While walking the exhibit hall at Digestive Disease Week in Chicago last May, I caught up with old friends and test-drove some innovative devices designed to provide physicians with enhanced views of the colon and improve cancer detection rates — without taking a big bite out of your facility’s capital budget. Here’s a sampling of some of the newest and neatest products that were on display.

1. STRAIGHT FLUSH Dr. Gross gives Medivators’ powerful solution to failed bowel preps a try.

1. Medivators
Jet Prep
Even with their best efforts, about 20% of colonoscopy patients fall short of properly cleansing the colon. Rather than let poor bowel prepping stop you, turn to Medivators’s Jet Prep. This endoscopic flushing device removes stool and debris while improving colon visibility and polyp detection. This is a nice way to salvage a colonoscopy and prevent patients from having to return on another day to complete the exam.

The device is inserted into the colonoscope’s working channel when it’s needed and flushes loose stool and obstructions off the colon wall with a blast of pressurized water, which the physician regulates with a handheld control. The physician can also back-flush the device’s channel if it becomes blocked with excess liquid or feces and aspirate the dirty fluid out of the patient. A company rep says Jet Prep provides significantly better visualization of the colon in real time to improve adenoma detection rates.

2. Pentax
EndoPro IQ Version 7.6
The biggest change to Pentax’s image management and endoscopic documentation software centers on GI Quick, an innovation that lets physicians submit quality data to the national registry and use intuitive narrative tools to report cases and discrete data in a physician-friendly form. They can navigate through the program easily, generating rich narrative texts for passing through to referring physicians or facilities’ EMR systems. The program is DIACAP certified — the highest level of online security — which is unique in the space, according to Pentax.

For colonoscopy reporting, we’re held to a high standard when supplying quality metrics, specifically adenoma detection rates and the number of complete exams indicated by success in reaching the cecum. The reporting of these quality metrics will soon expand to upper endoscopy, so it’s nice to have a software platform that makes it easy to produce a useful report that meets those requirements.

2. USER FRIENDLY Dr. Gross hears how Pentax’s upgraded its already successful image management and documentation software.

3. NDS Imaging
Zero Wire Ultra and Expand OR
The Zero Wire Ultra video management system builds on the platform’s previous generation with the added capacity to transmit images wirelessly among 9 devices in the procedure room. It also features technical enhancements that result in less interference from neighboring signals. Endoscopy is a specialty that relies heavily on video image capture, but we like working wirelessly, which provides a much cleaner look and enhances staff and patient safety by removing cabling from the floor of the procedure area. This device would play a key role in a facility interested in meeting those goals.

NDS Imaging also showcased its Expand OR medical grade video streaming device, which lets physicians connect remotely with colleagues across town or around the world, without fear of losing image quality during the transmission. The device is ideally suited for telemedicine, remote consultations and educational applications.

3. SEEING IS BELIEVING NDS Imaging improved upon its video-sharing technology.

4. FREEZE FRAME CSA Medical’s cryotherapy platform improves treatment of disease at the gastroesophageal junction.

4. CSA Medical
Tru Freeze System
Spray cryotherapy is used in dermatology, gynecology and general surgery to ablate unwanted tissue, resulting in normal wound healing and improved tissue response. It uses low-pressure liquid nitrogen at -196°C to freeze cellular tissue, avoiding the necrotic scarring caused by electrosurgical or radiofrequency technologies.

The anatomy of the gastroesophageal (GE) junction is difficult to access in order to treat disease, especially in patients with hiatal hernias that cause the stomach to stick out above the diaphragm. The upgraded catheter of this system is placed through a standard endoscope and designed for full retroflexion, providing a continuous spray in the GE junction, offering tremendous promise in using cryotherapy to treat diseases of the esophagus and stomach.

