Introduction
As 2025 draws to a close, the ripple effects of the CMS pause on broad coverage of anti-obesity GLP-1 receptor agonists are still being felt across the American healthcare landscape. For many clinicians, that single administrative decision crystallized the tension between scientific progress and system inertia. Drugs such as semaglutide and tirzepatide have reshaped the treatment of metabolic disease, showing benefit in cardiovascular risk reduction, liver fibrosis regression, and even inflammatory bowel disease comorbidities. Yet under current Medicare law, these same therapies remain excluded from routine reimbursement when prescribed for obesity alone.
This policy vacuum reaches far beyond endocrinology. Gastroenterologists see its consequences every day in untreated metabolic dysfunction-associated steatohepatitis (MASH), rising obesity-related reflux, and delayed prevention of colorectal neoplasia in high-risk populations. The CMS stance has effectively slowed the translation of breakthrough research into equitable clinical care.
Against this backdrop, the American College of Gastroenterology (ACG) 2025 Annual Scientific Meeting, which will be hold in Phoenix from October 24 to 29, arrives as both a celebration of innovation and a reminder of the obstacles that remain.
The program spans the spectrum from artificial-intelligence-assisted colonoscopy and updated colorectal cancer screening strategies to the growing recognition of metabolic and lipid abnormalities in IBD.
As I prepare to chair sessions and exchange notes with colleagues, one truth is evident: every advance showcased here, from endoscopic automation to precision biologics, must ultimately navigate the same policy and payment ecosystem. The science of gastroenterology continues to accelerate. The question for ACG 2025 is whether our systems and our advocacy can keep up. For additional perspective on how these themes have already been discussed in practice, see Digestive Disease Week 2025 – From IBD Breakthroughs to AI in Endoscopy. Reflections from Dr. David A. Lieberman.
By Dr. Douglas K. Rex, MD, MACG, Distinguished Professor of Medicine, Indiana University School of Medicine
Colorectal Cancer Screening: Rethinking Risk and Reach
Each year at the ACG Annual Scientific Meeting, I look first to the colorectal-cancer-screening agenda. It’s the foundation of what we do, and in 2025, the program in Phoenix promises to push that foundation forward. The sessions this October reflect both the maturity of our science and the urgency of catching up with the patients we lost during the pandemic years.
One symposium I’ll be watching closely, “Post-Pandemic CRC Screening: Who’s Still Missing and Why,” will review national adherence trends and payer data showing persistent disparities especially among Medicaid beneficiaries and rural populations. Screening rates may have recovered to two-thirds of adults, but the remaining one-third represents preventable disease. The discussion will focus on access models: mobile colonoscopy units, bundled navigation, and tele-referral systems that bring screening to the patient rather than the reverse.
On the scientific side, several late-breaking abstracts will explore risk-adaptive surveillance intervals after negative colonoscopy. We’re learning that comorbidities such as obesity, diabetes, and fatty-liver disease can accelerate adenoma formation. That insight could soon move us from fixed timeframes to biologically informed intervals a step toward true personalization of prevention.
AI will also play a leading role in the screening sessions. The Technology in Endoscopy Forum will present new data from FDA-cleared CADe platforms and early CADx prototypes capable of characterizing diminutive lesions in real time. These tools are not theoretical anymore; they’re entering routine U.S. practice. What I’ll be listening for are strategies to integrate AI metrics into existing quality-reporting frameworks, so that improvement is measured by clinical impact rather than novelty.
The program also highlights the expanding space for non-invasive options stool DNA, FIT-DNA hybrids, and plasma methylation assays. The question isn’t whether these tests will compete with colonoscopy but how they can complement it, reaching patients who would otherwise remain unscreened.
Finally, several panels link metabolic health and colorectal risk, echoing a broader theme across this year’s ACG: prevention is systemic.
Managing weight, diet, and inflammation, including through GLP-1 therapy where accessible, is part of the same mission. For attendees planning their schedules, I’d suggest starting here. The future of colorectal-cancer prevention will be defined not just by what we can detect, but by who we can reach, and ACG 2025 may help us get closer to that goal.
