TBD Meeting (5257-19)

SAN FRANCISCO – The growing sophistication of simulation technology has the potential to improve training and assessment of skills in gastrointestinal endoscopy, but there are gaps between the promise and evidence, according to an overview of this form of training at the 2019 AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology.

For endoscopy, the term simulator encompasses a broad expanse of tools that can range from a simple physical model with holes used to practice endoscope navigation skills to a complex virtual world that challenges technical skills as well as decision-making processes. In 2012, the American Society of Gastrointestinal Endoscopy (ASGE) issued a statement encouraging endoscopy simulation-based training in the context of other strategies to gain skills, but Catharine Walsh, MD, MEd, PhD, of the University of Toronto, warned of the current limits as well as the advantages of simulation training.

“There are many companies making simulators of varying price and complexity. For early skill acquisition, more expensive devices may not necessarily be better,” Dr. Walsh said. She highlighted that “one’s choice of simulator should be based on the educational goals as opposed to technology, as the effectiveness of simulation depends highly on a close match between the training goals and the simulation tool.” A longstanding issue in the field of simulation relates to cost and access. Simulation will not have widespread impact unless it is accessible. “There is a need for future development of inexpensive, portable simulators targeting specific skills to help facilitate uptake of simulation across endoscopy units and training programs,” said Dr. Walsh. Other strategies to increase uptake include specific learning modules designed to complement simulators.

Although simulators are increasingly being used during training to help endoscopists develop basic endoscopic skills, Dr. Walsh focused on the gap in development of simulator devices targeting practicing endoscopists and research examining their use for training new skills within practice, preventing skills decay, and remediating performance deficits. She explained that “currently, there is a lack of evidence that simulation adoption by practicing endoscopists leads to better patient outcomes. This remains a priority area for simulation education, research, and development.” It also remains to be seen how cost-effective simulators are compared with other reaching modalities, she said. 

“The potential is certainly there, but it is essential to develop simulators targeting training for low-volume, higher stakes therapeutic techniques, emerging procedures, and techniques and advanced endoscopic procedures, and perform well-controlled studies to demonstrate their effectiveness in practice,” Dr. Walsh said. “Embedding assessments within emerging simulation technology is key as it permits identification of skills requiring further practice and can form the basis of virtual coaching employing endoscopic simulation to improve skills and outcomes.”

Simulators offer the very important advantage of giving the physician the chance to acquire skills before participating in a clinical case and allowing errors to occur in a risk-free environment, suggesting that this type of training will only grow. For example, Dr. Walsh described emerging simulation-based team training that allows endoscopy teams to practice both technical skills as well as nontechnical skills, such as communication and decision making, which may be particularly important in the event of a crisis. Gamification is also being pursued as a potential adjunct strategy to help improve engagement and skill acquisition.

Current simulators are limited in their ability to train and assess cognitive and nontechnical skills. Development of simulation-based cognitive training tools for key areas such as lesion recognition, classification, and management decision-making skills is also a promising area to pursue. Such education could be delivered via portable electronic devices and incorporate assessment and feedback to facilitate skills acquisition.

“There remains a substantial gap between the promise of many types of simulation training and objective evidence that these are helping endoscopists gain skills,” Dr. Walsh said. This in no way diminishes the enormous promise of new simulation technology to be an effective and safe approach for clinicians to learn and maintain performance of endoscopic skills, but Dr. Walsh focused on the need for the development of new simulation technologies and controlled studies that will render these approaches evidence based.

SAN FRANCISCO – The growing sophistication of simulation technology has the potential to improve training and assessment of skills in gastrointestinal endoscopy, but there are gaps between the promise and evidence, according to an overview of this form of training at the 2019 AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology.

For endoscopy, the term simulator encompasses a broad expanse of tools that can range from a simple physical model with holes used to practice endoscope navigation skills to a complex virtual world that challenges technical skills as well as decision-making processes. In 2012, the American Society of Gastrointestinal Endoscopy (ASGE) issued a statement encouraging endoscopy simulation-based training in the context of other strategies to gain skills, but Catharine Walsh, MD, MEd, PhD, of the University of Toronto, warned of the current limits as well as the advantages of simulation training.

“There are many companies making simulators of varying price and complexity. For early skill acquisition, more expensive devices may not necessarily be better,” Dr. Walsh said. She highlighted that “one’s choice of simulator should be based on the educational goals as opposed to technology, as the effectiveness of simulation depends highly on a close match between the training goals and the simulation tool.” A longstanding issue in the field of simulation relates to cost and access. Simulation will not have widespread impact unless it is accessible. “There is a need for future development of inexpensive, portable simulators targeting specific skills to help facilitate uptake of simulation across endoscopy units and training programs,” said Dr. Walsh. Other strategies to increase uptake include specific learning modules designed to complement simulators.

