Damian McNamara

October 07, 2016

LAS VEGAS — A phase 3 multicenter trial of conscious sedation during colonoscopy is just one of the potentially practice-changing studies that will be presented here at the upcoming American College of Gastroenterology (ACG) 2016 Annual Scientific Meeting.

The trial, which compares remimazolam with midazolam, could lead to a "potential major advance," said John Saltzman, MD, from Brigham and Women's Hospital in Boston, who is chair of the ACG educational affairs committee.

"Remimazolam is a drug, in my understanding, that gastroenterologists can give," meaning there would be no added anesthesia charge, he told Medscape Medical News.

But "the beauty of the conference, if you look at it in its entirety, is that we cover almost all the areas in GI relevant to clinicians quite well," said Dr Saltzman.

Another potentially practice-changing presentation will be a case series of patients who underwent gastric peroral endoscopic pyloromyotomy (G-POEM), a new endoscopic technique for gastroparesis. The intervention involves tunneling through the submucosa into the muscle of the pylorus, similar to what a surgeon might do. It is promising, in part, because gastroparesis is "something that has been very problematic. We don't have drugs that work well," Dr Saltzman explained. And the drugs we do have "have major side effects."

And a proof-of-concept study on the management of gastrointestinal bleeding could also lead to a change in clinical practice. Researchers compared two reversal agents — four-factor prothrombin complex concentrate (4F-PCC) and standard fresh frozen plasma — in patients with elevated INR.

Guidelines from two cardiology societies now recommend the use of 4F-PCC. This is interesting for gastroenterologists, "because it goes along with what the current guidelines are saying, but not what the clinical practice is," Dr Saltzman said.

Biosimilars and Pancreatic Cysts

There will also be a symposium on the use of biosimilar agents and a research session on the safety and efficacy of new medications for ulcerative colitis and Crohn's disease.

Pancreatic cysts will be featured in a series of studies looking at management. Two studies will look at DNA and DNA methylation to determine whether a cyst has malignant potential, which Dr Saltzman described as "a very controversial area." A study of a tiny confocal probe inserted through a needle into a pancreatic cyst, allowing clinicians to assess a cyst in real time at the cellular level, will also be presented.

"Everyone is trying to figure out how we best manage pancreatic cyst patients right now," Dr Saltzman said. "When you look at all these together, there is a lot going on in this field."

"One of the strengths of our meeting is that we don't have a lot of competition," in the form of simultaneous sessions on the same topic, said ACG President Kenneth DeVault, MD, from the Mayo Clinic in Jacksonville, Florida.

This is no small feat. Of the 2764 abstracts submitted, 69 will be offered as oral presentations and about 2200 will be posters. And when you add in late-breaking studies, in-depth named lectures, and special receptions — for women and minorities, international attendees, and nurse practitioners and physician assistants — attendees will have a lot to choose from.

Practice Management

New this year is a symposium on practice management. It will address "issues that are really key to people in practice now: managing practice independence, incorporating alternative payment models, measuring patient satisfaction, and more," Dr Saltzman reported. "It's getting harder for independent practitioners to survive and understand what they need to do to meet quality metrics," he pointed out.

In one of his roles as president, Dr DeVault chooses the topics and speakers for named lectures.

The lecture on the past, present, and future of hepatitis C treatment "is one of the most important ones," he noted. Progress in this area has been "one of the biggest changes in my 25 years in gastroenterology" — from discovery of the virus to reliable treatment with new medications.

The lecture on squamous cell carcinoma in the esophagus of a member of the Masai tribe in Kenya will bring an international perspective to the meeting. "This is really something I want to have American doctors understand," he explained. "A lot of people in the College do work internationally, and the diseases are different."

"I want gastroenterologists to know there are things they can do in their community — and if they're bold, outside their community — to improve gastrointestinal health throughout the world," Dr DeVault said.

In addition, one of the presenters will look at the prospect of curing functional GI diseases, and prominent gastroenterologist Philip Katz, MD, from the Einstein Medical Center in Philadelphia, will report what he learned when he unexpectedly became a patient.

With so much going on over the 6 days, where will Dr DeVault start? "My specialty is esophageal diseases, so I will look for things related to what I do. But the meeting also gives me an opportunity to attend sessions outside my area of expertise."

Dr Saltzman and Dr DeVault have disclosed no relevant financial relationships.

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