Gastroenterology's need for high-quality visualization and minimally invasive therapy makes it a specialty that benefits greatly from technological advances. The exhibit hall at the Digestive Disease Week conference, held this year in Washington, D.C., featured products that increase our field of view and give us greater reach. Here are several products that really stood out in my tour of the exhibit hall, starting with a revolutionary same-day bowel prep system where patients go to a spa-like center and sit on a private basin, where a gentle stream of temperature controlled, gravity-flow water loosens stool and induces peristalsis, letting patients comfortably and odorlessly evacuate their colons with discreet bowel movements.
HyGIeaCare | HyGIeaCare Centers
There is definitely a need for improvement in the bowel-prepping process. Research tells us that 20 to 25% of patients come to their colonoscopies inadequately prepped, and while endoscopic visualization technology is advancing by leaps and bounds, it won't help you see much if the bowel isn't clean.
HyGIeaCare's same-day bowel prep alternative to the standard split-dose PEG could provide a revolutionary solution. Imagine this: Your physicians refer their colonoscopy patients (who aren't required to fast or drink oral preps) for appointments at one of the company's centers about 2 hours before their screenings. In the space of about 30 to 50 minutes, their bowels are gently cleansed through the infusion of warm, filtered water for consistently effective preps and, in turn, better outcomes. It's safe, fast, easy, comfortable and hygienic. It simplifies the bowel prep process and would be ideal for patients who can't tolerate traditional preps.
It would also be fantastic press for GI clinics who offer it to their patients. Keep in mind that most patients don't remember anything about their colonoscopies, but never forget the complicated instructions and unpleasant ordeal of the prep. HyGIeaCare's market research says a significant population of patients would be willing to pay $245 out of pocket for the option.
The company has set up a center in Austin, Texas, it's opening a second in Dallas, and has an eye on starting hundreds more nationwide, keyed to the locations of large gastro practices and high regional case volumes. Gavriel Meron, the company's chairman and CEO, was the founder and former CEO of PillCam pioneers Given Imaging, so he's clearly got a vision for GI innovation. It'll be interesting to see how this potentially game-changing concept plays out.
EndoChoice | Fuse Generation 2
Two years ago, EndoChoice made a big splash at Digestive Disease Week with Fuse (Full Spectrum Endoscopy), a flexible GI endoscopy system that employed 3 lenses and 3 monitors to provide us with a wide-angle view and the opportunity to spot what we'd potentially missed along the sides of our forward-looking images. Now the company's Generation 2 upgrade makes it possible for us to display that 330-degree view as a single integrated image on a 4K, ultra-HD screen. It adds a slimmer scope, whose 11.5 mm outer diameter insertion tube (down from 12.8 mm) has the same 3.8 mm instrument channel for no loss of functionality. It delivers more tactile feedback for improved scope drivability and less looping. EndoChoice turned this upgrade around within 24 months, which is amazing considering it's typically taken manufacturers 5 to 7 years to roll out a new scope.
Pentax Medical | i10 Series HD+ Endoscopes
Also in the category of scope innovations, Pentax Medical has introduced a new line of colonoscopy and EGD scopes, each type available in standard and slim sizes. The 140-degree field of view, high-definition scopes incorporate megapixel resolution CCD chips, which capture images consisting of more than 1 million pixels for image clarity and fine detail.
The instrument channels on the standard EGD scope and the slim colonoscope are larger than in previous versions of these scopes, lending us more therapeutic capability in their use. The 3.2 mm channel in the gastroscope and 3.8 mm channel in the colonoscope allow us to use larger forceps and other accessories, and more suction power.
In addition, the control body of the i10 series scopes has been redesigned for improved ergonomic comfort. The company says it'll fit in your physicians' hands better. It's 30 g lighter than Pentax's 90i series predecessor, with angulation knobs that make one-handed control easier and repositioned buttons for more intuitive operation. The i10 series scopes list at $31,000.
Avantis Medical Systems
| Third Eye Panoramic Device
Let's say you're an endo center administrator who recognizes the advantages that a wide-angle scope would bring your physicians (and their adenoma detection rates). But it's economically impractical to completely replace your endoscopy system, or your docs aren't eager to give up the scopes they like. Good news: There's an accessory that lets you expand their view without upgrading everything else.
The Third Eye Panoramic Device from Avantis Medical Systems clips onto the end of any standard colonoscope to provide a 300-degree-plus view without blocking the instrument channel. LED lights and side-viewing cameras on each side of the device supplement the scope's straight-ahead camera to present distinct, partially overlapping images on a single screen. According to a recent academic study (to which Avantis contributed), this accessory didn't affect the scope's HD image quality, handling, mobility, deflection, channel use or suction, and remained fixed during the course of procedures.
The company says that its single-use device has been FDA-approved, but that it would likely be a prohibitively expensive product for most facilities. In a nod to healthcare economics, the Third Eye's commercial launch is waiting on the FDA's review of a reusable version, which is in progress this summer. They estimate that device will cost about $25 to $30 per item.
Medigus | MUSE System
Our patient is suffering from GERD, and the proton-pump inhibitors aren't working. The next step is usually surgical intervention, namely a Nissen fundoplication to wrap the upper stomach around the bottom of the esophagus to assist it in closing. It's a popular solution, but it's not perfect. For one thing, it's a laparoscopic procedure, so it requires us to go in through the abdomen.