Although simulators are increasingly being used during training to help endoscopists develop basic endoscopic skills, Dr. Walsh focused on the gap in development of simulator devices targeting practicing endoscopists and research examining their use for training new skills within practice, preventing skills decay, and remediating performance deficits. She explained that “currently, there is a lack of evidence that simulation adoption by practicing endoscopists leads to better patient outcomes. This remains a priority area for simulation education, research, and development.” It also remains to be seen how cost-effective simulators are compared with other reaching modalities, she said. 

“The potential is certainly there, but it is essential to develop simulators targeting training for low-volume, higher stakes therapeutic techniques, emerging procedures, and techniques and advanced endoscopic procedures, and perform well-controlled studies to demonstrate their effectiveness in practice,” Dr. Walsh said. “Embedding assessments within emerging simulation technology is key as it permits identification of skills requiring further practice and can form the basis of virtual coaching employing endoscopic simulation to improve skills and outcomes.”

Simulators offer the very important advantage of giving the physician the chance to acquire skills before participating in a clinical case and allowing errors to occur in a risk-free environment, suggesting that this type of training will only grow. For example, Dr. Walsh described emerging simulation-based team training that allows endoscopy teams to practice both technical skills as well as nontechnical skills, such as communication and decision making, which may be particularly important in the event of a crisis. Gamification is also being pursued as a potential adjunct strategy to help improve engagement and skill acquisition.

Current simulators are limited in their ability to train and assess cognitive and nontechnical skills. Development of simulation-based cognitive training tools for key areas such as lesion recognition, classification, and management decision-making skills is also a promising area to pursue. Such education could be delivered via portable electronic devices and incorporate assessment and feedback to facilitate skills acquisition.

“There remains a substantial gap between the promise of many types of simulation training and objective evidence that these are helping endoscopists gain skills,” Dr. Walsh said. This in no way diminishes the enormous promise of new simulation technology to be an effective and safe approach for clinicians to learn and maintain performance of endoscopic skills, but Dr. Walsh focused on the need for the development of new simulation technologies and controlled studies that will render these approaches evidence based.

SAN FRANCISCO – The growing sophistication of simulation technology has the potential to improve training and assessment of skills in gastrointestinal endoscopy, but there are gaps between the promise and evidence, according to an overview of this form of training at the 2019 AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology.

For endoscopy, the term simulator encompasses a broad expanse of tools that can range from a simple physical model with holes used to practice endoscope navigation skills to a complex virtual world that challenges technical skills as well as decision-making processes. In 2012, the American Society of Gastrointestinal Endoscopy (ASGE) issued a statement encouraging endoscopy simulation-based training in the context of other strategies to gain skills, but Catharine Walsh, MD, MEd, PhD, of the University of Toronto, warned of the current limits as well as the advantages of simulation training.

“There are many companies making simulators of varying price and complexity. For early skill acquisition, more expensive devices may not necessarily be better,” Dr. Walsh said. She highlighted that “one’s choice of simulator should be based on the educational goals as opposed to technology, as the effectiveness of simulation depends highly on a close match between the training goals and the simulation tool.” A longstanding issue in the field of simulation relates to cost and access. Simulation will not have widespread impact unless it is accessible. “There is a need for future development of inexpensive, portable simulators targeting specific skills to help facilitate uptake of simulation across endoscopy units and training programs,” said Dr. Walsh. Other strategies to increase uptake include specific learning modules designed to complement simulators.

Although simulators are increasingly being used during training to help endoscopists develop basic endoscopic skills, Dr. Walsh focused on the gap in development of simulator devices targeting practicing endoscopists and research examining their use for training new skills within practice, preventing skills decay, and remediating performance deficits. She explained that “currently, there is a lack of evidence that simulation adoption by practicing endoscopists leads to better patient outcomes. This remains a priority area for simulation education, research, and development.” It also remains to be seen how cost-effective simulators are compared with other reaching modalities, she said. 

“The potential is certainly there, but it is essential to develop simulators targeting training for low-volume, higher stakes therapeutic techniques, emerging procedures, and techniques and advanced endoscopic procedures, and perform well-controlled studies to demonstrate their effectiveness in practice,” Dr. Walsh said. “Embedding assessments within emerging simulation technology is key as it permits identification of skills requiring further practice and can form the basis of virtual coaching employing endoscopic simulation to improve skills and outcomes.”

Simulators offer the very important advantage of giving the physician the chance to acquire skills before participating in a clinical case and allowing errors to occur in a risk-free environment, suggesting that this type of training will only grow. For example, Dr. Walsh described emerging simulation-based team training that allows endoscopy teams to practice both technical skills as well as nontechnical skills, such as communication and decision making, which may be particularly important in the event of a crisis. Gamification is also being pursued as a potential adjunct strategy to help improve engagement and skill acquisition.

Current simulators are limited in their ability to train and assess cognitive and nontechnical skills. Development of simulation-based cognitive training tools for key areas such as lesion recognition, classification, and management decision-making skills is also a promising area to pursue. Such education could be delivered via portable electronic devices and incorporate assessment and feedback to facilitate skills acquisition.

