Measuring Patient Satisfaction with Inflammatory Bowel Disease Treatments and Communication Regarding Treatment Changes 

How do you evaluate patients’ satisfaction and expectations when providing care for UC and CD?

How do you discuss with patients the idea of escalating/switching therapy, perhaps in the absence of symptoms, and target something they may not feel?

Silvio Danese, MD, PhD; Bruce Sands, MD, and Jean-Frederic Colombel, MD, conclude by sharing their approaches to evaluating patient satisfaction and expectations when providing care for ulcerative colitis and Crohn's disease, while also touching upon the importance of discussing the potential need for escalating or switching therapies to better manage the underlying disease processes. 

Bruce Sands, MD 

Atrial fibrillation (AF) is linked to an increase in embolic strokes and thus most patients with AF will be prescribed anticoagulants to decrease this incidence.

AF is frequent in chronic kidney disease (CKD) with estimates ranging from 16-21% in non-dialysis patient and up to 40% in dialysis patients.1 AF is associated with both worse cardiac and kidney outcomes with an increased risk of CKD progression.

 The incidence of stroke in End Stage Kidney Disease (ESRD) is 7-9 times greater than in the general population and 3-fold more deadly.

For many years, warfarin was the drug of choice to decrease strokes in all populations but serum monitoring requirements, diet restrictions and narrow therapeutic window led to multiple complications. With the introduction of the direct oral anticoagulant (DOACs) medications, the complication rate in AF was significantly decreased.

As is true for most drug trials, patients with severe CKD (defined as an eGFR 

25 ml/min) were excluded from the DOAC trials.

 This is not unexpected; kidney patients have multiple comorbidities and are treated with multiple medications.

These comorbidities and medications add a level of complexity to the evaluation of adverse events during a drug trial. Yet, for a population where close to half of the population has AF, we do not have answers about the use of DOACs.

As there is no guidance from the pivotal DOAC trials for the CKD and ESRD patients, the kidney community has undertaken the collection of data from real world use of DOACs. We know that acute kidney injury (AKI) is significantly lower with the use of DOACs vs warfarin.

This is true for all stages of CKD, even in the elderly.

Using a meta-analysis approach, we have seen that DOACs have a better safety and effectiveness profile than warfarin.

 For this reason, the Kidney Disease Improving Global Outcomes (KDIGO) expert workgroup has developed recommendations for use of DOACs in CKD.

Yet, there is still a population that KDIGO recommendations did not address: the ESRD patient.

In the kidney failure patient, the incidence of AF is 40% and the stroke and sudden cardiac death are common.

 While cardiology defers to nephrology when treating ESRD, nephrology is divided on optimal treatment for this population. Most trials are retrospective and observational. However, recently randomized, controlled trials have been conducted.

With the most recent trial data available, the consensus is that warfarin is the most dangerous for this population whether it is used for AF prophylaxis or treatment for recurrent thromboembolism.

 Warfarin increases the incidence of bleeding without decreasing mortality. Two other large trials looking at DOAC vs warfarin both showed a better safety profile for apixaban but there were significant episodes of bleeding in the dialysis population.

 For this reason, the recently closed preliminary trial of three separate trial arms, which examine apixaban, warfarin, and no treatment, respectively, is being closely watched.

This Canadian/Australian trial included 151 participants and is a pilot to evaluate if we should 

 be treating the dialysis population with anticoagulants. The trial was completed in late December 2022. Results are pending.

If, as expected, the no treatment arm has a similar outcome profile with less bleeding complications, we will have to reassess our mantra of 

 while we stop treating the AF patient on dialysis with anticoagulants. A definite relearn for all of us.

Wanner C, Herzog CA, Turakhia MP; Conference Steering Committee. Chronic kidney disease and arrhythmias: highlights from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. 

Bobot M, Suissa L, Hak JF, et al. Kidney disease and stroke: epidemiology and potential mechanisms of susceptibility. 

Garlo KG, Steele DJR, Nigwekar SU, et al. Demystifying the Benefits and Harms of Anticoagulation for Atrial Fibrillation in Chronic Kidney Disease. 

Harel Z, McArthur E, Jeyakumar N, et al. The Risk of Acute Kidney Injury with Oral Anticoagulants in Elderly Adults with Atrial Fibrillation. 

Malhotra K, Ishfaq MF, Goyal N, et al. Oral anticoagulation in patients with chronic kidney disease: A systematic review and meta-analysis. 

