In sunny San Diego, gastroenterologists from all over the country gathered at the annual Digestive Disease Week to learn about the latest tools and techniques for treating GI disorders. Amid a busy schedule, I found some time to tour the exhibit hall to check out the latest technology, and l wasn't disappointed. From imaging options that can help providers catch more polyps to innovative instruments designed with a physician's comfort in mind, there are plenty of gadgets your GI docs will want to get their hands on. OSM

US Endoscopy | Moray Micro Forceps
GI docs frequently complain that they don't have a more reliable way to take accurate tissue samples of lesions found in the GI tract, specifically from cysts found in the pancreatic head. Instead, most have to rely on aspirating the cyst with an endoscopic ultrasound (EUS) needle, hoping to capture a few cells in the fluid that might give them clues as to whether the cyst is benign, premalignant or malignant. The Moray Micro Forceps, though, gives docs a better option for diagnosing these cysts.

The first-of-its-kind forceps are inserted under ultrasound guidance and are just tiny enough to penetrate the lesion and take a bite out of its interior wall. The forceps' serrated jaws open just 4.3 mm, but they can effectively grab tissue samples, which provide a more accurate diagnosis than aspirated fluid. It's a single-use device and is compatible with most 19-gauge needles. After trying them out at the show, I found them to be surprisingly quick and easy to use.

Avantis Medical Systems | Third Eye Panoramic
Though Avantis showed off its single-use Third Eye Panoramic device at last year's DDW, this year's brand-new generation is much more affordable and practical than its predecessor. Earning 510(k) clearance from the FDA just a few days before the show, the Third Eye Panoramic is a small, reusable device that can attach to virtually any colonoscope to give doctors a 330 ? view of the colon.

The device features 2 cameras on its side that help clinicians see behind the folds of the colon, where polyps tend to hide. In fact, in some studies the Third Eye Panoramic has been shown to help physicians find up to 25% more pre-cancerous adenomas than a standard colonoscope alone. The reusable option can be used in up to 100 cases and is simply tossed in the top rack of your automated endoscope reprocessor for cleaning and disinfection after use. It's a great option for those who want wide views during their colonoscopies without the capital investment of a fancy new imaging system.

Olympus | EZ Shot 3 Plus
Olympus's updated EUS needle makes it much easier and more efficient to perform endoscopic ultrasonically guided fine needle aspiration (EUS-FNA) of lesions within the GI tract. In some areas of the body — notably the pancreatic head — EUS-FNA can require the endoscope tip to be inserted at a curve, often making it difficult to pass a needle through the scope's channel, or causing the needle to bend and become useless. Instead, the EZ Shot 3 Plus is designed to always stay straight, even after multiple passes.

The needle is made of nitinol, a material that holds its shape, and its tip is extremely sharp for precise aspiration. The design means that even if the tip of the scope is bent, the needle will consistently be deployed straight, which makes its trajectory much more predictable for the physician. The sheath of the needle is also designed to reduce friction, so physicians can pass the needle smoothly down the scope with minimal effort. These features could help shave time off of EUS-FNA procedures, since the physician won't have to delay a procedure to replace a bent needle, or spend extra time trying to maneuver the device down a curved scope.

Boston Scientific | AXIOS Stent and Electrocautery Enhanced Delivery System
Patients who've had pancreatitis often suffer from symptomatic pancreatic pseudocysts. These fluid-filled cavities can cause patients pain and discomfort, but treatment options have traditionally required either surgery or percutaneous catheter drainage using a CT scan for guidance. Instead, the AXIOS system is a minimally invasive way to drain the cyst more quickly, safely and efficiently.

The stent is inserted endoscopically using the electrocautery-enhanced delivery system. The physician inserts the dog-bone shaped stent between the cyst and the stomach to create a channel for the cyst to drain into. The procedure itself takes roughly 10 minutes to perform (compared to 2+ hours for surgery) and doesn't require any incisions through the skin. Its efficiency means you can reduce turnover time, limit the patient's time under anesthesia and reduce staff and patient exposure to fluoroscopy, since it doesn't require CT scan guidance. Additionally, doctors will like that the device features an ergonomic design that allows them greater control over the movement and placement of the stent.

Boston Scientific | Resolution 360 Clip
Boston Scientific's Resolution Clip is already one of the most popular hemostatic clips among GI physicians. At DDW, the company showed off its Resolution 360 Clip, which keeps the original's most popular features, but is reengineered with a physician's preferences in mind.

While the business side of the clip is essentially the same, efficiently stopping or preventing bleeding after the removal of a lesion, the clip's new catheter allows for a 1-to-1 rotation, so each time you turn the handle, the clip itself turns as well. This boosts your accuracy during the positioning of the clip. The device's tip also acts independently of this rotation, so when you open and close the jaws, the clip won't rotate away from the angle the doctor has positioned it at. Additionally, the clip allows the physician or the nurse to control its movement, depending on the doctor's preference. Finally, the company also redesigned the handle of the device to improve its ergonomics, and removed its sheath, which minimizes setup steps.