“There remains a substantial gap between the promise of many types of simulation training and objective evidence that these are helping endoscopists gain skills,” Dr. Walsh said. This in no way diminishes the enormous promise of new simulation technology to be an effective and safe approach for clinicians to learn and maintain performance of endoscopic skills, but Dr. Walsh focused on the need for the development of new simulation technologies and controlled studies that will render these approaches evidence based.

SAN FRANCISCO – The body of evidence to support virtual reality (VR) as a therapeutic modality will increasingly involve the GI tract, according to evidence summarized at the 2019 AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology. Evolving from its early use in acute or chronic pain, where its function was to simply divert attention from symptoms, VR computer-generated environments are now being applied to alter patient perceptions and behavior that may involve changes in brain function, according to Brennan Spiegel, MD, AGAF, director of Health Services Research for Cedars-Sinai Medical Center, Los Angeles.

“The field of gastroenterology is a particularly promising area for treatment based on VR because of the well-established brain-gut interaction,” Dr. Spiegel explained. He said this tool has now been shown repeatedly to change how patients experience their symptoms in a variety of clinical contexts.

The field is not entirely new. Already by 2017, 11 randomized controlled trials of VR for therapeutic purposes were identified in a systematic review (Innov Clin Neurosci 2017;14:14-21). These trials, dating back to 2010, have explored this technology in depression, cognitive and motor rehabilitation, and eating disorders. Most showed significant benefit. In eating disorders, for example, response at one year was 44% in those receiving VR as an adjunct to cognitive behavioral therapy versus 10% in the controls.

“VR may not just alter perception. In studies being conducted with functional MRI imaging, changes in brain function similar to those observed in patients taking opioids have been observed,” said Dr. Spiegel, outlining objective evidence that VR has physiological effects.

VR already has an established role as a training tool for physicians in GI and other areas of medicine, but Dr. Spiegel focused on the evidence of its applications in treatment. Earlier this year, an expert panel in which he participated published a methodology for VR clinical trials to help move the field forward by defining how to establish evidence of benefit (JMIR Mental Health 2019;6:e11973). With a growing body of data suggesting VR has measurable clinical benefits, the field is poised to grow quickly.

In gastroenterology specifically, Dr. Spiegel envisions applications in functional diseases, such as irritable bowel syndrome (IBS), in which there is already strong evidence of a mind-gut component to symptom flares. He said, “VR can help patients to engage with their body differently, changing how they react to symptoms and leading to better coping mechanisms.”

In one example, Dr. Spiegel displayed a video depicting a woman with severe pain due to liver ascites testifying to substantial pain relief after a VR experience that included images that took her far from the hospital room in which she was sitting at the time. He reported that gastrointestinal pain relief is so consistent with VR that failure to respond prompts him to reevaluate patients for missed organic pathology.

Implementation of VR as a therapeutic tool is not without obstacles. For example, patients susceptible to motion sickness can react poorly to the three-dimensional environment created by VR, according to Dr. Spiegel. Many patients have expressed reluctance to try VR for any one of a number of reasons, including skepticism. However, there are many potential advantages. In the management of pain, for example, VR circumvents a long list of adverse events related to opioids or other analgesics.

This technology is only being used in a few centers, but there is enough evidence of clinical benefit that Dr. Siegel expects it to be more broadly adopted as indications expand. With more controlled trials being performed to measure and establish benefits, he envisions an evidence-based VR pharmacy that will allow clinicians to prescribe specific VR software suitable not only for the target condition but matched to patient preferences for VR environments.

“We have good evidence that VR is a powerful tool to manage mood disorders and pain perception. Although there is so far a fairly limited about of research specific to GI conditions, this is coming,” Dr. Spiegel said.

SAN FRANCISCO – The body of evidence to support virtual reality (VR) as a therapeutic modality will increasingly involve the GI tract, according to evidence summarized at the 2019 AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology. Evolving from its early use in acute or chronic pain, where its function was to simply divert attention from symptoms, VR computer-generated environments are now being applied to alter patient perceptions and behavior that may involve changes in brain function, according to Brennan Spiegel, MD, AGAF, director of Health Services Research for Cedars-Sinai Medical Center, Los Angeles.

“The field of gastroenterology is a particularly promising area for treatment based on VR because of the well-established brain-gut interaction,” Dr. Spiegel explained. He said this tool has now been shown repeatedly to change how patients experience their symptoms in a variety of clinical contexts.

The field is not entirely new. Already by 2017, 11 randomized controlled trials of VR for therapeutic purposes were identified in a systematic review (Innov Clin Neurosci 2017;14:14-21). These trials, dating back to 2010, have explored this technology in depression, cognitive and motor rehabilitation, and eating disorders. Most showed significant benefit. In eating disorders, for example, response at one year was 44% in those receiving VR as an adjunct to cognitive behavioral therapy versus 10% in the controls.

