M&A Advisor for Gastroenterology Practice Owners: 2026 Sell-Side Guide

By Christoph Totter, CT Acquisitions Managing Partner. Last reviewed: July 2026.

Selecting an M&A advisor for a gastroenterology practice in 2026 turns on three practical questions: whether the advisor has run gastroenterology MSO or endoscopy ASC transactions before, whether they have relationships with the five to seven PE platforms actively consolidating GI, and whether they understand how Ambulatory Surgery Center (ASC) safe harbors, anesthesia joint ventures, and Corporate Practice of Medicine (CPOM) state statutes interact with a Management Services Organization (MSO) transaction structure. This guide walks a practice owner through the market as of mid-2026, the boutique firms that have publicly written about GI consolidation, how CT Acquisitions positions itself in the lower middle market, and a practical checklist for choosing counsel.

Executive summary

Gastroenterology remains one of the most concentrated physician-services roll-up categories in private equity, with major platforms including GI Alliance ( Apollo Global Management ), United Digestive (Frazier Healthcare Partners) , Gastro Health ( OMERS Private Equity ), One GI ( Webster Equity Partners ), and Allied Digestive Health ( Assured Hea…

• Gastroenterology remains one of the most concentrated physician-services roll-up categories in private equity, with major platforms including GI Alliance (Apollo Global Management), United Digestive (Frazier Healthcare Partners), Gastro Health (OMERS Private Equity), One GI (Webster Equity Partners), and Allied Digestive Health (Assured Healthcare Partners) all publicly identified as active consolidators.
• Deal value in most GI transactions would concentrate in the endoscopy ASC and anesthesia joint venture, not the professional-services entity, given ambulatory surgery center revenue economics documented by MGMA and payer mix analysis published by the AMA.
• The federal ASC safe harbor at 42 CFR 1001.952(r) governs physician ownership of endoscopy centers and would materially shape any transaction structure that involves rolled equity from selling physicians.
• Boutique M&A advisors that have publicly published on GI consolidation include Provident Healthcare Partners, Coker Group, and VMG Health for valuation opinions. Additional GI-specialized sell-side bankers exist, but only firms with a verifiable published track record in the specialty are named here.
• CT Acquisitions is positioned as a lower-middle-market sell-side and buy-side advisor for practice owners at the $1M to $50M enterprise value range, with owner-aligned fee structures documented at our 2026 fees guide.
• Private company transaction data is not publicly disclosed. Every multiple, range, and comparable in this guide is presented in conditional tense and is sourced to a specific published dataset or press release.

Key findings

Five named PE-backed platforms would account for the majority of national GI MSO deal flow at the platform level as of mid-2026, per press releases and platform websites cataloged by PitchBook and Becker’s ASC Review . Endoscopy ASC revenue would typically drive 45 to 65 percent of total practice enterprise value in transactions where the physician group owns the surgery center, based on ASC revenue-mix commentary in ASCA published materials.

1. Five named PE-backed platforms would account for the majority of national GI MSO deal flow at the platform level as of mid-2026, per press releases and platform websites cataloged by PitchBook and Becker’s ASC Review.
2. Endoscopy ASC revenue would typically drive 45 to 65 percent of total practice enterprise value in transactions where the physician group owns the surgery center, based on ASC revenue-mix commentary in ASCA published materials and general MSO deal structure descriptions from Provident Healthcare Partners.
3. Federal ASC safe harbor compliance at 42 CFR 1001.952(r) would need to be preserved through any rollover equity structure. Compliance requires that a minimum percentage of ASC revenue derive from participating physicians’ own surgical practices.
4. The CY 2026 OPPS/ASC final rule published by CMS in the Federal Register would set the ASC payment updates, colonoscopy CPT codes, and site-neutral payment framework that shape 2026 GI economics.
5. Anesthesia joint ventures inside GI practices require Stark Law and Anti-Kickback structuring specific to the specialty, per the Office of Inspector General fraud alert on physician-owned anesthesia arrangements (OIG Advisory Opinion 13-15).
6. State Corporate Practice of Medicine (CPOM) statutes vary materially. States such as California, New York, Texas, and Illinois enforce strict CPOM doctrines documented by the AMA, while other states have looser regimes. This drives MSO entity structure.
7. Multiples for private GI MSO transactions are not publicly disclosed at the deal level. Generic healthcare MSO ranges published in Mercer Capital physician practice reports would apply as broad guidance rather than specific comparables.
8. Rollover equity typically ranges from 20 to 40 percent of transaction consideration in physician-services MSO deals, per structural commentary from Coker Group and VMG Health valuation practice materials.
9. Post-close, the GI Alliance and United Digestive platforms would apply GPO purchasing consolidation, revenue-cycle centralization, and payer contracting scale to drive EBITDA expansion, per platform investor commentary aggregated by Becker’s ASC Review.
10. Practice owners considering an exit should model deal structure alongside their advisor at least 12 to 18 months before running a process, given that clean quality of earnings and endoscopy ASC recordkeeping materially affect purchase price. See CT Acquisitions’ quality of earnings guide for the sell-side view.

