Gastroenterology's most controversial issues

Private equity and artificial intelligence are two of the most controversial issues in gastroenterology, according to five gastroenterologists who spoke to Becker's ASC Review.

Editor's note: Responses were lightly edited for clarity and brevity. 

Samuel Giordano, MD, of Cooper University Health Care (Willingboro, N.J.): I think the most controversial trend in gastroenterology today is navigating and implementing the usage of artificial intelligence technology to help assist endoscopists with polyp detection. It is clear, based on the early data, that there is an opportunity for practice improvement and evolution, but the tricky part is the implementation. There are several companies that are competing right now in the AI technology realm and trying to become the "gold standard" in AI technology as it relates to gastroenterology. It will be interesting to see how this competition settles out and how soon we can implement the technology into our daily practice. This is extremely exciting for both patients and practitioners to have the ability to improve what's considered by some the "gold standard" procedure in screening and prevention and make it even better.

Rami Abbass, MD, of University Hospitals (Mentor, Ohio): The current most controversial trend in gastroenterology is the growing role of private equity in the acquisition of practices.  This trend has seen growing momentum in the past five years. The field presents an attractive PE target, as a significant portion of gastroenterologists remain in independent practices with ownership in ambulatory endoscopy centers. The growing regulatory environment, high cost of capital, administrative burdens and challenges of partner recruitment have made private equity attractive to some practices.   

Pankaj Vashi MD. Department Head of gastroenterology/nutrition and Vice Chief of Staff at CTCA Chicago: Changing screening for colon cancer recommendations and finding the ideal noninvasive test are the most controversial issues. We will not have enough gastroenterologists to accommodate all average-risk colon cancer patients for colonoscopy. Thus, DNA-based stool testing is an alternative that has gained a lot of popularity among the primary care providers. The controversy lies in the ideal test for it. Secondly, fellowship training in gastroenterology has changed, creating a smaller number of graduating physicians trained in interventional procedures. This is creating an increase in demand in rural areas for complex cases. Lastly, while artificial intelligence has come to our field, how much are we going to rely on this technology, and do we see it replacing some of the routine procedures we do today? 

Carl Raczkowski, MD. President of Integris Health Partners (Oklahoma City, Okla.): I think the most controversial issue is the inappropriate use of stool testing. We continue to get asked to follow up positive results in patients who are high-risk and never should have had stool-based tests for colorectal cancer screening. It is a dangerous situation. If the tests are negative, they will likely not be sent to us for appropriate screening. We must educate the public and the primary care providers .  

Aasma Shaukat, MD. Director of outcomes research in NYU Langone Health's division of gastroenterology and hepatology (New York City): Gastroenterology practices rely heavily on screening colonoscopy volumes. There is concern that the option of noninvasive tests will reduce the volumes. However, the other side is that it may overall improve colorectal cancer screening and bring more people for diagnostic colonoscopy and expand the pool of surveillance colonoscopy over time. Hence, there is enthusiasm and fear of the emerging trends. 

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