“VR may not just alter perception. In studies being conducted with functional MRI imaging, changes in brain function similar to those observed in patients taking opioids have been observed,” said Dr. Spiegel, outlining objective evidence that VR has physiological effects.

VR already has an established role as a training tool for physicians in GI and other areas of medicine, but Dr. Spiegel focused on the evidence of its applications in treatment. Earlier this year, an expert panel in which he participated published a methodology for VR clinical trials to help move the field forward by defining how to establish evidence of benefit (JMIR Mental Health 2019;6:e11973). With a growing body of data suggesting VR has measurable clinical benefits, the field is poised to grow quickly.

In gastroenterology specifically, Dr. Spiegel envisions applications in functional diseases, such as irritable bowel syndrome (IBS), in which there is already strong evidence of a mind-gut component to symptom flares. He said, “VR can help patients to engage with their body differently, changing how they react to symptoms and leading to better coping mechanisms.”

In one example, Dr. Spiegel displayed a video depicting a woman with severe pain due to liver ascites testifying to substantial pain relief after a VR experience that included images that took her far from the hospital room in which she was sitting at the time. He reported that gastrointestinal pain relief is so consistent with VR that failure to respond prompts him to reevaluate patients for missed organic pathology.

Implementation of VR as a therapeutic tool is not without obstacles. For example, patients susceptible to motion sickness can react poorly to the three-dimensional environment created by VR, according to Dr. Spiegel. Many patients have expressed reluctance to try VR for any one of a number of reasons, including skepticism. However, there are many potential advantages. In the management of pain, for example, VR circumvents a long list of adverse events related to opioids or other analgesics.

This technology is only being used in a few centers, but there is enough evidence of clinical benefit that Dr. Siegel expects it to be more broadly adopted as indications expand. With more controlled trials being performed to measure and establish benefits, he envisions an evidence-based VR pharmacy that will allow clinicians to prescribe specific VR software suitable not only for the target condition but matched to patient preferences for VR environments.

“We have good evidence that VR is a powerful tool to manage mood disorders and pain perception. Although there is so far a fairly limited about of research specific to GI conditions, this is coming,” Dr. Spiegel said.

SAN FRANCISCO – The body of evidence to support virtual reality (VR) as a therapeutic modality will increasingly involve the GI tract, according to evidence summarized at the 2019 AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology. Evolving from its early use in acute or chronic pain, where its function was to simply divert attention from symptoms, VR computer-generated environments are now being applied to alter patient perceptions and behavior that may involve changes in brain function, according to Brennan Spiegel, MD, AGAF, director of Health Services Research for Cedars-Sinai Medical Center, Los Angeles.

“The field of gastroenterology is a particularly promising area for treatment based on VR because of the well-established brain-gut interaction,” Dr. Spiegel explained. He said this tool has now been shown repeatedly to change how patients experience their symptoms in a variety of clinical contexts.

The field is not entirely new. Already by 2017, 11 randomized controlled trials of VR for therapeutic purposes were identified in a systematic review (Innov Clin Neurosci 2017;14:14-21). These trials, dating back to 2010, have explored this technology in depression, cognitive and motor rehabilitation, and eating disorders. Most showed significant benefit. In eating disorders, for example, response at one year was 44% in those receiving VR as an adjunct to cognitive behavioral therapy versus 10% in the controls.

“VR may not just alter perception. In studies being conducted with functional MRI imaging, changes in brain function similar to those observed in patients taking opioids have been observed,” said Dr. Spiegel, outlining objective evidence that VR has physiological effects.

VR already has an established role as a training tool for physicians in GI and other areas of medicine, but Dr. Spiegel focused on the evidence of its applications in treatment. Earlier this year, an expert panel in which he participated published a methodology for VR clinical trials to help move the field forward by defining how to establish evidence of benefit (JMIR Mental Health 2019;6:e11973). With a growing body of data suggesting VR has measurable clinical benefits, the field is poised to grow quickly.

In gastroenterology specifically, Dr. Spiegel envisions applications in functional diseases, such as irritable bowel syndrome (IBS), in which there is already strong evidence of a mind-gut component to symptom flares. He said, “VR can help patients to engage with their body differently, changing how they react to symptoms and leading to better coping mechanisms.”

In one example, Dr. Spiegel displayed a video depicting a woman with severe pain due to liver ascites testifying to substantial pain relief after a VR experience that included images that took her far from the hospital room in which she was sitting at the time. He reported that gastrointestinal pain relief is so consistent with VR that failure to respond prompts him to reevaluate patients for missed organic pathology.

Implementation of VR as a therapeutic tool is not without obstacles. For example, patients susceptible to motion sickness can react poorly to the three-dimensional environment created by VR, according to Dr. Spiegel. Many patients have expressed reluctance to try VR for any one of a number of reasons, including skepticism. However, there are many potential advantages. In the management of pain, for example, VR circumvents a long list of adverse events related to opioids or other analgesics.