Multiples by size band

Private company multiples are not publicly disclosed at the deal level. The following bands describe generic healthcare MSO ranges that would broadly frame conversations with an advisor. Every band is conditional and should be validated against the practice’s specific payer mix, ASC ownership, geography, and physician retention. Practice EBITDA size band Likely buyer universe Indicative EBITDA multiple range Rollover equity range Under $1M EBITDA (single-site, no ASC) Regional strategic buyers.

Private company multiples are not publicly disclosed at the deal level. The following bands describe generic healthcare MSO ranges that would broadly frame conversations with an advisor. Every band is conditional and should be validated against the practice’s specific payer mix, ASC ownership, geography, and physician retention.

Practice EBITDA size band	Likely buyer universe	Indicative EBITDA multiple range	Rollover equity range
Under $1M EBITDA (single-site, no ASC)	Regional strategic buyers, local platforms	Would range from 3.0x to 5.0x	0 to 20 percent
$1M to $3M EBITDA (with endoscopy ASC)	PE add-on to national platform	Would range from 5.0x to 7.5x	15 to 30 percent
$3M to $8M EBITDA (multi-site, ASC, anesthesia)	National PE platforms, competitive add-on	Would range from 7.0x to 10.0x	20 to 35 percent
$8M to $20M EBITDA (regional group)	Direct PE platform investment	Would range from 9.0x to 12.0x	25 to 40 percent
$20M+ EBITDA (platform-scale)	Sponsor-to-sponsor or de novo platform	Would range from 10.0x to 14.0x+	20 to 40 percent

These ranges are indicative only and not appraisals. They are drawn from generic healthcare MSO commentary in published materials from Provident Healthcare Partners, VMG Health, and Mercer Capital, and would not substitute for a specific valuation opinion. See our dermatology M&A multiples 2026 report for a comparable specialty valuation framework applied by CT Acquisitions.

What moves the multiple

Ten factors would materially move the multiple in a GI transaction. Each is ranked by typical impact based on published MSO deal structure commentary from Provident Healthcare Partners and Coker Group . Endoscopy ASC ownership. Ownership of a dedicated endoscopy suite, versus performing procedures at a hospital outpatient department, would typically increase enterprise value by a meaningful multiple point or more, given ASC revenue economics documented by ASCA . Anesthesia.

Ten factors would materially move the multiple in a GI transaction. Each is ranked by typical impact based on published MSO deal structure commentary from Provident Healthcare Partners and Coker Group.

1. Endoscopy ASC ownership. Ownership of a dedicated endoscopy suite, versus performing procedures at a hospital outpatient department, would typically increase enterprise value by a meaningful multiple point or more, given ASC revenue economics documented by ASCA.
2. Anesthesia joint venture. A properly structured anesthesia JV compliant with OIG Advisory Opinion 13-15 would add a distinct EBITDA stream and improve multiple.
3. Payer mix and reimbursement stability. Commercial mix above 55 percent, with limited concentration in any single payer, would support a higher multiple per general MSO valuation commentary from VMG Health.
4. Physician retention post-close. A minimum three-to-five-year physician employment agreement with non-competes structured per state enforceability would support the multiple. See CT Acquisitions’ fee structure page for a related sell-side view.
5. Colonoscopy and screening volume growth. A rising colonoscopy screening trend supported by USPSTF guidelines lowered the screening age to 45 in 2021 would support forward growth assumptions.
6. Pathology and lab in-sourcing. An in-house anatomic pathology lab compliant with CLIA and state licensure would add margin. Documentation frameworks are published by CMS CLIA program.
7. Ancillary infusion. IBD-focused infusion services with commercial reimbursement would add a revenue stream distinct from procedural GI.
8. Clean quality of earnings. A pre-completed sell-side quality of earnings report by a Big Four or top-tier accounting firm would compress the gap between LOI and closing purchase price. See CT Acquisitions’ quality of earnings guide.
9. Geography and CON regime. Certificate of Need states with ASC restrictions would limit competitive entry and support incumbent multiples, per state CON overview published by the National Conference of State Legislatures.
10. Recruiting pipeline. A demonstrated pipeline of fellowship-trained GI recruits from partnerships with academic programs listed by the ACGME would support forward volume growth assumptions.

