Digestive Disease Week 2025 Summary

Douglas Robertson, MD, MPH, Dartmouth, Geisel School of Medicine, AGA Council Chair

Hi, Doug Robertson. I'm at the Geisel School of Medicine at Dartmouth. I'm a professor there. It's been a really exciting few days here. I have the opportunity to participate in some of the planning. But of course, I've been here as well.

I'm interested in colorectal cancer. That's the area that I do most of my research in, in the area of screening and surveillance for colorectal cancer. We think we have some ideas about the causes of colorectal cancer -- obviously, some combination of nature and nurture. There's genetic risk factors and there's also environmental risk factors. But there was this interesting abstract where they looked at maps and showed the incidents of colorectal cancer along the Mississippi River and showed how there was increases in areas where there was likely runoff from the Mississippi river.

And, you know, I'm not suggesting folks along Mississippi River should move. It's not that dramatic, but it raises this idea about toxins, hat could be in the water. Could that be an important risk factor in certain areas of our country? So, just kind of a I think an interesting abstract in a way that that caught my attention.

In terms of what I think will be an important paper that people will definitely read about and see is a large, randomized controlled trial in the space of Barrett's esophagus. It is a risk factor for the subsequent development of esophageal cancer. But there have been questions or controversies over many years about how frequently to do these follow-up examinations in people with Barrett's esophagus.

Initially, we were doing them much more frequently, more on the kind of yearly or every three years. Now, recommendation statements have kind of lengthened that out.

But this particular study that was established many years ago, over a decade ago, randomized folks who had Barrett esophagus to no surveillance versus every two years surveillance.

Again, the no surveillance group certainly could get endoscopy if they had symptoms. But in terms of this idea of routinely doing them, one group was getting them every two years, the other group just as needed.

And so, in this very large study with 3,500 folks or so in the UK, they didn't identify any clear benefit in having the regular surveillance exams in terms of the kind of outcomes that were most interested, developing, dying from esophageal cancer.

So, I think that's the kind of I would say groundbreaking trial that I think I enjoy coming to DDW because you see that presented and you see the research actually before or as it's just getting into the journals.

Bariatric surgery or GLP-1 agonist in patients with MASLD? A retrospective cohort analysis over a 6-year period.

Kaitlyn Gernhard, Resident, Internal Medicine, Allegheny Health Network, Pittsburgh

My name is Kaitlyn Gernhard. I am a first-year internal medicine resident at Allegheny General Hospital. Our research was done through Allegheny General Hospital, Stanford Medicine, and Beth Israel Hospital.

Our study looked at clinical outcomes in patients with MASLD to treatment with GLP one receptor agonists versus bariatric surgery. We really performed the study because the prevalence of obesity is increasing in the United States. It’s estimated that four in 10 Americans are considered obese and it's estimated that 66 million Americans in the United States have MASLD.

So, we really wanted to take a look into if there was a difference in clinical outcomes in patients treated with GLP-1 and bariatric surgery, which are two very common mechanisms that we use to treat these conditions.

So, we used the TriNetX database and did a retrospective study using that database. We had two different cohorts.

We first identified any patients who had a diagnosis of MASLD from January 1^st, 2015, to December 31^st, 2021. And after we had those that patient population identified we divided them into if they were treated with bariatric surgery and only included those with gastric bypass and sleeve gastrectomy and then our second cohort was patients treated with GLP-1 receptor agonists and we only used the ones that were approved for weight loss specifically.

And then after we defined our cohorts, we did propensity matching for like laboratory values, procedures, medications, comorbid medical conditions, just to try to limit any confounding variables.

And after we ran the study through TriNetX, we found that patients who were treated with bariatric surgery had a higher risk of all-cause mortality, a higher risk of MALO, which is major adverse liver outcomes. Those were really the biggest findings in our study.

It was a retrospective study, so it's kind of hard to draw like a direct cause and effect relationship. We would like to see randomized control trials and prospective studies that really look at GLP1 receptor agonists versus bariatric surgery to give better guidelines.

However, in the future it might be found that it might be beneficial to start patients with GLP1 receptor agonists like patients with MASLD start with GLP1 receptor agonists before going straight to bariatric surgery which is more invasive.