This technology is only being used in a few centers, but there is enough evidence of clinical benefit that Dr. Siegel expects it to be more broadly adopted as indications expand. With more controlled trials being performed to measure and establish benefits, he envisions an evidence-based VR pharmacy that will allow clinicians to prescribe specific VR software suitable not only for the target condition but matched to patient preferences for VR environments.

“We have good evidence that VR is a powerful tool to manage mood disorders and pain perception. Although there is so far a fairly limited about of research specific to GI conditions, this is coming,” Dr. Spiegel said.

SAN FRANCISCO – Artificial intelligence (AI) can improve video recording and physician support during colonoscopy procedures, and the data being collected could eventually pave the way to AI systems powerful enough to detect polyps on their own.

AI has been touted as a means to reduce costs and improve patient outcomes, but there’s another benefit that is sometimes overlooked – physician satisfaction. Examining colonoscopy after colonoscopy can get a little overwhelming. “There’s only so much the human eye can see, and when you’re doing multiple colonoscopies a day, there’s a possibility that you’re just seeing too much. [AI] could help lessen the burden in making those diagnoses,” said Kurt Heine in an interview.

Mr. Heine is vice president of the endoscopy division at Olympus America. He joined other speakers at a panel on artificial intelligence at the 2019 AGA Tech Summit sponsored by the AGA Center for GI Innovation and Technology.

Physicians are under an increasing burden with the aging population and recommendations from the American Cancer Society that colonoscopies should begin at age 45. “We need a more efficient way to perform colonoscopies. Ideally AI would aid in the adenoma detection rate and perhaps someday in diagnosis. We’re trying to build a support tool to assist in that procedure,” said Heine.

That point was echoed by Matt Schwartz, CEO of Virgo, which specializes in video recording of colonoscopies. In an effort to ease physician burden, it is automating some simple tasks, like starting and stopping video recording during a procedure. That’s a time-consuming process, and “it’s the sort of task that AI is really good at, so it’s a natural fit to get our first foray of AI on the market,” said Mr. Schwartz in an interview. Virgo currently provides a small, Apple TV–sized box that connects directly to an existing endoscopy system that independently records procedures.

The system uploads captured video into the cloud, and automatically creates highlights for easy viewing. That feature is available now. In the future, Virgo hopes to offer advanced analysis of withdrawal time, cecal intubation rate, and other features. “We want to provide video analytics that can help doctors and physician groups make informed decisions on how to improve quality,” said Mr. Schwartz.

Developing AI poses distinct challenges, and can be costly and time-consuming, said Jason Tucker-Schwartz, PhD, director of marketing for NinePoint Medical. During the session, he outlined the development of the AI component of the company’s NvisionVLE Imaging System, which is the only Food and Drug Administration–approved AI product for upper GI imaging. It reveals layers inside the esophageal tissue wall with high resolution, where 90% of cancers begin.

“It’s a new type of data that gastroenterologists are not used to seeing,” said Dr. Tucker-Schwartz. But that has presented a challenge to physicians attempting to identify and process all that novel information.

That called for AI, but because NinePoint is a small company with limited resources, it needed to control development costs. To streamline matters, they developed a system that focuses on three features that are most useful in making esophageal diagnoses. “The AI algorithms find those features as a function of depth so we can flatten them and use them to create a roadmap that physicians can use to guide their [interpretation],” said Dr. Tucker-Schwartz.

The resulting system has garnered lots of positive feedback, according to Dr. Tucker-Schwartz. The experience highlights the need to incorporate physician input into product development. “You need to involve them in all the steps along the path to end with a product that meets not only their goals but your business goals as well,” he said.

The electric dream

The long-term goal for AI in colonoscopy is automated polyp detection, a so-called optical biopsy, but that vision lies well in the future, said Mr. Schwartz. The primary issue is that only still images are available as training sets, and these don’t capture the diversity of patients, endoscopy systems, and operators that will be required to create a robust, generalizable polyp detection system. Existing efforts have shown promise on training sets, but struggle in real-world tests. “AI is good at tricking you into thinking it’s a working system when it’s only looking at retrospective data,” said Mr. Schwartz.

Olympus signed an agreement last year with ai4gi, a commercial initiative applying deep learning to gastrointestinal cancer, to combine its AI systems with Olympus’ colonoscopy line, but Mr. Heine agreed that optical biopsies won’t appear any time soon: “We’re not ready right now to launch anything that’s making a diagnosis claim. It’s not about optical biopsies at this point. It’s about supporting the physician,” he said.

Along with improving video capture and quality-control efforts, Mr. Schwartz believes that Virgo’s systems can help solve the problem of limited training data. By capturing and storing video data from a wide range of procedures, it is generating a resource that could boost the field and may one day make optical biopsies a reality. “It becomes the training set to build the AI video systems of the future,” he said.

Mr. Heine is an employee of Olympus. Dr. Tucker-Schwartz is an employee of NinePoint Medical. Mr. Schwartz is an employee of Virgo.