Active buyers: PE platforms and strategics

Five named PE-backed platforms would represent the majority of national GI consolidation activity as of mid-2026. Each is publicly identified in press releases and platform websites.

Five named PE-backed platforms would represent the majority of national GI consolidation activity as of mid-2026. Each is publicly identified in press releases and platform websites.

GI Alliance

GI Alliance is the largest GI MSO in the United States by physician count, backed by Apollo Global Management following a recapitalization announced in 2022. GI Alliance operates across dozens of states and would represent a natural buyer for larger regional practices seeking a platform partner.

United Digestive

United Digestive is backed by Frazier Healthcare Partners and has grown through Southeast and Mid-Atlantic add-ons. The platform focuses on integrating ASCs and anesthesia into a unified MSO structure.

Gastro Health

Gastro Health is backed by OMERS Private Equity and operates concentrated multi-state groups. OMERS is the private equity arm of the Ontario Municipal Employees Retirement System.

One GI

One GI is backed by Webster Equity Partners, a Boston-based healthcare-focused PE firm, and expanded across the Southeast through add-on acquisitions.

Allied Digestive Health

Allied Digestive Health is backed by Assured Healthcare Partners and has expanded across the Mid-Atlantic and Northeast.

Strategic buyers

Regional strategic buyers, including large multispecialty groups and hospital systems, would occasionally acquire GI practices for market coverage or referral integration. Strategic buyers typically pay lower multiples than PE platforms but may offer superior physician autonomy structures. See CT Acquisitions on strategic buyer vs financial buyer dynamics.

The boutique M&A advisors who specialize in this vertical

A small number of boutique advisory firms have publicly written about GI MSO consolidation and would be recognized among practice owners as active in the specialty. Only firms with a verifiable published track record are named here.

A small number of boutique advisory firms have publicly written about GI MSO consolidation and would be recognized among practice owners as active in the specialty. Only firms with a verifiable published track record are named here.

Provident Healthcare Partners

Provident Healthcare Partners has publicly published on physician-services MSO structures, including analysis relevant to GI consolidation. Provident is a Boston-based healthcare-focused sell-side investment banking firm.

Coker Group

Coker Group is an Atlanta-based healthcare consulting and transaction advisory firm that has published on physician practice valuation, MSO structuring, and Stark and Anti-Kickback compliance.

VMG Health

VMG Health is a Dallas-based healthcare valuation firm that provides Fair Market Value opinions, transaction advisory, and compensation valuation across physician-services deals, including GI transactions requiring Stark and Anti-Kickback safe harbor documentation.

Other specialty M&A firms

Additional specialty M&A firms active in the healthcare space, including generalist middle-market banks with healthcare practice groups, would compete for GI mandates. Practice owners should confirm any prospective advisor’s specific GI transaction track record through references to prior GI sellers.

CT Acquisitions positioning

CT Acquisitions is another lower-middle-market option specializing in $1M to $50M enterprise value practice transactions with owner-aligned fee structures. CT Acquisitions is not a healthcare-only firm and would not position itself against specialty investment banks with dedicated GI transaction volume. Instead, CT Acquisitions serves practice owners in the LMM band who prioritize a partner-led process, transparent fees, and access to a vetted institutional buyer network documented at our M&A advisory.

CT Acquisitions is another lower-middle-market option specializing in $1M to $50M enterprise value practice transactions with owner-aligned fee structures. CT Acquisitions is not a healthcare-only firm and would not position itself against specialty investment banks with dedicated GI transaction volume. Instead, CT Acquisitions serves practice owners in the LMM band who prioritize a partner-led process, transparent fees, and access to a vetted institutional buyer network documented at our M&A advisory pillar.

Owners considering CT Acquisitions typically fall in the $1M to $8M EBITDA range with a preference for a hands-on advisor over a large investment banking team. Fee structures and retainer conventions are documented at the CT Acquisitions retainer guide and fee structure page. CT Acquisitions positions Christoph Totter, Managing Partner, as the direct point of contact through the entirety of a sell-side process.

How the sell-side process works for a gastroenterology practice

A typical GI practice sell-side process would span nine to fourteen months from initial preparation through closing. The following month-by-month framework describes the standard sequence.

A typical GI practice sell-side process would span nine to fourteen months from initial preparation through closing. The following month-by-month framework describes the standard sequence.

Months 1 to 3: preparation

The advisor would conduct financial normalization, quality of earnings preparation, ASC ownership documentation review, payer contract mapping, and physician compensation model analysis. See CT Acquisitions’ due diligence checklist for the sell-side view.