AI Endoscopy and Real-World Integration
Of all the technologies transforming gastroenterology, artificial intelligence in endoscopy remains the most tangible and the most debated. At ACG 2025 in Phoenix, AI is set to dominate the technology track. From live demonstrations to FDA-regulated updates, it’s clear that we’ve moved past theoretical enthusiasm and into the stage of operational realism.
The session I’m most eager to attend, “AI in Colonoscopy: Beyond Detection,” promises to explore the practical frontier: how to integrate AI into existing clinical workflows without slowing procedures or overwhelming staff. Detection algorithms, or CADe systems, have already proven their value, increasing adenoma-per-colonoscopy rates by roughly 10–15% across multiple multicenter studies. But now attention is shifting to characterization (CADx) AI’s ability to predict histology in real time, potentially allowing for “resect and discard” strategies in diminutive lesions.
This evolution raises practical questions that ACG 2025 will tackle head-on:
- How will reimbursement evolve when AI contributes directly to polyp characterization?
- Should AI outputs become part of the quality metrics used for pay-for-performance?
- Who holds liability if an AI-assisted report misses a lesion or misclassifies tissue?
The Technology Forum and the ACG Endoscopy Master Course will each include discussions on these medico-legal dimensions, with speakers from the FDA’s Digital Health Center of Excellence offering regulatory perspective. I’m particularly interested in the panel titled “From Research to Routine: Coding, Billing, and Accountability in AI Endoscopy.” It’s the kind of conversation that determines whether a promising tool becomes a practical standard.
One of the most valuable aspects of this year’s AI programming is its realism. Presenters will discuss not only detection rates but also workflow fatigue, false positives, and the learning curve required to trust (but verify) AI cues. For many centers, especially smaller U.S. practices, the challenge is logisticalintegrating new visual interfaces into existing scopes and monitors without major hardware investment. That’s why I’ll be watching for data on portable and cloud-based AI platforms that could make adoption feasible beyond academic hospitals.
As I’ve said before, “AI is not about replacing endoscopists, it’s about raising the baseline.” The best systems amplify human skill rather than automate it. This year’s ACG agenda reflects that philosophy: AI as an assistant, not an authority.
For colleagues attending virtually, I recommend the ACG Tech Showcase (Oct. 26), which will stream multiple AI-assisted colonoscopy sessions live. For those in person, the hands-on AI demonstration lab may be the closest glimpse we’ll get at the future of colonoscopy in real time.
Lipid and Metabolic Comorbidities in IBD
One of the most forward-looking threads in this year’s ACG 2025 program is the growing focus on metabolic and lipid comorbidities in inflammatory bowel disease (IBD). For years, we have treated Crohn’s disease and ulcerative colitis as isolated inflammatory conditions. Now, emerging evidence is forcing us to view them as systemic metabolic disorders that intertwine with obesity, dyslipidemia, and fatty-liver disease.
The symposium titled “Inflammation Meets Metabolism: Rethinking IBD Risk” will explore this evolving connection. Several presentations are expected to discuss how insulin resistance, visceral adiposity, and lipid signaling contribute to disease persistence and treatment resistance. In a preview released by ACG, researchers from Mayo Clinic and Mount Sinai will present data showing that patients with Crohn’s disease who have uncontrolled dyslipidemia experience higher relapse rates and poorer biologic response than metabolically healthier counterparts.
For clinicians, the takeaway is clear: IBD is no longer just an immune disease, but a metabolic one, too.
This shift has practical consequences. The ACG’s clinical update session will cover new screening protocols for metabolic dysfunction-associated steatohepatitis (MASH) in long-term IBD patients and the implications for biologic dosing, especially with IL-23 and JAK inhibitors. The intersection with the GLP-1 coverage debate is impossible to ignore. GLP-1 receptor agonists are demonstrating meaningful reductions in systemic inflammation and hepatic steatosis, pathways directly relevant to IBD outcomes. Yet, as discussed across recent meetings, CMS’s refusal to broadly cover these medications means many of our IBD patients with metabolic overlap remain untreated. It’s a frustrating example of science outrunning policy.
