeting underline that quality colonoscopy remains essential — even as stool- and blood-based tests help triage patients.
New data showed that higher sessile serrated lesion detection rates can significantly reduce post-colonoscopy colorectal cancer, supporting performance targets such as a blended ADR of 35% and SSLDR of 6%.
Another study found bowel prep remains a major barrier: among 16.7 million colonoscopies, only 32% of patients with inadequate prep returned within one year, despite guideline recommendations.
The research conveys that while noninvasive tests can help identify which patients need further evaluation, colonoscopy is still the definitive step for detection, prevention and follow-up care.
- GI procedure growth drives rapid ASC expansion nationwide: GI procedure volume continues to accelerate in outpatient settings, pushing major gastroenterology groups to expand their ASC footprints.
In 2025, several of the largest GI platforms, including Exton, Pa.-based U.S. Digestive Health, Southlake, Texas-based GI Alliance, Miami-based Gastro Health, Atlanta-based United Digestive and West Long Branch, N.J.-based Allied Digestive Health, operated dozens of GI-focused ASCs through joint ventures, acquisitions and de novo development.
Their growth reflects gastroenterology’s broad shift toward lower-cost, procedure-focused outpatient care and underscores how central ASCs have become in delivering high-volume colonoscopy and endoscopy services.
