The three of us, Britt Houwen, Meta van Lanschot, and Arne Bleijenberg, were probably among the youngest to attend the WEO CRC SC meeting in San Diego two weeks ago. We are getting happily accustomed to this very engaging satellite event, now a regular prelude to our Digestive Disease Week® (DDW) and UEG Week activities! And, as in Washington and Vienna in 2018, the San Diego WEO CRC SC meeting was dynamic, inspiring and full of valued input from experts from all over the world.

Despite waking up at 4am, somewhat jetlagged after a long flight, we were eager to get started with the parallel meetings of the expert working groups. We were intrigued to hear about Leon Moon’s pioneering study on tumor seeding. His study convincingly shows that if we first resect or biopsy a tumor, and then perform polypectomies with the same instruments elsewhere in the colon, we might be transporting (or submucosally injecting!) viable cancer cells to other areas in the colon. If this is true for cancer, it might also be true for polyps.

What does this mean for our understanding of metachronous risk after resection of baseline advanced adenomas? We eagerly await inspired researchers who will advance on Moon’s findings. The next session we attended mostly focused on artificial intelligence (AI) in endoscopy. It was clear that everyone in the audience has great expectations of AI. Current algorithms are very promising and sometimes already outperform expert eyes, but the overviews of Yuichi Mori and Britt Houwen also highlighted the need for large prospective and independent studies to confirm the promising results of recent publications.

After catching some sun, fresh air, and a delightful lunch we enjoyed the rest of the day’s plenary sessions. What stood out most to us was Uri Ladabaum’s presentation on the cost–effectiveness of the new recommendation to start screening at age 45. With 758 additional colonoscopies per 1000 persons and a price of $33 900 per quality-adjusted life year (QALY) gained, this has been previously shown to be cost-effective yet expensive. Ladabaum argued, however, that alternative strategies, such as improving screening participation to 80% among those aged 50+, might result in greater CRC-related mortality reduction at much lower costs. In an era of ever-increasing healthcare costs this presentation gave us plenty of food for thought during the rest of our DDW visit.

Next stop: UEG Week in Barcelona! October 19-21, 2019.