Emerging innovation, artificial intelligence, and digital technology in esophagology.

New medical technology and techniques provide opportunities for better, faster care for patients with esophageal diseases, spanning robotics and minimally invasive techniques, artificial intelligence, medical devices, and digital health that are changing how to diagnose and manage patients with both benign and malignant esophageal diseases. We conducted a concise narrative review of recent advances in esophagology from the perspectives of innovators and physicians alike, with an emphasis on ensuring the environment around successful innovation over the next decade. To our knowledge, this is the first innovation-oriented review centered on the clinical field of esophagology, focusing on applicable content and knowledge gaps across the several individual domains covered in this review.

Multicenter Validation of Video-based Deep Learning to Evaluate Defecation Patterns on 3-dimensional High-definition Anorectal Manometry.

Background & Aims: Deep learning technologies have demonstrated the ability to identify dyssynergic defecation for diagnosis of common gastrointestinal motility disorders through nuanced interpretation of 3-dimensional high-definition anal manometry (3D-HDAM). We aimed to validate a deep learning algorithm capable of spatiotemporal analysis of 3D-HDAM in a multicenter setting.

Methods: We included 1214 consecutive anorectal manometry studies performed across 3 large health care systems between 2018 and 2022.

Optimizing the Cost-Effective Evaluation of Gastroesophageal Reflux by Typical Symptom Phenotypes After Failure of Empiric Acid Suppression Trial.

Introduction: Concern for gastroesophageal reflux disease (GERD) is the most common reason to consult gastroenterology. We aimed to optimize routine GERD evaluation on cost-effectiveness according to the dominant typical symptom among patients with persistent symptoms failing empiric proton-pump inhibitors (PPI).

Methods: We developed a decision analytic model evaluating all permutations of GERD diagnostics including empiric trials of PPI optimization or discontinuation, upper endoscopy, wireless pH-monitoring, and pH-impedance monitoring.

The Safety of Pharmacotherapy for Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis.

Introduction: Understanding the safety of pharmacotherapy for irritable bowel syndrome (IBS) enables individuals to make informed treatment decisions. While many studies include the number needed to treat to highlight therapeutic benefits, adding the number needed to harm (NNH), a measure we evaluate herein, could enable more comprehensive risk-benefit assessments.

Methods: PubMed, Web of Science, and Cochrane databases were searched through October 2024.

Changes in Gastroenterology Service Volumes and Billing Patterns Associated With Declining Medicare Reimbursement.

Introduction: Efforts to control health spending within the United States have led to reductions in physician reimbursement. This study aims to elucidate the effects of such efforts on physician behavior and care access.

Methods: For all gastrointestinal procedures, public Medicare data sets were reviewed to extract variables of interest, leveraging a t test to assess significant change over time.

Contemporary Landscape of Medical Technology in Gastroenterology Between 2013 and 2023.

Medical technology in gastroenterology spans devices, point-of-care diagnostics, digital health, and artificial intelligence. We conducted a narrative review of US Food and Drug Administration (FDA)-reviewed medical technology on the available evidence base to support uptake in clinical practice. Seven hundred thirteen new gastrointestinal devices were FDA approved or cleared between 2013 and 2023.

Low Utility of Routine Thyroid Function Testing for Bowel Symptoms: A Population-Based Assessment.

Background: Chronic constipation, diarrhea, and fecal incontinence (FI) are prevalent with significant impact on quality of life and healthcare utilization. Thyroid dysfunction was recognized as a potential contributor to bowel disturbances in selected populations, but the strength/consistency of this association remain unclear.

Aims: To investigate the relationship between thyroid function and bowel health measures (constipation, diarrhea, and FI) in a nationally representative sample of the U.

Size of Pelvic Outlet as a Potential Risk Factor of Fecal Incontinence: A Population-Based Exploratory Analysis.

Introduction: The impact of pelvic bone structure on fecal incontinence (FI) is unclear. We assessed the association between weight-adjusted pelvic area and FI.

Methods: This was a population-based analysis of the National Health and Nutrition Examination Survey in 2005-2006.

Cost-Effectiveness Analysis of Current Treatment Options for Eosinophilic Esophagitis.

Introduction: The management strategies for eosinophilic esophagitis include proton pump inhibitors (PPIs), swallowed topical corticosteroids (tCSs), elimination diets, and the biologic agent dupilumab, although there remains little guidance on the selection of initial treatment. We performed cost-effectiveness analyses to compare these approaches of first-line therapy.