Wetmore JB, Herzog CA, Yan H, et al. Apixaban versus Warfarin for Treatment of Venous Thromboembolism in Patients Receiving Long-Term Dialysis. 

Mavrakanas TA. Should Oral Anticoagulation Be Used in ESKD Patients on Hemodialysis with Atrial Fibrillation?: COMMENTARY. 

Pokorney SD, Chertow GM, Al-Khalidi HR, et al for the RENAL-AF Investigators. Apixaban for Patients With Atrial Fibrillation on Hemodialysis: A Multicenter Randomized Controlled Trial. 

Reinecke H, Engelbertz C, Bauersachs R, et al. A Randomized Controlled Trial Comparing Apixaban With the Vitamin K Antagonist Phenprocoumon in Patients on Chronic Hemodialysis: The AXADIA-AFNET 8 Study. 

Strategies for the management of atrial fibrillation in patients receiving dialysis (Safe-D) ClinicalTrials.gov identifier NCT03987711

Kim Zuber, PA-C, and Jane Davis, DNP, offer insight into the use of DOACs in people with atrial fibrillation and chronic kidney disease. 

Using DOACs in People with Chronic Kidney Disease, with Kim Zuber, PA-C, and Jane Davis, DNP

Debra Davis, CRNP

Let’s talk about the elephant in the room. We’ve been bouncing around it a little. Let’s talk about vaccine hesitancy and how you guys address that in education standpoints as well as how that can impact vaccination compliance or resistance. What’s your language? What’s your methodology around noticing that? Do you notice it? Do people say it to you? Do you feel it? How do you work down that road to try to convince people to get a vaccine?

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP:

 This is my baby. This is my doctoral work, so I love this stuff. A couple of things that I want people to know is that studies are pretty clear these days that even people who are vaccine proponents now feel the need to question science and vaccines. Every provider should expect what used to be a 30-second recommendation to now take 5 minutes because people feel the need to ask the questions about it. Even though they’re going to take it, they feel the need. There’s more vaccine hesitancy out there.

The other thing is that we talked about strong recommendations. We call it presumptive vs participatory. In a study, they followed providers who asked, “How do you feel about getting your shots today?” It shouldn’t surprise you that less than 10% of people took their shots. But when the provider said, “You’re due for 2 shots today. It’s okay to give them together,” 80% of people took those vaccines.

My last point on vaccine hesitancy is that you have to be prepared that people are going to ask about it. Take a deep breath and answer their questions. There are going to be the 4% of the population who are vaccine refusers. I’ve learned from all of my research that you will never move those folks. They believe in something that none of us can even fathom, but they come up with it. If they want to believe something, they’re going to google it and find research to support their beliefs. You’re never going to move them.

It’s the movable middle that we have to focus on. That’s the 20% to 40% of the population who will go based on a trusted source, as JAM [Jacinda Abdul-Mutakabbir, PharmD] mentioned. If they trust you and you make that recommendation, they’ll listen. Focus on the movable middle. The ones who march in and say, “What vaccines do I need? Give them to me,” are a provider’s dream. “Sure, give me everything I need.” With people in the middle, we have to take a breath, meet them where they’re at, be honest with them, give them what they’re asking, and don’t go into too much detail.

 Yes. I’ve also seen people talk about how sometimes it takes more than 1 interaction with a patient to convince them. Maybe they come in and you tell them, “You need this vaccine today,” and they say, “Absolutely not.” But by the end of the appointment, they say, “Tell me more about it and I’ll think about it for next time.” We see this with patients in the clinic with other vaccines as well. “I’m not ready to get 5 vaccines today, but I’ll get 1 next time.” We think, “OK, we’ll take what we can get. Let’s just start off on the right foot.” Sometimes it takes persistence and patience, which we don’t all have at this point in the pandemic. But there are people who can be swayed if we take the time, ask them multiple times, and not give up on them.

 Yes. We use a Z code in our charts for vaccine refusal by patient or parent. That’s a signal to the nurse practitioner who sees them next that there’s been a vaccine that they didn’t get the last time, and to take a look at the note and try to follow up on that conversation.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP, and Madeline King, PharmD, BCIDP, provide insight on vaccine hesitancy among patients and the importance of increasing vaccine uptake to protect against SARS-CoV-2.

Addressing Vaccine Hesitancy and Uptake for SARS-CoV-2

Jacinda Abdul-Mutakabbir, PharmD

The panel discusses the mechanism of treatment-emergent hypophosphatemia that occurs following the administration of certain intravenous iron formulations.

