In a viewpoint published Nov. 10 in Medscape, David Johnson, MD, chief of gastroenterology at Eastern Virginia Medical School and Old Dominion University in Norfolk, outlined four studies presented at the American College of Gastroenterology 2025 Annual Meeting in Phoenix, Ariz.
The studies reflect key clinical issues within the specialty and may shape the gastroenterologists’ focus moving forward:
1. Higher SSLDR can reduce post-colonoscopy CRC. The first study, conducted by co-authors Joseph Anderson, MD and Douglas Rex, MD, looked at data from the New Hampshire Colonoscopy Registry from 115,585 patients who underwent index colonoscopy, including 177 subsequently diagnosed with colorectal cancer. The searchers evaluated the sessile serrated lesion detection rate as an independent predictor of interval cancer and how higher SSLDRs affected relative risk reduction.
In an update published in September 2024, the researchers recommended a “blended” adenoma detection rate of at least 35% and establishing a new performance target of SSLDR of at least 6% across all colonoscopies, including both screening and diagnostic.
2. Colonoscopy prep is still inadequate. Earlier this year, the U.S. Multi-Society Task Force on CRC recommended that endoscopists target at least a 90% adequate bowel prep rate. The task force also recommended that if colonoscopy prep is inadequate, and there are indications for alarm symptoms or discriminants such as positive stool-based tests, the exam should be repeated within one year or as soon as possible.
The next study, co-authored by Dr. Johnson himself, used data from the GIQuIC registry to examine the adequacy of bowel prep. It analyzed 16,747,770 colonoscopies performed between 2011 and 2022. Inadequate bowel prep was noted in 920,551 of these cases and only 32% of cases with inadequate prep were revisited within a year, as recommended by professional guidelines.
“Alarmingly, 57% didn’t come back within five years, suggesting they were lost to follow-up,” Dr. Johnson writes. “Even among patients with advanced adenomas or high-risk lesions detected on index exam, only 20% came back within a year, and more than half never returned.”
3. Neuromodulation reduces neuropathy in fecal incontinence. The third study was led by Satish Rao, MD, at Augusta (Ga.) University Medical Center. It explored the potential of translumbosacral neuromodulation therapy for reversing neuropathy in patients with fecal incontinence.
The trial included 109 patients, 86 of whom were female, who experienced one or more episodes of fecal incontinence per week. Patients received weekly treatments for six weeks of either TNT — with one group received 2400 magnetic stimulation and one group receiving 3600 — or a placebo. TNT involved pacing four magnets at right at left lumbar and sacral.
The results were “highly favorable” for TNT, Dr. Johnson writes. Average episodes of fecal incontinence dropped dramatically from 7.7 to 2.8 in the 2400-stimulation group and from 8.3 to 3.5 in the 3600-stimulation group. “The effect here was simply off the chart,” Dr. Johnson writes.
4. Novel approach targets advanced fibrosis. The final study looked at resmetirom, a selective thyroid hormone receptor beta agonist that represents a “dramatic” new advancement for treating fatty liver disease. The drug was approved by the FDA in March 2024 for noncirrhotic metabolic dysfunction-associated steatohepatitis with moderate to advanced fibrosis.
The study evaluated 122 patients with MASH cirrhosis, who received 80mg of resmetirom for up to two years. At the start, 63% of patients had probable or definitive clinically significant portal hypertension. After one year, 20% of patients with clinically significant portal hypertension no longer met diagnostic criteria for this condition, which rose to 28% at two years. Another 35% of patients with stage four fibrosis at baseline transitioned for stage three at two years, which was a “dramatic improvement,” Dr. Johnson writes.
“However, the results with clinically significant portal hypertension were particularly impressive, suggesting that a meaningful clinical impact can be obtained in patients with advanced liver disease,” he said. “Given that resmetirom is already approved, I think these findings are actionable now.”