Check this out, though: the MUSE (Medigus Ultrasonic Surgical Endostapler) System makes it possible for a single endoscopist to treat GERD incisionlessly and with fewer resources, through transoral anterior fundoplication.
This all-in-one device, which resembles a flexible GI scope, is a video- and ultrasound-guided endoscopic surgical stapler. Advanced into the stomach and retroflexed, it clamps the tissue around the gastroesophageal junction and secures it with standard titanium staples. The multitasking distal tip includes a camera, light source and ultrasound transducer; irrigation, insufflation and suction; an alignment pin and stapling anvil. The disposable unit sidesteps the infection control risks that difficult-to-clean tools present.
The MUSE System is currently in use among registry patients in select locations, say company reps, who are awaiting a reimbursement amount designation before pricing the equipment.
Medivators | Defendo
Sterile Single-Use Valves
Time is money, and instrument reprocessing consumes both. Endoscope reprocessing is particularly laborious, and not just because of the long lumens. A scope's spring-loaded valves each require meticulous manual cleaning.
More efficient scope turnarounds aren't the only reason to consider disposable valves, though. Medivators' Defendo single-use valves, available for Olympus and Pentax scopes, provide a level of infection control assurance with every use by eliminating a potential contamination risk. Each kit includes a sterile, pre-greased air/water valve, suction valve, biopsy valve, and single-use auxiliary water port connector. They list at $8 to $10 per set and are sold in multiples of 50 or 100.
US Endoscopy | Lariat Snare
And Histolock Resection Device
US Endoscopy has introduced a pair of new endoscopic resection devices. The Lariat Snare is a multifunctional, single-use tool that's able to adjust to 3 different sizes and shapes from a 6 mm diamond to a 10 mm narrow hexagon to a 30 mm oval to handle multiple polyps, piecemeal resection, or other situations without having to switch snares. The grippable wire goes from stiff to flexible as the snare loop increases in size, but it maintains its shape and integrity even after multiple resections. The price is $250 per box of 10.
The Histolock Resection Device isn't retractable like the Lariat, but its 14 mm diamond shape easily gathers the mucosa into the loop and its stiff, twisted, monofilament wire (not a braided combination wire) delivers thermal efficiency in resecting flat, sessile polyps and other complex cases. Torsion at the tip helps to maintain its open shape even after multiple resections. In fact, the company says the disposable device is able to make 15 cuts in a single case. The Histolock is sold as part of a kit that also includes a Mio medical device organizer, a Carr-Locke injection needle, a Roth Net retriever and an eTrap polyp trap. A set of 3 kits costs $835.
ALSO ON DISPLAY
- Airless intubation. Reduce the risk of intestinal and abdominal distention among colonoscopy patients with long or redundant anatomy and previously unsuccessful or difficult screenings by using Vizballoons by Remington Medical instead of air inflation to ease insertion. The single-use accessories, compatible with all manufacturers' scopes, enable a clear view in a similar manner to aquatic goggles to speed the completion of cecal intubation with less pain and perforation risk for the patient. Vizballoons cost $90 each.
- Balloon catheter sizes and ablates. Choosing an ablation catheter for Barrett's esophagus cases used to be a multi-step affair. First you measured the anatomy several times with a balloon catheter to detect width. Then you selected the ablation catheter from the several types you had to stock. Covidien's Barrx 360 Express makes this a single-step process. The circumferential ablation catheter unwinds with a balloon to automatically do both jobs at once, saving time in the process.
- More efficient tissue sampling. Covidien also introduced its SharkCore Fine Needle Biopsy option for the company's Beacon Endoscopic Ultrasound system. The uniquely shaped tip is designed to collect more tissue, and more continuous and cohesive tissue samples, than traditional beveled needles, with less force needed. Available in 22 and 25 gauge sizes, the needles cost $350 to $400.
- Scan beneath the surface. White-light endoscopy is standard practice for esophageal examinations, but that only shows you the surface, not the abnormalities which may lie below. Random biopsies can help to diagnose Barrett's esophagus or other diseases, but they, too, are limited in what they can examine. Nine Point Medical's NvisionVLE Imaging System employs advanced optical coherence tomography and volumetric laser endomicroscopy to view the esophagus more thoroughly. A 90-second scan sees a 6 cm segment up to 3 mm deep at 20 times the resolution of endoscopic ultrasound, in real time. Cross-sectional, longitudinal and zoom views are available on the intuitive user interface.
C2 Therapeutics | Coldplay
CryoBalloon Focal Ablation System
The chief advantage of this cryotherapy technology for Barrett's esophagus and it's a big advantage is that it expands gastro docs' opportunities for ablation treatment without demanding a major capital investment. The fact that it's a handheld device with no large equipment to wheel in means that the nurses who set up the cases will appreciate it, too.
The system ablates lesions with a single-use balloon catheter that's passed through an endoscope's working channel, then inflated and cooled by a cartridge of nitrous oxide plugged into a single-use, self-contained, battery-powered control handle. The balloon conforms to the shape of the esophagus and a precise spray of the inert coolant treats the lesions. No $100,000 radiofrequency ablation generator or huge tank of liquid nitrogen necessary.
A rep from C2 Therapeutics says the product, which is currently in a "contained commercial launch," is expected to be priced to a similar cost-per-case as other ablation methods.