SAN FRANCISCO – Artificial intelligence (AI) can improve video recording and physician support during colonoscopy procedures, and the data being collected could eventually pave the way to AI systems powerful enough to detect polyps on their own.

AI has been touted as a means to reduce costs and improve patient outcomes, but there’s another benefit that is sometimes overlooked – physician satisfaction. Examining colonoscopy after colonoscopy can get a little overwhelming. “There’s only so much the human eye can see, and when you’re doing multiple colonoscopies a day, there’s a possibility that you’re just seeing too much. [AI] could help lessen the burden in making those diagnoses,” said Kurt Heine in an interview.

Mr. Heine is vice president of the endoscopy division at Olympus America. He joined other speakers at a panel on artificial intelligence at the 2019 AGA Tech Summit sponsored by the AGA Center for GI Innovation and Technology.

Physicians are under an increasing burden with the aging population and recommendations from the American Cancer Society that colonoscopies should begin at age 45. “We need a more efficient way to perform colonoscopies. Ideally AI would aid in the adenoma detection rate and perhaps someday in diagnosis. We’re trying to build a support tool to assist in that procedure,” said Heine.

That point was echoed by Matt Schwartz, CEO of Virgo, which specializes in video recording of colonoscopies. In an effort to ease physician burden, it is automating some simple tasks, like starting and stopping video recording during a procedure. That’s a time-consuming process, and “it’s the sort of task that AI is really good at, so it’s a natural fit to get our first foray of AI on the market,” said Mr. Schwartz in an interview. Virgo currently provides a small, Apple TV–sized box that connects directly to an existing endoscopy system that independently records procedures.

The system uploads captured video into the cloud, and automatically creates highlights for easy viewing. That feature is available now. In the future, Virgo hopes to offer advanced analysis of withdrawal time, cecal intubation rate, and other features. “We want to provide video analytics that can help doctors and physician groups make informed decisions on how to improve quality,” said Mr. Schwartz.

Developing AI poses distinct challenges, and can be costly and time-consuming, said Jason Tucker-Schwartz, PhD, director of marketing for NinePoint Medical. During the session, he outlined the development of the AI component of the company’s NvisionVLE Imaging System, which is the only Food and Drug Administration–approved AI product for upper GI imaging. It reveals layers inside the esophageal tissue wall with high resolution, where 90% of cancers begin.

“It’s a new type of data that gastroenterologists are not used to seeing,” said Dr. Tucker-Schwartz. But that has presented a challenge to physicians attempting to identify and process all that novel information.

That called for AI, but because NinePoint is a small company with limited resources, it needed to control development costs. To streamline matters, they developed a system that focuses on three features that are most useful in making esophageal diagnoses. “The AI algorithms find those features as a function of depth so we can flatten them and use them to create a roadmap that physicians can use to guide their [interpretation],” said Dr. Tucker-Schwartz.

The resulting system has garnered lots of positive feedback, according to Dr. Tucker-Schwartz. The experience highlights the need to incorporate physician input into product development. “You need to involve them in all the steps along the path to end with a product that meets not only their goals but your business goals as well,” he said.

The electric dream

The long-term goal for AI in colonoscopy is automated polyp detection, a so-called optical biopsy, but that vision lies well in the future, said Mr. Schwartz. The primary issue is that only still images are available as training sets, and these don’t capture the diversity of patients, endoscopy systems, and operators that will be required to create a robust, generalizable polyp detection system. Existing efforts have shown promise on training sets, but struggle in real-world tests. “AI is good at tricking you into thinking it’s a working system when it’s only looking at retrospective data,” said Mr. Schwartz.

Olympus signed an agreement last year with ai4gi, a commercial initiative applying deep learning to gastrointestinal cancer, to combine its AI systems with Olympus’ colonoscopy line, but Mr. Heine agreed that optical biopsies won’t appear any time soon: “We’re not ready right now to launch anything that’s making a diagnosis claim. It’s not about optical biopsies at this point. It’s about supporting the physician,” he said.

Along with improving video capture and quality-control efforts, Mr. Schwartz believes that Virgo’s systems can help solve the problem of limited training data. By capturing and storing video data from a wide range of procedures, it is generating a resource that could boost the field and may one day make optical biopsies a reality. “It becomes the training set to build the AI video systems of the future,” he said.

Mr. Heine is an employee of Olympus. Dr. Tucker-Schwartz is an employee of NinePoint Medical. Mr. Schwartz is an employee of Virgo.

SAN FRANCISCO – Artificial intelligence (AI) can improve video recording and physician support during colonoscopy procedures, and the data being collected could eventually pave the way to AI systems powerful enough to detect polyps on their own.

AI has been touted as a means to reduce costs and improve patient outcomes, but there’s another benefit that is sometimes overlooked – physician satisfaction. Examining colonoscopy after colonoscopy can get a little overwhelming. “There’s only so much the human eye can see, and when you’re doing multiple colonoscopies a day, there’s a possibility that you’re just seeing too much. [AI] could help lessen the burden in making those diagnoses,” said Kurt Heine in an interview.

