COVID-19 & the 5 trends that defined GI in 2020

COVID-19-related elective procedure delays greatly affected gastroenterology in 2020 in a year that was synonymous with drastic change. 

At the beginning of the pandemic, elective procedures were delayed across the U.S., creating a large backlog of colonoscopies. Fears over viral transmission and patient reluctance to seek hospital-based care left a lasting mark on the specialty and could increase CRC-related mortality by 11.9 percent. And while volumes have returned as the pandemic progresses, GI faced one of the slowest returns because of transmission-related fears. 

As more research emerged around COVID-19, GI was in the middle of many new discoveries. GI symptoms were present in many cases, and GIs had to take an abundance of caution. Research found patients searched for GI symptoms shortly before a region became a COVID-19 hot spot and, unfortunately, had worse outcomes when they presented with GI symptoms. 

Today, as the U.S. enters into record territory for case spread and mortality rates triggering another round of elective procedure shutdowns, hospitals and outpatient surgery centers are keeping colonoscopy programs active to prevent further increases in potential CRC mortality. ASCs and outpatient-based endoscopy centers have become more essential now than ever before. 

Despite COVID-19 dominating the year's trends, several other stories made a notable mark on the specialty in 2020:

The U.S. Multi-Society Task Force of Colorectal Cancer's big year. The change we thought was coming, came and the task force proposed lowering the CRC screening age to 45 in response to growing early-onset CRC rates. The task force also released guidelines for endoscopists on assessing colorectal lesions for features associated with cancer and updated its guidelines for post-colonoscopy follow-up with or without polypectomy. 

Colonoscopy screening alternatives. Colonoscopy alternatives continued to have a big year with Exact Sciences' Cologuard dominating the alternative market in terms of share and utilization. However, blood-based alternatives are beginning to emerge and vie for position in the market. CMS, notably, created a guideline for still-in-development tests to earn approval at the request of pharmaceutical company Epigenomics, who created the first FDA-approved blood-based CRC test. CMS declined to recommend Epigenomics' Epi proColon, creating a guideline using benchmarks from established colonoscopy alternative tests.  

Private equity's delayed shopping spree. Coming off a banner year for activity in 2019, COVID-19 disrupted PE investment in the GI space at the beginning of the year, but as we approach 2020's finish line, investment activity is back up and booming. There have been 11 deals in the GI space, with seven of those closing in the second half of the year. Most notably, two new platforms were formed in Webster Equity Partners' partnership with Memphis, Tenn.-based Gastro One and H.I.G. Growth Partners' partnership with Rochester, Minn.-based The Center for Digestive Health. 

Now, eight acquisition platforms are scattered throughout the U.S. With the number of large, established practices beginning to dwindle, the fight for medium and small practices will ramp up as these practices continue to turn to platforms for financial assistance. 

Compensation keeps rising, but is this the end? GIs reported average annual compensation of $419,000, the sixth highest amount of specialty physicians, according to Medscape's "Physician Debt & Net Worth Report 2020." Unfortunately, compensation has remained flat for GI between 2019 and 2020, one of only four other specialties that didn't report an increase, and COVID-19's effect on compensation is expected to be large. 

A hard line on probiotics in GI. The American Gastroenterological Association issued a guideline on probiotics use in GI, recommending against the use of such treatments in June. The guideline, published in Gastroenterology, found only three clinical scenarios where probiotics were beneficial to patients; in general, there was not enough evidence to support the use of probiotics for most conditions.   

What do you think is in store for gastroenterology in 2021? Email to be included in our year-previewing feature piece.

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