Treatment-Emergent Hypophosphatemia Following Administration of Intravenous Iron

Video content above is prompted by the following:

Treatment-emergent hypophosphatemia is now widely recognized as a phenomenon that can occur following administration of certain IV iron formulations and within the first 2 weeks after administration. Can you discuss the mechanism of treatment-emergent hypophosphatemia?

Jordan Axelrad, MD, MPH

We have heard the statistics many times. There are more than 7000 

 and for more than 90%, there are no treatments available. Our organization supports a community affected by one of the 90%—Niemann-Pick Disease including ASMD and NPC, both rare genetic, progressive, and often-fatal lysosomal storage disorders.

There are fewer than 2000 known cases worldwide, many affecting children. Symptoms include cognitive impairment, clumsiness and difficulty walking, enlarged spleen and liver, difficulty swallowing and eating, fatigue, increased fracture risk, and early satiety. There are currently no approved treatment options in the US.

The great news for the Niemann-Pick community is that promising treatments are in the later stages of clinical development with the potential for regulatory approval in the coming year. Achieving this milestone would be a significant victory for patients and their families who face significant challenges living with Niemann-Pick. But this potential good news also highlights an important consideration in planning for the introduction of new treatments for patients who are in desperate need. How do you prepare patients and families to transition from an era of no hope to one where treatment is available?

Much of our work at the National Niemann-Pick Disease Foundation (NNPDF) in recent years has focused on meeting this challenge head on and our approach in many ways serves as a template that other rare disease communities might consider.

From our earliest days, NNPDF has provided support services to patients living with Nieman-Pick Disease and their families. These efforts have focused on building broader awareness of the disease and helping to identify and expand the services and resources that families need.

We have also taken steps to keep families updated about the range of clinical research programs that have been initiated in recent years to try to develop new treatments. Our recent annual conference included a full schedule of presentations and updates on these clinical research programs, and we had more participants in our virtual meeting this year than ever before.

As we continue our focus on disease awareness and patient support, we have also in recent years had to expand our efforts to include both information and education to prepare the Niemann-Pick community to transition to an era when treatment might be available. In addition to helping families learn about and understand the process for developing and approving drugs in the US, we are also now providing resources to help them better understand and manage issues related to their healthcare coverage, reimbursement, patient access and industry-sponsored financial assistance programs.

We are helping them understand that there will be indications and eligibility criteria for different treatments and that NNPDF is working to ensure that access to treatment through healthcare coverage is available to as many patients as possible. We are also developing new resources that outline the important questions and topics that patients and families should discuss with their medical provider to empower them to take a more active role in often complex treatment decisions.

While availability of treatment is good news, many of the issues associated with patient access can cause stress and confusion. An important goal in developing programs related to the introduction of an approved treatment is to help reduce anxiety and outline a clear path forward in accessing care. For many rare disease communities, another daunting but welcome challenge for many families may be the need to reconsider many longstanding plans for the future once approved treatment is available.

In many cases, an approved treatment will mean major changes in how patients think about their own health, plan for their care, and engage with their medical teams. Treatment may present new challenges that require careful planning and monitoring. Patients and caregivers might need to reassess plans related to education, careers, job training, and living independently. Once again, our goal must be to provide the insights and support services that can help reduce any challenges associated with making important life decisions at every stage.

The final focus in supporting patients is often related to helping them manage expectations. In many cases, treatments for rare diseases will have some limitations in areas including efficacy, safety and cost. Advocacy leaders can play a role in helping their communities work with their healthcare teams to assess, understand, and address all the factors related to treatment so that patients and caregivers can make informed decisions.

In some cases, patients and caregivers may need very targeted services to support their psychological and emotional health. Peer-to-peer connections can be especially effective in helping patients handle the emotional impact of the transition to treatment.

Of course, none of these challenges should dampen the new hope that a first approved treatment can bring to a rare disease community. A first treatment is both a milestone and a sign that research is advancing and could lead to more personalized treatment options or combination therapies in the years ahead.

By recognizing the needs of patients and families whenever a new treatment becomes available, advocacy organizations can continue to lead in bringing them the targeted information and support they need to access care and thrive. The key is recognizing that an approved treatment and a new standard of care is not the end of the road in patient advocacy. It is a new direction and the beginning of a new era of hope that requires careful planning, new resources and very customized support.