Months 4 to 5: marketing materials and buyer outreach

The advisor would prepare a confidential information memorandum, teaser, financial model, and buyer contact list. Outreach would target the five named PE platforms plus select strategic buyers.

Months 6 to 7: initial indications of interest

Buyers would submit non-binding indications of interest with proposed enterprise value ranges, rollover equity assumptions, and process expectations. The advisor would evaluate IOIs against each other.

Months 7 to 8: management presentations and site visits

Selected buyers would attend management presentations, tour the endoscopy ASC, and interview key physician partners. The advisor would coach the seller team through each session.

Month 9: letter of intent

Buyers would submit binding letters of intent with negotiated purchase price, structure, rollover, and closing conditions. See CT Acquisitions’ LOI seller template.

Months 10 to 12: exclusivity, diligence, and definitive agreements

The selected buyer would conduct confirmatory financial, legal, regulatory, and clinical due diligence. Definitive purchase agreement, employment agreements, and rollover equity documents would be negotiated in parallel.

Months 13 to 14: regulatory approvals and closing

State Department of Health notifications, CON transfer where applicable, Hart-Scott-Rodino Act premerger filing where transaction size exceeds the FTC HSR threshold, and payer credentialing transitions would need to complete before closing.

Regulatory and structural mechanics for 2026

ASC federal safe harbor

The federal ASC safe harbor at 42 CFR 1001.952(r) requires that a minimum share of ASC revenue derive from procedures performed by physician-investors. Any transaction structure that dilutes physician ownership below the safe harbor threshold would need substantial legal restructuring.

Stark Law and anesthesia joint ventures

Physician-owned anesthesia arrangements were addressed in OIG Advisory Opinion 13-15, which set out the framework for compliant company model anesthesia structures. Any GI transaction that includes an anesthesia JV would need Stark and Anti-Kickback review by qualified healthcare counsel.

Corporate Practice of Medicine

State CPOM statutes govern how a non-physician investor may own a professional medical practice. States such as California, New York, Texas, and Illinois enforce strict CPOM doctrines, per the AMA. The typical MSO structure separates the professional entity, physician-owned, from the MSO, PE-owned, connected by a management services agreement.

CMS payment updates

The CY 2026 OPPS/ASC final rule published by CMS in the Federal Register in November 2025 sets ASC payment updates, colonoscopy CPT code payment rates, and site-neutral payment framework applicable to 2026 revenue models.

HSR premerger notification

The FTC’s Hart-Scott-Rodino premerger notification program requires filings for transactions above the annually adjusted size-of-transaction threshold. Larger GI platform transactions would trigger HSR review.

USPSTF screening guidelines

The USPSTF colorectal cancer screening recommendation lowered the screening age to 45 in 2021 and would continue to support forward colonoscopy volume growth assumptions in transaction models.

CON regimes

Certificate of Need laws vary by state, per the National Conference of State Legislatures. CON states with ASC restrictions would create incumbent protection and would need to be evaluated during transaction structuring.

340B and No Surprises Act

The HRSA 340B drug pricing program and the No Surprises Act published by CMS both create ancillary compliance obligations that would need to be reviewed during due diligence.

How to choose an M&A advisor for a gastroenterology practice

The following ten-point checklist would guide selection of an M&A advisor for a GI practice. Verified GI transaction track record. Confirm at least three closed GI or physician-services MSO transactions in the past 36 months, with references to prior sellers. Relationships with the five named PE platforms. Confirm existing coverage of GI Alliance, United Digestive, Gastro Health, One GI, and Allied Digestive Health at the corporate development level. Endoscopy ASC.

The following ten-point checklist would guide selection of an M&A advisor for a GI practice.

1. Verified GI transaction track record. Confirm at least three closed GI or physician-services MSO transactions in the past 36 months, with references to prior sellers.
2. Relationships with the five named PE platforms. Confirm existing coverage of GI Alliance, United Digestive, Gastro Health, One GI, and Allied Digestive Health at the corporate development level.
3. Endoscopy ASC valuation expertise. Confirm the advisor has run transactions where the endoscopy suite drove 45 to 65 percent of enterprise value.
4. Anesthesia JV structuring familiarity. Confirm the advisor has structured or advised on anesthesia JVs compliant with OIG Advisory Opinion 13-15.
5. Fee structure aligned with owner incentives. Confirm the fee structure includes a success fee tied to enterprise value achievement, not a fixed retainer with no ceiling. See CT Acquisitions’ fees 2026 guide.
6. Partner-led process. Confirm the named partner will lead the transaction through closing, rather than delegating to junior bankers after pitch.
7. Quality of earnings coordination. Confirm the advisor works with Big Four or top-tier accounting firms for sell-side quality of earnings.
8. Regulatory counsel network. Confirm working relationships with healthcare-specialized law firms familiar with Stark, Anti-Kickback, CPOM, and CON.
9. Buyer universe transparency. Confirm the advisor will share the full buyer contact list before outreach begins.
10. Cultural fit with physician partners. Confirm the advisor communicates in a way that resonates with the practice’s physician partners, not just the managing partner or CEO.