5. INFLATED WORTH Smart Medical Systems’s balloon catheter turns standard colonoscopes into deep enteroscopes.

5. Smart Medical Systems
NaviAid AB (Advancing Balloon) Platform
This innovative device lets physicians advance standard endoscopes into the small bowel to perform deep balloon-assisted enteroscopy. Physicians work the device’s soft-tipped catheter containing a latex-free balloon through the scope’s instrument channel and position it in the pylorus or terminal ileum. With the balloon advanced ahead of the scope, the physician taps on a foot pedal to inflate the balloon. A nurse or technician holds the catheter in place while the physician pushes the scope forward, deflates the balloon by the tapping the foot pedal again and repeats the process for continued propagation. When the physician reaches the intended destination to look for bleeds or pathology, the balloon can be removed back through the instrument channel while the scope remains in position. Physicians can also withdraw the scope in a controlled manner by using the balloon as an anchor along the way.

Capsule endoscopy finds pathology in the small intestine, but physicians are hampered by the limited number of tools that are capable of reaching the area. This simple device lets physicians turn the scopes they’re comfortable handling into deep enteroscopes without investing in a new platform.

6. THREE-RING SURFACE EndoAid’s new device improves views behind folds in the colon.

6. EndoAid
EndoRings
EndoAid’s colonoscope add-on device is designed to increase adenoma detection rates by providing physicians with improved views between the colon’s folds and around its turns without having to endure a learning curve or make a capital investment. The device attaches to the tip of a standard scope, slightly behind the camera. During intubation, the device is passive, giving physicians the feel of conventional colonoscopy and letting them maneuver and retroflex as normal. When they reach the cecum and start withdrawing the scope, however, the 3 rings bend over each other to create radial force that “irons” the colon wall and centers the scope within the pathway. This device is another great example of the industry continuing to offer solutions for finding polyps behind folds that in the past have been difficult to identify. It’s nice that it provides physicians with improved visualization with the scopes they’re already using.

7. LOOKING AROUND Avantis Medical’s clip-on device provides panoramic views of the colon.

7. Avantis Medical
Third Eye Panoramic Device
Clip this imaging device on any colonoscope for panoramic views of the colon. Light sources and cameras on the left and right sides of the device augment the middle view of the colonoscope’s lens, resulting in 3 images displayed on a single screen. Unlike a competing technology that delivers similar views, this device works with existing platforms without the need for additional capital equipment, giving physicians the flexibility to perform better exams with their current equipment.

THERAPEUTIC ENDOSCOPY
Surgeon Touts Endoscopic Treatment of Esophageal Cancer

HOT SPOT Experts gathered at the Olympus booth to discuss the exciting potential of endoscopic submucosal dissection.

Endoscopic Submucosal Dissection (ESD) is much preferred to esophagectomy for the early treatment of esophageal cancers. ESD is a well-established technique in Eastern medicine, but it’s still an emerging technology in the United States. That might soon change.

“ESD is superior to what’s being currently offered in many facilities,” says Christopher Thompson, MD, MHES, the director of therapeutic endoscopy at Brigham and Women’s Hospital and associate professor at Harvard Medical School in Boston. “It’s a big deal, and just a matter of time until more physicians learn how to perform it.”

Speaking to Outpatient Surgery at Digestive Disease Week, Dr. Thompson says ESD is a very effective treatment for early malignancies. It results in great cure rates with low risks of complications, he says.

ESD is a natural orifice procedure performed with an endoscope placed through the mouth. Surgeons mark around mucosal-based lesions — cancer in the lining of the esophagus — tunnel underneath, lift up the defect and resect it without fully cutting through the esophagus.

“It does not involve a transluminal approach into the abdominal cavity,” says Dr. Thompson. “It’s often called a ‘third-space procedure,’ because the technique shaves beneath lesions, but does not cut all the way through the lumen structure.”

During conventional esophagectomy, surgeons remove diseased sections of the esophagus. “There are immediate complications, which are vast, but also delayed complications,” said Dr. Thompson. “Patients don’t have a high quality of life after esophageal resection.”

Submucosal dissection turns a complex inpatient surgery into a relatively painless outpatient procedure. Olympus Medical makes specially designed electrosurgical knives — which recently gained FDA approval — that work with any electrosurgery generator. Experts from Asia and the U.S. gathered in Chicago in May at Digestive Disease Week to discuss their experiences with ESD with the hopes of bringing the procedure to more American facilities.

— Daniel Cook