Joslyn Crowe, MSW, MA, is executive director of the National Niemann-Pick Disease Foundation, Inc., a non-profit, unbiased patient advocacy and family support organization dedicated to supporting and empowering patients and families affected by Niemann-Pick disease, through education, collaboration and research.

The views expressed in this piece are those of the author, not necessarily those of the publication.

Healthcare experts and clinicians interested in contributing to HCPLive may contact the editorial staff 

Getting a Treatment Is Not the End of the Road in Rare Diseases

Joslyn Crowe

Maliha Ahmed, DO

Muthiah Vaduganathan, MD, MPH, is a cardiologist specializing in cardiorenal metabolism at Brigham and Women's Hospital in Boston, MA. Vaduganathan is a member of Practical Cardiology's advisory board and co-host of Don't Miss a Beat, a podcast presented by Inside Cardiology.

Finding a Role for GLP-1 RAs, Incretin Therapies in Heart Failure, with Muthiah Vaduganathan, MD, MPH

GLP-1 receptor agonists and combination incretin therapies have taken the medical community by storm in recent years with trial after trial proving benefits on outcomes across a multitude of diseases, including weight management, secondary prevention of cardiovascular disease, and, now, obesity-related heart failure with preserved ejection fraction (HFpEF) based on data from the SUMMIT trial.

A multicenter, randomized, double-blind, parallel, placebo-controlled phase 3 trial, SUMMIT assessed the safety and efficacy of tirzepatide among a cohort of 731 adult patient adults with HFpEF and obesity, with or without type 2 diabetes, enrolled at sites in 10 countries across 4 continents. The trial leveraged a pair of primary outcomes of interest—a composite of time-to-first occurrence of urgent heart failure visit, heart failure hospitalization, oral diuretic intensification and cardiovascular death to study completion and the change in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) from baseline to week 52.

Results of the trial suggested a composite endpoint event occurred among 9.9% of the tirzepatide group and 15.3% of the placebo group (HR, 0.62; 95% CI, 0.41 to 0.95; 

 = .026). Analysis of KCCQ-CSS at 52 weeks suggested use of tirzepatide was associated with a mean change of 19.5 (SD, 1.2) from baseline to week 52 compared to a change of 12.7 (SD, 1.3) among the placebo group (between-group difference, 6.9; 95% CI, 3.3 to 10.6; 

Although not examining hospitalization outcomes, SUMMIT is the second trial to demonstrate meaningful changes in quality of life among patients with obesity-related HFpEF, with the STEP-HFpEF program finding benefit on KCCQ with use of semaglutide.

American Heart Association (AHA) Annual Scientific Sessions 2024

, Muthiah Vaduganathan, MD, MPH, codirector of the Center for Cardiometabolic Implementation Science of Brigham and Women’s Hospital, took part in a debate session where he argued in favor of a role for GLP-1 receptor agonists in heart failure care. As part of our on-site coverage of AHA 24, we sat down with Vaduganathan to learn more about how he envisions GLP-1 receptor agonists and incretin therapies fitting into heart failure care in light of recent data.

 include Amgen, AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Cytokinetics, Lexicon, and others.

Tirzepatide for Patients with Heart Failure with Preserved Ejection Fraction and Obesity: the SUMMIT Trial

. Paper presented at: American Heart Association Scientific Sessions 2024; November 15 - 18; Chicago, Il. Accessed November 16, 2024.

Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. 

. 2023;389(12):1069-1084. doi:10.1056/NEJMoa2306963

GLP-1 receptor agonists and combination incretin therapies have shown significant benefits in managing obesity-related heart failure with preserved ejection fraction (HFpEF), as evidenced by the SUMMIT trial. This phase 3 trial demonstrated that tirzepatide significantly reduced composite endpoint events and improved quality of life, as measured by the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS), compared to placebo. These findings align with previous results from the STEP-HFpEF program using semaglutide. The role of GLP-1 receptor agonists in heart failure care is gaining support among experts.

Muthiah Vaduganathan, MD, MPH, discusses the need for cardiology to embrace a role for GLP-1 receptor agonists and incretin therapies, with a focus on obesity-related HFpEF.

Muthiah Vaduganathan, MD, MPH

 I want to give us all an opportunity to give some advice or practice pearls to all of our viewers including other hematologists, maybe focusing a bit on red blood cell health or other areas that you think are important including decreasing long term organ damage. I’ll start with you Elna. What advice or practice pearls do you have for our audience?

