CMS has steadily expanded colorectal cancer screening coverage over the past three years by lowering the screening age to 45, adding coverage for blood-based biomarker tests and CT colonography, and eliminating patient cost-sharing for follow-up colonoscopies after positive noninvasive screening tests. These changes are expected to increase screening participation and drive more patients into ambulatory surgery centers (ASCs) for colonoscopy. However, the increase in procedure volume is being offset by lower reimbursement. Under the 2026 Medicare payment changes, gastroenterologists performing endoscopy in ASCs and hospital outpatient departments face an average 8% reduction in physician payments, driven by adjustments to work…
Author: Abhay Panchal
A randomized, sham-controlled study published in JAMA Internal Medicine found that a single fecal microbiota transplantation (FMT) session did not significantly eliminate multidrug-resistant organisms (MDROs) or reduce antimicrobial resistance genes in patients with gastrointestinal diseases such as pancreatitis and cirrhosis. Four weeks after treatment, MDRO decolonization rates were nearly identical between the FMT and sham groups (31% vs. 30.4%), suggesting that one FMT procedure alone is insufficient to eradicate persistent drug-resistant bacteria. Despite failing to meet its primary endpoints, FMT produced meaningful changes in the gut microbiome. Gene-sequencing analyses showed increased microbial diversity and enrichment of beneficial short-chain fatty acid–producing…
Rather than challenging the value of colonoscopy, Dr. Paul Limburg argues that the U.S. can no longer rely on it as the primary colorectal cancer screening strategy. With nearly 60 million Americans eligible for screening but capacity for only about 15 million colonoscopies annually, the healthcare system faces a widening gap that could delay cancer detection and treatment. Drawing on new modeling studies and the 2026 American Cancer Society screening guideline, the article makes the case for a complementary approach: use next-generation multitarget stool DNA (mt-sDNA) tests for initial screening in average-risk patients, while reserving colonoscopy for diagnostic follow-up and…
A cost-effectiveness analysis of the IBD-BOOST randomized controlled trial found that a facilitator-supported digital self-management program is highly likely to be a cost-effective addition to standard care for people with inflammatory bowel disease (IBD) experiencing persistent pain, fatigue, and fecal incontinence. Although the original trial did not achieve statistically significant improvements in its primary clinical endpoints, participants using the online intervention gained modest improvements in quality-adjusted life years (QALYs) while reducing healthcare utilization and overall costs over 12 months. The web-based program combines cognitive behavioral therapy principles with symptom-specific self-management strategies delivered through 12 interactive online sessions, supported by trained…
Experts at IDWeek 2025 emphasized that diagnosing Clostridioides difficile infection (CDI) now requires greater clinical judgment, as highly sensitive molecular tests can detect bacterial colonization without confirming active disease. While PCR-based nucleic acid amplification tests (NAATs) are excellent at identifying C. difficile, they may overdiagnose infection if used indiscriminately. Clinicians were advised to reserve testing for patients with genuine, profuse watery diarrhea, typically six or more stools per day, rather than relying solely on laboratory results. Dr. Javier A. Villafuerte Gálvez of Beth Israel Deaconess Medical Center noted that certain symptom patterns should prompt consideration of alternative diagnoses. Intermittent diarrhea,…
The American College of Gastroenterology and the American Gastroenterological Association have issued statements highlighting some concerns and important factors to consider as new colorectal cancer screening guidance from the American Cancer Society draws attention to the growing number of testing options. Although the ACS did not list blood-based tests as a preferred option (Table), noting that these tests have “demonstrated lower sensitivity for both advanced precancerous lesions and stage I cancers, with modeling studies predicting less effectiveness in reducing CRC incidence and mortality,” they left the door open for use of such tests for some patients: “individuals who decline or…
Researchers from the University of Occupational and Environmental Health in Japan have developed the Autonomous Colonoscope Robot System (ACRS), an AI-powered robotic platform capable of performing fully automated colonoscope insertion under controlled laboratory conditions. Built on the Endoscopic Operation Robot (EOR) version 4, the system was trained using insertion data from an expert endoscopist and combines computer vision with robotic control to autonomously navigate a colonoscopy training model. In testing, the ACRS successfully completed fully autonomous (Level 4) insertion in 62 of 72 evaluable procedures (86.1%), with an average cecal intubation time of 2.9 minutes. Although slower than an expert…
Zobair Younossi, Chairman of the Global NASH/MASH Council and Professor of Medicine at Georgetown University, reviewed the latest global consensus recommendations for the diagnosis and management of Metabolic dysfunction-associated steatotic liver disease and Metabolic dysfunction-associated steatohepatitis. The updated recommendations were developed through a systematic literature review and Delphi consensus process involving approximately 290 experts from 65 countries, with the goal of harmonizing international guidance and providing a practical framework for everyday clinical care.
In this perspective, Dr. Aasma Shaukat contends that the American Cancer Society’s updated colorectal cancer screening guideline strikes the right scientific balance by classifying blood-based screening tests as “non-preferred” options. However, she believes the guideline falls short because it does not provide practical implementation guidance to ensure these tests remain secondary choices rather than becoming routine first-line screening. She explains that once a screening test is included in a major guideline, many patients, clinicians, health systems, payers, and the media are likely to interpret that inclusion as an endorsement. Without clear operational guardrails, blood-based tests—which are intended only for average-risk…
A new study published in Cell Host & Microbe suggests that removing precancerous colorectal polyps may not fully eliminate a person’s long-term risk of colorectal cancer because underlying changes in the gut microbiome can persist for more than a decade. Researchers compared stool samples from women who had adenomas removed approximately 12 years earlier with those from individuals who had never developed adenomas and found significant differences in 31 microbial species. The post-polypectomy microbiome also shared several characteristics previously linked to colorectal cancer, indicating that polyp removal may not restore the gut to a low-risk biological state.