The market for gastrointestinal as well as endoscopic devices and technology has grown substantially more sophisticated over the last several years. The evolution of the device and technology market for gastroenterology directly affects the quality and delivery of care. Michael L. Kochman, MD, FASGE, a governing board councilor with the American Society for Gastrointestinal Endoscopy and NOSCAR® Research Subcommittee co-chair, shares five technological advances every gastroenterologist should be aware of.
1. Advancements in accuracy and visibility. The field of view and accuracy in endoscopes have dramatically improved over the last several decades. Dr. Kochman recalls his earlier years of practice when he performed fiber optic procedures, a time he jokingly refers to as "the dark ages." Since then, endoscopes have hugely improved and now come fully equipped to help physicians more accurately detect and view lesions during an endoscopic procedure.
"There have been huge improvements in the visual accuracy and field of view in [GI/endoscopic] technology," Dr. Kochman says. "These technologies allow physicians to see through the endoscope with a wider angle of view and with much better resolution, which allows them to identify smaller lesions and smaller features on lesions that we wouldn't normally be able to see previously."
Not only does greater visibility allow for improved accuracy in detecting lesions and polyps but also allows physicians to become more selective on what is removed for biopsy, a move that Dr. Kochman says could help contain healthcare costs.
2. Introduction of high-def TVs. Sports fans and adolescents aren't the only ones excited about the ever-evolving market of high-definition televisions; GI physicians are reaping the benefits as well. The emergence of HDTVs has allowed GI physicians to view the journey of an endoscope on a large screen, forever doing away with relying on the small eye pieces traditionally attached to the old fiberoptic endoscopes. Just like any other leisure viewing, GI physicians have the capability of viewing very small and minute details on a bigger scale and with much greater detail.
"The advancement of HDTVs has really emerged for two reasons," Dr. Kochman says. "The lighting technology (or the bulbs) is able to put out light at much higher luminosity with accurate color reproduction. Additionally, the miniaturization of megapixel CCD chips (or camera receivers) allows everything [seen through an endoscope] to be projected onto a TV screen."
3. Manipulation of endoscopes imaging. Technology has also allowed physicians to manipulate what is viewed through the endoscope for more accurate detection of lesions and polyps. One example of how viewing can be manipulated is the use of stains or dyes on the surface of the GI tract to better highlight certain areas of a patient's colon.
"With electronics, we are starting to learn how to better use technology to obtain signatures from different types of tissue by [using electronics to reproduce stains and dyes] or magnifying the view of the GI tract even more," Dr. Kochman says. "We can actually zoom in on selected areas with the endoscopes."
4. Out with the old. With any piece of old technology, Dr. Kochman says there are also GI technologies and devices that should be phased out completely due to the development of complementary and innovative technology. He says hot biopsy forceps for colon polypectomy is one of those devices.
"There is an increasing established body of literature that holds snare polypectomies are as effective at removing small polyps [as hot biopsy forceps] with a lower bleed rate. So today, cold snares are the way to go," Dr. Kochman says. "Similarly, sclerotherapy, for the most part, is replaced by endoscopic band ligation. Also, diagnostic ERCP — not to be confused with therapeutic ERCP — for the most shouldn't exist due to the wide dissemination of MR/MRCP."
5. In with the new. New and improved technologies are constantly coming down the pike for GI physicians to use for their procedures. Apart from the specific products such as endoprosthetic placements that have made an introduction into the GI device market, Dr. Kochman says GI physicians should also be paying attention to devices that have changed from being a diagnostic tool to a therapeutic tool.
"As with all procedures, most of those procedures and devices start off as diagnostic tools and as time goes on, therapeutic capability develops," Dr. Kochman says. "We are really starting to see a critical change in the acceptance of technological management of mucosal lesions and endoscopic management of early neoplasms."
Dr. Kochman says these new technologies previously faced great resistance from healthcare payors and were not as widely utilized in the United States as in other countries. However, the trend is beginning to reverse. "Even to this day, payors are not necessarily reimbursing the physician and technical fees as well as they should be for what may be a longer but overall more cost-effective endoscopic procedure compared to an open surgical procedure," he says.
