Has the field of interventional endoscopic ultrasound (EUS) reached a plateau? Professor Marc Giovannini, a pioneer of EUS-guided fine-needle aspiration and EUS-guided bilioduodenal anastomosis, attempts to answer this question in the Advances in Endoscopy column of this month’s issue of Gastroenterology & Hepatology. Professor Giovannini discusses how this field has evolved, the latest stent technologies, recent advances in EUS-guided drainage techniques, and how interventional EUS has impacted endohepatology. He also discusses what challenges still remain, how endoscopists should be trained in interventional EUS, and how the field may evolve in the future, along with related issues.
One of our feature articles this month centers on attempts to break the therapeutic ceiling in inflammatory bowel disease (IBD) by combining advanced medical therapies to target multiple inflammatory pathways. Dr Arpita Jajoo, Ms Katherine Margolin, Dr Berkeley N. Limketkai, and Dr Alyssa Parian examine the current clinical data on a variety of advanced combination treatments, such as anti–tumor necrosis factor therapy + an anti-integrin, interleukin (IL)-12/23 antagonist, or Janus kinase inhibitor; an anti-integrin + IL-12/23 antagonist or small molecule inhibitor; and an IL-12/23 antagonist + small molecule inhibitor. The authors also propose criteria for de-escalation of advanced combination treatment and address safety issues and financial concerns.
Our other feature article this month includes a review of remote patient monitoring and associated technologies in IBD. Dr Hyder Said and Dr Robert P. Hirten examine different types of remote patient monitoring, their use in different disease settings, and their benefits in patient care. Additionally, the authors review the current state of remote monitoring in IBD, including fecal calprotectin testing, capillary C-reactive protein, sweat-based biomarkers, and salivary and colorectal mucus biomarkers, in addition to the use of physiologic parameters such as heart rate, heart rate variability, activity, and sleep. Also discussed are evidence gaps and future directions in this field.
Our Advances in Hepatology column, which is authored by Dr Elizabeth Verna, explores the recent practice guideline on adult liver transplantation from the American Association for the Study of Liver Diseases and the American Society of Transplantation. Topics of discussion include machine perfusion devices, the optimal approach to immunosuppression following liver transplant, key recommendations for hepatitis C–viremic livers, and follow-up for patients transplanted for alcohol-associated liver disease or metabolic dysfunction-associated steatotic liver disease.
Colonoscopic surveillance for dysplasia is the focus of our Advances in IBD column. Dr James D. Lewis discusses how colonoscopic imaging has evolved, when chromoendoscopy should be used, differences between ulcerative colitis and Crohn’s disease surveillance, the extension of surveillance intervals, and several controversial issues such as whether biopsies should be targeted or random, among other topics.
Finally, our quarterly content partnership with the Crohn’s & Colitis Foundation places a spotlight on bowel urgency, which can be a distressing symptom for patients with IBD. Readers can scan the QR code on page 741 to access a patient webinar on bowel urgency.
May this issue provide you with helpful information that you can put to good use in your clinical practice.
Sincerely,
Gary R. Lichtenstein, MD, FACG, AGAF, FCCF, FACP