 I think it is the shifting paradigm that yes sickle cell is an anemia and it causes pain, but the thing that reduces survival and still has maintained the early mortality in sickle cell disease patients compared to the general population is not necessarily the pain or the pain episodes. It is the progressive organ dysfunction and so we should slowly move away from the deception of sickle cell being a mild disease. We should consider it like diabetes or hypertension and that the organ damage is also a silent killer. If we shift that paradigm the way we approach them and how we approach our practice even towards them, we will shift an emphasis in embracing and offering disease-modifying agents to almost all of our patients and having the discussion of the impact of end organ dysfunction and damage in overall longevity and mortality.

 Thank you so much, Elna. Nirmish, you’re next.

 I would just extend the conversation in the sense that educate and be real, continue to educate. I love the descriptions that came up in our conversation today. As I told Matt, I’m going to use some of those. I’m very graphic about drawing pictures and being in the room and getting them to really understand and see what’s happening inside of them because that gives them a little bit of control of knowing what’s happening to themselves. Otherwise, it’s a chronic disease that they have no control of. What control can you give them? It’s educating them about the disease and being able to tell others about what’s happening to them. I think the pearl for me is to educate them and that includes education about these new therapies, and the new drugs that are available now. I even actually started to talk to them about the new drugs that potentially could come.

When we talk about gene therapy, I still kind of give a teaser about it. We’re not there yet. It’s all about being real with them. We don’t have the data. I’m trying to get them to understand that’s why research studies are occurring; this is what we hope that patients can be involved enough with. The patients, I can’t say this enough, they’re really smart. They’re really savvy about connecting to others and they want the information. They just take it up and soak up this information and I think it’s good for the community. Those are some of the pearls. And I mentioned it before, talk about these new medicines when they don’t need it. Talk about everything but pain until you have to talk about pain. Elna brought this up, that there might be the pediatrician inside of us trying to think about the whole world and not the adult side, but I think that our adult colleagues, and I know Biree you do this as well, I think we’re understanding that the quality of life is a big deal. Thus, I think those are some things to consider as we have our colleagues continue to see patients with these new drugs.

 I’ll leave you with 2 more images or analogies that I use because I think that there’s nothing sexy about having a chronic disease and a lot of it is just persistence of the patients, families, and providers in meeting the treatment goals and treatment plan. As I tell families when they’re going for their annual ophthalmology visit or their annual TCD [Trans Cranial Doppler], there’s nothing sexy about this. It’s like changing the oil in your car. It’s a pain. It’s annoying. It costs a little money. But if you don’t do it, what happens to the car? All the kids know the answer to that. It breaks down. Thus, that’s why [there is] this constant persistent pressure to keep on the plan is really very important.

The other one that I find useful to try and sometimes improve adherence to the treatment plan is the idea that organs are like a rock on the beach and the waves every day hit the beach, and they hit that rock and every day you don’t see anything. It’s just like the damage which is done every day with sickling even though you have no symptoms. There’s some clinical inexorable accrual of organ damage is what my mentor used to call it. There’s a little bit of damage every day that’s imperceptible. When you come back to that beach at the end of high school and you see the rock there, it’s still getting pounded by the wave and then you go away to college and then you have kids and you come back and all of a sudden there’s no rock on the beach. It’s just sand. It’s that daily pounding of that rock by a wave that you don’t notice the rock changes, but it’s becoming sand slowly and that’s what we’re trying to prevent with the daily damage of sickle cell disease on your organs.

Hydroxyurea and other disease-modifying agents are trying to prevent that from the daily point of view so that, as Nirmish pointed out or Elna pointed out, we’re trying to improve the overall health and organs of our patients who we present to our adult colleagues so that they can ultimately hopefully have a prolonged life and that sickle will no longer be an either immediately life-threatening or life-limiting disease, but hopefully have normal lifespan and quality of life. That’s really the goal. It’s hard. It’s hard to do that as a child, as a teen, and as an adult with so many other pressures on us but to encourage them to continue to follow the treatment plan with what we have while also being cognizant of what’s coming and what might be until something better comes along, as I say. Let’s follow this plan now. My promise is to keep them informed of what’s potentially available, both experimental and approved, and then they can choose collaboratively with us to potentially take on some of those new therapies.