Learn more about the American Society for Gastrointestinal Endoscopy.
Learn more about the Natural Orifice Surgery Consortium for Assessment and Research®.
1. Advancements in accuracy and visibility. The field of view and accuracy in endoscopes have dramatically improved over the last several decades. Dr. Kochman recalls his earlier years of practice when he performed fiber optic procedures, a time he jokingly refers to as "the dark ages." Since then, endoscopes have hugely improved and now come fully equipped to help physicians more accurately detect and view lesions during an endoscopic procedure.
"There have been huge improvements in the visual accuracy and field of view in [GI/endoscopic] technology," Dr. Kochman says. "These technologies allow physicians to see through the endoscope with a wider angle of view and with much better resolution, which allows them to identify smaller lesions and smaller features on lesions that we wouldn't normally be able to see previously."
Not only does greater visibility allow for improved accuracy in detecting lesions and polyps but also allows physicians to become more selective on what is removed for biopsy, a move that Dr. Kochman says could help contain healthcare costs.
2. Introduction of high-def TVs. Sports fans and adolescents aren't the only ones excited about the ever-evolving market of high-definition televisions; GI physicians are reaping the benefits as well. The emergence of HDTVs has allowed GI physicians to view the journey of an endoscope on a large screen, forever doing away with relying on the small eye pieces traditionally attached to the old fiberoptic endoscopes. Just like any other leisure viewing, GI physicians have the capability of viewing very small and minute details on a bigger scale and with much greater detail.
"The advancement of HDTVs has really emerged for two reasons," Dr. Kochman says. "The lighting technology (or the bulbs) is able to put out light at much higher luminosity with accurate color reproduction. Additionally, the miniaturization of megapixel CCD chips (or camera receivers) allows everything [seen through an endoscope] to be projected onto a TV screen."
3. Manipulation of endoscopes imaging. Technology has also allowed physicians to manipulate what is viewed through the endoscope for more accurate detection of lesions and polyps. One example of how viewing can be manipulated is the use of stains or dyes on the surface of the GI tract to better highlight certain areas of a patient's colon.
"With electronics, we are starting to learn how to better use technology to obtain signatures from different types of tissue by [using electronics to reproduce stains and dyes] or magnifying the view of the GI tract even more," Dr. Kochman says. "We can actually zoom in on selected areas with the endoscopes."
4. Out with the old. With any piece of old technology, Dr. Kochman says there are also GI technologies and devices that should be phased out completely due to the development of complementary and innovative technology. He says hot biopsy forceps for colon polypectomy is one of those devices.
"There is an increasing established body of literature that holds snare polypectomies are as effective at removing small polyps [as hot biopsy forceps] with a lower bleed rate. So today, cold snares are the way to go," Dr. Kochman says. "Similarly, sclerotherapy, for the most part, is replaced by endoscopic band ligation. Also, diagnostic ERCP — not to be confused with therapeutic ERCP — for the most shouldn't exist due to the wide dissemination of MR/MRCP."
5. In with the new. New and improved technologies are constantly coming down the pike for GI physicians to use for their procedures. Apart from the specific products such as endoprosthetic placements that have made an introduction into the GI device market, Dr. Kochman says GI physicians should also be paying attention to devices that have changed from being a diagnostic tool to a therapeutic tool.
"As with all procedures, most of those procedures and devices start off as diagnostic tools and as time goes on, therapeutic capability develops," Dr. Kochman says. "We are really starting to see a critical change in the acceptance of technological management of mucosal lesions and endoscopic management of early neoplasms."
Dr. Kochman says these new technologies previously faced great resistance from healthcare payors and were not as widely utilized in the United States as in other countries. However, the trend is beginning to reverse. "Even to this day, payors are not necessarily reimbursing the physician and technical fees as well as they should be for what may be a longer but overall more cost-effective endoscopic procedure compared to an open surgical procedure," he says.
Learn more about the American Society for Gastrointestinal Endoscopy.
Learn more about the Natural Orifice Surgery Consortium for Assessment and Research®.