CSA Medical | truFreeze
There are a lot of energy options that doctors can use for ablating GI lesions, but one innovative system is truFreeze, which uses liquid nitrogen to kill pre-cancerous or cancerous cells. The system's device is inserted down the channel of an endoscope, and the physician can then spray the -196 ?C liquid onto the damaged tissue. The tissue is flash-frozen, and as it warms up, the cells die off and eventually new, healthy cells replace the dead ones. The treatment causes less inflammation and tissue damage than heat methods like radiofrequency, and takes roughly 10 to 20 minutes per procedure.

While the concept has been around for a while, the big news out of DDW was a peer-reviewed study that showed just how effective liquid nitrogen cryotherapy is compared to other ablation methods. The system was shown to effectively penetrate tissue more deeply than other freezing options, ablating 138.5 mm of simulated malignant tissue volume while both nitrous oxide and carbon dioxide ablated 0 mm each after a 15- to 30-second application.

Invendo Medical | invendoscope SC200
The risk of cross-contamination from flexible endoscopes has dominated the headlines for more than a year now. In an attempt to address this risk, Invendo has debuted the world's first single-use, computer-assisted colonoscope, with the hope that other flexible scopes (including a duodenoscope) will follow.

The scope itself features a radically different design than the devices your GI docs are used to. Instead of controlling the scope's movements using standard wheels, the single-use scope uses a detachable handpiece that's reminiscent of a video-game console. The scope itself is connected to a computer system that can help improve visualization by offering 180 ? bending in all directions and a proprietary diagnostic mode that lets the tip circulate at the push of a button.

In keeping with its infection prevention focus, the scope also comes with single-use irrigation and suction tubes to reduce the risk of cross-contamination. For facilities just starting out with GI procedures, or those that lack the reprocessing areas needed for flexible scopes, the single-use option may be a great fit.

DIGESTIVE DISEASE WEEK WISH LIST
Ingenious Devices That Could Boost Your GI Service

Medivators | Endodry
This drying and storage cabinet not only can boost your scope turnaround time with its quick drying capabilities, but also can help prevent bacterial growth on stored endoscopes. The cabinet forces HEPA-filtered air around the scope and through its channels to prevent moisture, which is in accordance with new AORN guidelines. The cabinet features 8 endoscopic trays with interlocks and also has a barcode reader that could help your facility with consistent logging of data, including endoscope tracking.

 

Medicapture | MediCap MVR Lite
This small medical video recorder packs a powerful punch. The MVR Lite is compact and affordable at $3,000, says a company rep, but it's able to record full HD video from your endoscope. The device can record full 1080p video at 60 frames a second, double that of its predecessor, and provides a bright, clear image. There's also a remote control option and the device doesn't require any training to use — simply plug it in and go.

 

Endochoice | Fuse Generation 3
The Fuse system — which gives doctors a 330 ? view of the colon — has undergone another update to improve its ergonomics and provide brighter, clearer images. The system's latest generation features controls that fit a larger range of hand sizes and reduce pressure points. The system projects its images onto a 4K ultra HD display for sharper, clearer images. As part of the Fuse 3, the company also debuted the Lumos Adaptive Matrix Imaging system (pending FDA approval), which is a white light smart enhancement feature that helps docs detect vascular patterns and anatomic details that are hard to see with traditional imaging systems.

 

Pentax Medical | Optivista EPK-i7010
This high-definition video processor is the first to combine both optical and digital imaging enhancement technologies, which could increase accuracy during endoscopic diagnosis, says the company. The i-scan Surface and Tone Enhancement digital imaging mode provides real-time virtual chromoendoscopy for better views of mucosal and vascular patterns, while the i-scan OE optical filter better displays surface structures of blood vessels, glandular ducts and mucosal membranes at a higher contrast than standard white-light images. The processor seamlessly switches between the optical and digital mode, giving doctors more insight when diagnosing problems in a patient's GI tract.

 

EMcision | Habib EUS RFA
Doctors can cauterize and coagulate lesions in the pancreas and other soft-tissue organs in a minimally invasive manner with this radiofrequency ablation catheter. The EMcision monopolar catheter, the first of its kind in the United States, is inserted using an endoscope and FNA needle. It works with a range of commonly available generators, and because you don't need a host of new capital equipment, you can easily add the procedure to your facility, says a company rep.

 

Fujifilm | EN-580T Double Balloon Endoscope
Though the Double Balloon system has been around for a while, Fujifilm debuted a few new updates to the system's scope to better accommodate physicians. The system — which allows doctors to visualize and treat the small intestine — has a new scope with a larger 3.2 mm accessory channel to increase access and improve suction. Additionally, the system features improved close-focus imaging, thanks to a new high-resolution Super CCD chip, so doctors can get up-close views of tissue without image distortion.

 

ConMed | DuraClip
This clip gives physicians more control and accuracy when creating hemostasis in the GI tract. Compared to some other clips, which can only be opened and closed up to 5 times, the DuraClip can be repositioned an unlimited number of times prior to deployment, helping docs secure precise positioning and save time and money in supplies. The clip also allows for 1-to-1 rotation, which gives the provider more control over its movement, and a shorter clip design so physicians can place clips in closer proximity to the mucosal defect and improve hemostasis.

— Kendal Gapinski