Thank you, Matt. I really love the imagery in those analogies. I think we’ll all start to use them. I just wanted to add that I think when I speak to colleagues, clinicians of any specialty, patients, the community, family members who help to support their loves ones living with sickle cell disease; I really tell them that the tide is changing in sickle cell disease and it’s changing pretty quickly. Not only do we have more therapies available now, but our understanding of new potential targets is also growing exponentially and we’re seeing that playing out in the clinical trials that are available and that will be emerging in the near future. I think that sickle cell disease as we know it is changing. It is changing. Our patients may not feel that way today, but I do talk to my pediatric colleagues including some of you on the webinar today and I’m always heart-warmed when I hear the hydroxyurea story, for example. My colleagues say that ever since we’ve been giving it to babies starting at 9 months of age, we have such a healthier kindergarten class when we see those 5-year-old’s go off. That just warms my heart.

I think as an adult practitioner I’ve not yet begun fully to that extent to see the effects of novel agents or disease-modifying therapies or even transplant for that matter because we don’t do enough of it in the adult world. But I think that that tide is really changing. Just like hemophilia, for example, where we’ve come a long way, the expectation in hemophilia management is no leads. When we think about HIV care and we were making people toxic, sick with therapy as we knew it a few decades ago, and now people can be on 1 pill once a day. I think that there’s the potential in the very near future, hopefully in all of our lifetimes, to see that amazing impact on those affected by sickle cell disease. I’d say the future is definitely bright. I want to thank Elna, Nirmish, and Matt. And I want to thank you all for watching this 

. If you enjoyed the content, please subscribe for our E-newsletters to receive upcoming peer exchanges and other great content right in your inbox.

A panel of experts in hematology discuss the future directions for sickle cell disease and share practice pearls for disease management. 

Practice Pearls for the Management of SCD

Nirmish Shah, MD

The panelists stress the significance of a comprehensive approach to patient care.

Cardiometabolic Medicine: Seeing the Patient as a Whole

The panelists stress the significance of a comprehensive approach to patient care, acknowledging the interconnected nature of cardiovascular, kidney, endocrine, and obesity-related benefits, and highlighting that addressing secondary diseases can minimize overall disease risk in patients.

Pam Taub, MD, FACC, FASPC

Colorectal cancer is the third most common cancer and a leading cause of cancer death in the United States. Colonoscopy, recommended for all adults aged 45 or older, is a crucial screening tool where gastroenterologists remove polyps to prevent them from becoming cancerous. Recognizing the importance of detecting these polyps, the FDA authorized the first AI-assisted device for colonoscopies in 2021.

Dr. Gyanprakash Ketwaroo at the West Haven VA emphasizes the value of AI in providing a "second set of eyes" during colonoscopies. This technology, known as computer-aided detection (CADe), has shown promise in increasing adenoma detection rates, according to a meta-analysis led by Dr. Dennis Shung. The analysis, which reviewed 44 studies, found that CADe systems improved adenoma detection compared to standard colonoscopies, although the increase in advanced colorectal neoplasia detection was slight.

Shung's meta-analysis suggests further research is needed to assess AI's impact on interval colorectal cancer rates and recommends that future studies should randomize colonoscopists to understand better where CADe can be most effective. Yale has implemented this AI technology at the West Haven VA campus, providing additional support for endoscopists and trainees during procedures.

The American Gastroenterological Association (AGA) is also preparing new clinical guidelines for using AI in colonoscopies, for which Dr. Shung is the co-first author. These draft guidelines conditionally recommend CADe for polyp detection in adults, considering the technology's safety and efficiency. The AGA is gathering feedback from both providers and patients on AI use in screening, aiming to publish the final guideline in March 2025, with regular updates as the technology evolves.

Overall, AI-assisted colonoscopies represent a significant advancement in colorectal cancer screening, with the potential to enhance detection rates and outcomes for patients. Clinicians are advised to stay informed on evolving guidelines and technological developments to offer the best care possible.

Colorectal cancer ranks as the third most prevalent cancer and a major cause of cancer mortality in the U.S. Colonoscopy is vital for early detection, with AI-assisted devices enhancing polyp detection. The FDA approved the first AI device for colonoscopies in 2021, and studies show improved adenoma detection rates with AI. Further research is needed to evaluate AI's impact on interval cancer rates. The American Gastroenterological Association is developing guidelines for AI use in colonoscopies, with final recommendations expected in March 2025, emphasizing the importance of staying updated on advancements.

Computer-aided detection during colonoscopies with AI may help increase adenoma detection rates.

Authors