The American Gastroenterological Association and their friends at GI & Hepatology News do an annual deep dive into data and other catalysts underscoring GI trends to watch in the coming year, and three trends in particular caught our eye.
“Understanding and addressing a patient’s culture and socioeconomic situation is vital to their well-being, and physicians who share in the cultural backgrounds and lived experiences of their patients are more likely to bring this insight and understanding to medicine,” she says. “Yet over the last two decades, diversity among medical faculty is largely unchanged.”
The AGA and its diversity committee launched the AGA Equity Project to eliminate health disparities and inequities in access, support GI research that addresses the realities of diverse patient populations and educate AGA members of unconscious bias. AGA member demographics show a diversifying society, as the trainee community includes a higher percentage of underrepresented groups than full AGA members.
Then-ASGE president elect Dr. Jennifer Christie discussed how she plans to address issues of diversity, equity and inclusion while leading the society at Digestive Disease Week 2022 in May.
At U.S. medical schools, the proportion of racially or ethically underserved students has grown slowly since the early 2000s. The University of Maryland School of Medicine implemented a five-part plan in 2018 to recruit a more diverse group of students by mitigating bias and optimizing equity in the selection process. Within a year, no single ethnicity or race comprised the majority of a class for the first time. The proportion of underrepresented students in incoming classes rose from 13 percent in 2019 to 31 percent in 2021.
Back in 2013, the Centers for Disease Control and Prevention warned the U.S. Food and Drug Administration that ERCP patients were becoming infected likely due to reusable duodenoscopes, writes Dr. Rajesh N. Keswani, director of endoscopy for Northwestern Memorial Hospital and the director of quality for the Northwestern Medicine Digestive Health Center.
The FDA, as a result, has issued communications urging hospitals and endoscopy facilities to transition to innovative single-use duodenoscopes or reusable models that feature disposable components.
“The FDA’s request has created a lively debate among endoscopists,” Dr. Keswani writes. “While single-use instruments would, by definition, eliminate risk of infection and save time related to endoscope cleanings, the constant replacement costs and the environmental impact of their disposal have prompted much discussion.”
In addition to removing infection risk, single-use duodenoscopes offer ergonomic benefits, he adds. They do, however, increase greenhouse gas emissions from their manufacturing and produce more physical waste. Research has found single-use scopes to be effective in performing ERCPs of various complexity scores.
CRC screening was underutilized even before the onset of the novel coronavirus pandemic despite evidence that colonoscopy and stool-based tests are cost-effective and save lives, according to Dr. Rachel B. Issaka.
Dr. Issaka, an assistant professor of medicine and Kathryn Surace-Smith Endowed Chair in Health Equity Research at University of Washington School of Medicine, said the necessary initial recommendations to delay non-urgent procedures created unprecedented disruptions to CRC screening. They also risked increasing persistent racial and ethnic disparities in screenings and outcomes.
Populations who have been historically underserved medically also had the greatest morbidity and mortality from COVID-19. They therefore tended to be the most reluctant to return to care, including CRC screening, Issaka writes.
Mailed-to-the-home, stool-based CRC screening tests, including FIT, offer promise for increasing screening rates, but must be implemented as part of a broader CRC screening program to realize maximal benefit, she says: “For example, to ensure that mailed FIT programs do not exacerbate racial and ethnic disparities in CRC outcomes, abnormal results must be followed by a colonoscopy.”
The pandemic has provided the field with a “clear mandate,” Dr. Issaka adds: To develop long-term solutions that lead to consistent, effective, and trustworthy care for groups who have been historically medically underserved. CRC screening is a valuable way to accomplish this goal.
An October issue of GI & Hepatology News, the official newspaper of the AGA Institute, analyzed the most significant data trends from the previous year which will likely remain top of mind in the one to come.