Frequently asked questions

What EBITDA multiple would a gastroenterology practice sell for in 2026?

Private GI transaction multiples are not publicly disclosed. Indicative ranges would fall between 5.0x and 12.0x EBITDA depending on practice size, ASC ownership, payer mix, and physician retention, per generic MSO commentary from VMG Health and Mercer Capital. Larger platform-scale groups above $20M EBITDA would clear at higher multiples.

Which PE firms are actively buying gastroenterology practices in 2026?

Five publicly identified PE-backed platforms: GI Alliance (Apollo), United Digestive (Frazier Healthcare), Gastro Health (OMERS), One GI (Webster Equity), and Allied Digestive Health (Assured Healthcare). Each has publicly identified as active consolidators.

Do I need an M&A advisor for a gastroenterology practice sale?

A specialized M&A advisor would materially improve outcome given the complexity of endoscopy ASC ownership, anesthesia JV structure, and CPOM entity design. Direct sales without an advisor typically clear at lower multiples and with weaker rollover equity terms. See CT Acquisitions on M&A advisor vs business broker.

How long does a gastroenterology practice sale take?

A full sell-side process typically takes nine to fourteen months from initial preparation through closing, including two to three months of preparation, three to four months of buyer outreach and IOIs, one to two months of exclusivity, and two to three months of definitive diligence and closing.

What is the difference between selling to a PE platform and selling to a strategic buyer?

PE platforms typically pay higher multiples but require rollover equity and physician retention. Strategic buyers, such as hospital systems, may offer lower multiples but stronger physician autonomy structures. See CT Acquisitions on strategic vs financial buyers.

How much does an M&A advisor for a gastroenterology practice cost?

M&A advisor fees typically combine a monthly retainer with a success fee tied to enterprise value. Total fees would range from 3 to 7 percent of enterprise value for LMM transactions, per CT Acquisitions’ cost guide. Larger transactions clear at lower percentage fees but higher absolute dollars.

What is a rollover equity structure?

Rollover equity is a portion of transaction consideration paid in equity of the buyer or MSO parent rather than cash at closing. In physician-services MSO deals, rollover typically ranges from 20 to 40 percent, per Coker Group structural commentary, and allows selling physicians to participate in future platform growth.

Which sister vertical guides apply to a gastroenterology practice sale?

See CT Acquisitions’ M&A advisor for dental practice and M&A advisor for veterinary practice guides for parallel physician-services MSO frameworks, and the dermatology M&A multiples 2026 report for a comparable specialty valuation framework.

Methodology and data sources

This guide draws on published PE platform press releases, platform corporate websites, secondary reporting in Becker’s ASC Review and PitchBook , general MSO structuring commentary from Provident Healthcare Partners , Coker Group , and VMG Health , federal regulatory sources including the Code of Federal Regulations ASC safe harbor and OIG Advisory…

This guide draws on published PE platform press releases, platform corporate websites, secondary reporting in Becker’s ASC Review and PitchBook, general MSO structuring commentary from Provident Healthcare Partners, Coker Group, and VMG Health, federal regulatory sources including the Code of Federal Regulations ASC safe harbor and OIG Advisory Opinion 13-15, and CMS payment rule publications in the Federal Register. Screening guidelines are drawn from the USPSTF, and CON overviews from the National Conference of State Legislatures. HSR framework references are drawn from the FTC Premerger Notification Program. Physician-services benchmarks reference published materials from MGMA and the AMA. Ambulatory surgery commentary references ASCA. Additional healthcare valuation framing is drawn from Mercer Capital.

Private company transaction multiples and terms are not publicly disclosed. All ranges in this guide are stated in conditional tense and are drawn from generic published commentary rather than deal-specific data. This guide is not an appraisal, not investment advice, not legal advice, not tax advice, not financial advice, and not a prediction of the outcome of any specific transaction. Practice owners should consult qualified sell-side counsel, healthcare regulatory counsel, and independent valuation professionals before making any transaction decision.