Mr. Heine is vice president of the endoscopy division at Olympus America. He joined other speakers at a panel on artificial intelligence at the 2019 AGA Tech Summit sponsored by the AGA Center for GI Innovation and Technology.

Physicians are under an increasing burden with the aging population and recommendations from the American Cancer Society that colonoscopies should begin at age 45. “We need a more efficient way to perform colonoscopies. Ideally AI would aid in the adenoma detection rate and perhaps someday in diagnosis. We’re trying to build a support tool to assist in that procedure,” said Heine.

That point was echoed by Matt Schwartz, CEO of Virgo, which specializes in video recording of colonoscopies. In an effort to ease physician burden, it is automating some simple tasks, like starting and stopping video recording during a procedure. That’s a time-consuming process, and “it’s the sort of task that AI is really good at, so it’s a natural fit to get our first foray of AI on the market,” said Mr. Schwartz in an interview. Virgo currently provides a small, Apple TV–sized box that connects directly to an existing endoscopy system that independently records procedures.

The system uploads captured video into the cloud, and automatically creates highlights for easy viewing. That feature is available now. In the future, Virgo hopes to offer advanced analysis of withdrawal time, cecal intubation rate, and other features. “We want to provide video analytics that can help doctors and physician groups make informed decisions on how to improve quality,” said Mr. Schwartz.

Developing AI poses distinct challenges, and can be costly and time-consuming, said Jason Tucker-Schwartz, PhD, director of marketing for NinePoint Medical. During the session, he outlined the development of the AI component of the company’s NvisionVLE Imaging System, which is the only Food and Drug Administration–approved AI product for upper GI imaging. It reveals layers inside the esophageal tissue wall with high resolution, where 90% of cancers begin.

“It’s a new type of data that gastroenterologists are not used to seeing,” said Dr. Tucker-Schwartz. But that has presented a challenge to physicians attempting to identify and process all that novel information.

That called for AI, but because NinePoint is a small company with limited resources, it needed to control development costs. To streamline matters, they developed a system that focuses on three features that are most useful in making esophageal diagnoses. “The AI algorithms find those features as a function of depth so we can flatten them and use them to create a roadmap that physicians can use to guide their [interpretation],” said Dr. Tucker-Schwartz.

The resulting system has garnered lots of positive feedback, according to Dr. Tucker-Schwartz. The experience highlights the need to incorporate physician input into product development. “You need to involve them in all the steps along the path to end with a product that meets not only their goals but your business goals as well,” he said.

The electric dream

The long-term goal for AI in colonoscopy is automated polyp detection, a so-called optical biopsy, but that vision lies well in the future, said Mr. Schwartz. The primary issue is that only still images are available as training sets, and these don’t capture the diversity of patients, endoscopy systems, and operators that will be required to create a robust, generalizable polyp detection system. Existing efforts have shown promise on training sets, but struggle in real-world tests. “AI is good at tricking you into thinking it’s a working system when it’s only looking at retrospective data,” said Mr. Schwartz.

Olympus signed an agreement last year with ai4gi, a commercial initiative applying deep learning to gastrointestinal cancer, to combine its AI systems with Olympus’ colonoscopy line, but Mr. Heine agreed that optical biopsies won’t appear any time soon: “We’re not ready right now to launch anything that’s making a diagnosis claim. It’s not about optical biopsies at this point. It’s about supporting the physician,” he said.

Along with improving video capture and quality-control efforts, Mr. Schwartz believes that Virgo’s systems can help solve the problem of limited training data. By capturing and storing video data from a wide range of procedures, it is generating a resource that could boost the field and may one day make optical biopsies a reality. “It becomes the training set to build the AI video systems of the future,” he said.

Mr. Heine is an employee of Olympus. Dr. Tucker-Schwartz is an employee of NinePoint Medical. Mr. Schwartz is an employee of Virgo.

SAN FRANCISCO – Artificial intelligence (AI) is using computer technology to solve particular kinds of medical problems, Sushovan Guha, MD, PhD, AGAF, chair, division of gastroenterology, University of Arizona, Phoenix, said in an interview at the AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology.

Vidyard Video

Computers are good at doing many processes in a short period of time and executing repetitive tasks with no errors, whereas humans tend to introduce errors after many repetitions. Using algorithms by which physicians assess and diagnose colonic lesions, computer software can learn the criteria that diagnose adenomas and assist in the process of diagnosis, Dr. Guha said.

Computers are also ideal for managing and analyzing large amounts of data – this ability has so far been used to personalize cancer treatment – and is now being used to suggest the best treatment and predict remission in patients with inflammatory bowel disease. AI can use anatomical data combined with endoscopy to predict GI bleeding so that physicians can target therapy. Dr. Guha predicts that there will be an “explosion” of applications of AI in gastroenterology in the next 5-10 years.