This year’s ACG lineup positions gastroenterologists as central players in metabolic medicine. It’s an exciting but challenging role. For those of us trained to think in terms of lumens and mucosa, managing lipid panels and insulin sensitivity might feel like unfamiliar territory. But if the science holds, and it increasingly does, our future IBD care models will require just that kind of metabolic literacy.
Practical Updates for the U.S. Clinician
One of the strengths of the ACG Annual Meeting has always been its balance between discovery and practicality. It’s where advanced science meets the real-world pressures of American clinical practice. This year’s agenda is no exception. While the headlines will go to AI and new biologics, I’d encourage every practicing gastroenterologist to spend time in the clinical skills and guideline update sessions. That’s where the daily work of patient care evolves.
Among the most anticipated sessions is “Managing Antithrombotic Therapy Around Endoscopy.” The updated ACG–ASGE consensus recommendations will clarify peri-procedural management for patients on direct oral anticoagulants (DOACs) and dual antiplatelet therapy. With an aging population and overlapping cardiovascular risk, this issue affects nearly every colonoscopy list. Practical algorithms and case simulations will walk attendees through timing, bridging, and coordination with cardiology.
Another important update comes from the ACG GERD Task Force, which will preview revised reflux management pathways emphasizing symptom clusters, impedance testing, and PPI step-down strategies. In an era when reflux, obesity, and airway disease overlap so frequently, clarity on diagnostic tiers and non-acid reflux testing will be invaluable.
The “Clinical Pearls” sessions also deserve attention. Topics this year range from endoscopic management of post-polypectomy bleeding to new protocols for bowel preparation in patients with renal dysfunction. These are sessions that often get overlooked in favor of plenaries but end up changing Monday-morning practice.
For hepatology-focused clinicians, the “MASH and the Community Gastroenterologist” course will be essential. It will cover simplified fibrosis staging tools, referral thresholds, and emerging pharmacologic options, especially GLP-1–based regimens and FXR agonists. With CMS coverage still stalled, practical guidance on patient selection and documentation will be key for those navigating prior authorizations.
Finally, I’d highlight the Practice Management & Reimbursement Update workshop, which will dive into telehealth billing, AI documentation standards, and CMS’s evolving stance on digital pathology codes.
These are not glamorous topics, but they directly determine how innovation translates into viable care. At its best, ACG is where discovery meets deliverability.
Watching ACG 2025 Online: What Not to Miss
Not everyone can make it to Phoenix this October, but one of the enduring strengths of the American College of Gastroenterology is how well it has adapted to hybrid learning. The ACG 2025 virtual platform will stream dozens of sessions live and on-demand, allowing clinicians across the country to engage with cutting-edge science without leaving their practices.
If you plan to attend remotely, three sessions stand out. The first is “AI in Colonoscopy: Beyond Detection,” part of the Technology Forum, which will be broadcast live on October 26. It’s a must-watch for anyone interested in the real-world mechanics of deploying artificial intelligence in endoscopy. Expect detailed discussions on interoperability, liability, and the next steps toward integrating AI-generated metrics into quality dashboards.
The second essential stream is “Inflammation Meets Metabolism: Rethinking IBD Risk.” This symposium (October 27) dives into the metabolic dimension of inflammatory bowel disease, a topic that’s rapidly moving from the research lab to routine clinic visits. It’s also where the conversation around GLP-1 therapies and access is likely to reappear, bridging policy and pathophysiology.
The third is the ACG Presidential Plenary (October 28), which will include several late-breaking abstracts on colorectal-cancer-screening optimization and non-invasive detection technologies. These presentations often set the agenda for the following year’s clinical guidelines.
For clinicians juggling full schedules, the ACG’s on-demand format will keep content available for 90 days post-meeting, allowing time to absorb and apply new insights. Whether online or in person, ACG 2025 will serve as a barometer for where American gastroenterology is heading scientifically, technologically, and politically.
References
- American College of Gastroenterology. (2025). ACG Annual Scientific Meeting & Postgraduate Course 2025. ACG Meeting website
- U.S. Food and Drug Administration (FDA). (2024). List of cleared AI/ML-enabled medical devices. FDA resource page