Methods: A Markov model was constructed from a payer perspective to evaluate the cost-effectiveness of first-line therapies for eosinophilic esophagitis, including PPI, tCS, and 6-food elimination diet (SFED), with crossover in treatments for primary and secondary nonresponse.

Optimizing Cost-Effective Care for Chronic Constipation in General Gastroenterology Using an Office-Based, Point-Of-Care Test (RED): Cost-Effectiveness and Cost-Minimization Analysis.

Introduction: We aimed to evaluate the cost-effectiveness/cost-savings of point-of-care anorectal function testing with an investigational device (RED) to triage therapy for chronic constipation in general gastroenterology.

Methods: A Markov model was constructed to evaluate cost-effectiveness/cost-savings over a 1-year time horizon comparing empiric drug/pelvic floor physical therapy to testing guided care.

Results: RED appears to inform the cost-effective strategy for chronic constipation.

Centrally Distributed Adiposity as a Modifiable Risk Factor for Fecal Incontinence: United States Population-based Analysis.

Background And Aims: Fecal incontinence (FI) is highly prevalent with substantial impacts on quality of life and health care utilization. The impact of obesity on FI remains unclear, with differing conclusions using body mass index (BMI) as a risk factor. We aimed to determine the association between obesity and FI, and whether this relationship is dependent on the distribution of adiposity (waist circumference-to-height ratio [WHtR]).

Heartburn Relief Is the Major Unmet Need for Drug Development in Gastroesophageal Reflux Disease: Threshold Value Analysis.

Background And Aims: Heartburn symptoms contribute to healthcare-seeking among patients with gastroesophageal reflux disease (GERD). Despite clinical guidance, management is often dictated by insurance restrictions. Several potassium-competitive acid blockers (PCABs) are under development as a new class of therapy.

Valuing innovative endoscopic techniques: hemostatic powder for the treatment of GI tumor bleeding.

Background And Aims: Access to new endoscopic treatment modalities often depends on price. To resolve this gap and therefore help to ensure that care delivery can occur on a clinical basis, we aimed to establish the value to insurers of novel hemostatic powder to treat GI tumor bleeding.

Methods: A decision-analytic model developed to assess the impact of endoscopic intervention on the risk of 30-day readmission for GI bleeding from an insurer perspective was adapted to assess GI tumor bleeding with hemostatic powder or standard endoscopic therapy.

Mini-review: Tailored per-oral endoscopic myotomy for type III achalasia.

This mini-review summarizes the most recent literature regarding per-oral endoscopic myotomy for type III achalasia, emphasizing the poorly understood science of tailoring myotomy length during this procedure. In addition, special attention will be placed on the current subjective and objective biomarkers, such as the Eckardt score, used to evaluate treatment outcomes in this population to better contextualize the existing data on patient outcomes, as proposed by Low et al in the current issue of the Journal. Understanding the current treatment landscape for type III achalasia and identifying the key areas of research deficiencies will guide future investigation and management of this disease.

Optimizing the Management Algorithm for Esophageal Dysphagia After Index Endoscopy: Cost-Effectiveness and Cost-Minimization Analysis.

Introduction: Guidelines advise esophageal motility testing for dysphagia when structural disorders are ruled out, but cost concerns impede adoption. We evaluated cost-effective positioning of esophageal motility testing in the algorithm to evaluate esophageal dysphagia.

Methods: We developed a decision analytic model comparing 3 strategies: (i) esophageal manometry, (ii) screening impedance planimetry followed by esophageal manometry if needed, or (iii) nonalgorithmic usual care.

Impact of Patient Subgroups on the Efficacy and Safety of Methylnaltrexone for Opioid-Induced Constipation in Patients with Advanced Illness.

Purpose: We evaluated the impact of baseline patient characteristics on safety and efficacy of methylnaltrexone, a peripherally acting µ-opioid receptor antagonist, in patients with advanced illness with opioid-induced constipation (OIC).

Patients And Methods: This analysis pooled data from 2 randomized, double-blind, placebo-controlled studies (study 302: NCT00402038; study 4000: NCT00672477) in patients with advanced illness, including cancer, and OIC. Patients were randomized to receive subcutaneous methylnaltrexone (study 302: 0.

The Rise of Private Equity in Gastroenterology Practices.

Private equity (PE) investment in gastroenterology practices has significantly increased over the past several years. Because PE firms are prevented legally from owning a medical practice in many states, they usually form a management services organization to oversee all nonclinical aspects of the practice, leaving all clinical functions to the physician owners. Gastroenterology practices have become attractive investments to PE firms because of the willingness of gastroenterologists to join a PE-backed practice and the potential to earn profits through consolidating the market.