SAN FRANCISCO – Artificial intelligence (AI) is using computer technology to solve particular kinds of medical problems, Sushovan Guha, MD, PhD, AGAF, chair, division of gastroenterology, University of Arizona, Phoenix, said in an interview at the AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology.

Vidyard Video

Computers are good at doing many processes in a short period of time and executing repetitive tasks with no errors, whereas humans tend to introduce errors after many repetitions. Using algorithms by which physicians assess and diagnose colonic lesions, computer software can learn the criteria that diagnose adenomas and assist in the process of diagnosis, Dr. Guha said.

Computers are also ideal for managing and analyzing large amounts of data – this ability has so far been used to personalize cancer treatment – and is now being used to suggest the best treatment and predict remission in patients with inflammatory bowel disease. AI can use anatomical data combined with endoscopy to predict GI bleeding so that physicians can target therapy. Dr. Guha predicts that there will be an “explosion” of applications of AI in gastroenterology in the next 5-10 years.

SAN FRANCISCO – Artificial intelligence (AI) is using computer technology to solve particular kinds of medical problems, Sushovan Guha, MD, PhD, AGAF, chair, division of gastroenterology, University of Arizona, Phoenix, said in an interview at the AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology.

Vidyard Video

Computers are good at doing many processes in a short period of time and executing repetitive tasks with no errors, whereas humans tend to introduce errors after many repetitions. Using algorithms by which physicians assess and diagnose colonic lesions, computer software can learn the criteria that diagnose adenomas and assist in the process of diagnosis, Dr. Guha said.

Computers are also ideal for managing and analyzing large amounts of data – this ability has so far been used to personalize cancer treatment – and is now being used to suggest the best treatment and predict remission in patients with inflammatory bowel disease. AI can use anatomical data combined with endoscopy to predict GI bleeding so that physicians can target therapy. Dr. Guha predicts that there will be an “explosion” of applications of AI in gastroenterology in the next 5-10 years.

Think about what a puppet can do: Not much, since it’s typically controlled by a single hand. Then consider the skills of a marionette in the hands – both of them – of a talented performer: It can gesture and jump and even dance. A whole new world of movement opens up thanks to the capacity for fine-tuned control.

When it comes to GI endoscopy, revolutionary two-handed marionette-style control beckons on the horizon thanks to robotics. That’s the word from Josh DeFonzo, chief operating officer of Auris Health, who will present a keynote speech on “Opportunities in GI Over the Next Decade” at the 2019 AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology.

“I’ll be talking about where opportunities will lie in the GI space over the next decade,” Mr. DeFonzo said. “One of the major themes will be the need to accelerate technical capabilities in endoscopy. Noninvasive treatment is quite challenging for interventional endoscopists. They generally don’t have the tools they need to reach where they need to reach, see where they need to see, and perform complex tasks, at least not at scale.”

This is all changing thanks to the work of companies like Auris Health, which is working to advance endoscopy through flexible robotics. Auris Health, which was recently acquired by Johnson & Johnson, is offering robotic endoscopy to pulmonologists and developing it for gastroenterology.

The challenges of existing endoscopic technology, Mr. DeFonzo said, revolve around the limitations of access. “In the world of GI, it’s not difficult to get to polyps or cancerous lesions. It’s harder to do something when you’re there,” he said. “In the colon, stomach, and esophagus, you’re in a cylindrical hallway with a cylindrical device, and both are moving. You don’t have the stability to achieve traction, and you are usually limited to a single hand and single working channel.”

Robotic endoscopic technology offers physicians the ability to overcome these barriers through two-handed control and other advances. “It’s all about reach, vision, control, and the ability to perform tasks as a result of those three things,” he said. “The hope is empower endoscopists with more tools and capabilities to prevent patients from having to undergo surgery.”

Within the next 5 years, he predicts, physicians will be able to use robotic endoscopy to remove potentially cancerous lesions during colonoscopy instead of referring patients for colectomy. And over the longer term, perhaps over more than a decade, he expects patients will be able to undergo endoscopic removal of those lesions during colonoscopy instead of being referred.

Meanwhile, he said, scientists are advancing areas such as two-handed robotic control, Google Maps-style navigation based on preoperative scans, and pattern recognition to detect abnormalities such as lesions.

Think about what a puppet can do: Not much, since it’s typically controlled by a single hand. Then consider the skills of a marionette in the hands – both of them – of a talented performer: It can gesture and jump and even dance. A whole new world of movement opens up thanks to the capacity for fine-tuned control.

When it comes to GI endoscopy, revolutionary two-handed marionette-style control beckons on the horizon thanks to robotics. That’s the word from Josh DeFonzo, chief operating officer of Auris Health, who will present a keynote speech on “Opportunities in GI Over the Next Decade” at the 2019 AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology.

“I’ll be talking about where opportunities will lie in the GI space over the next decade,” Mr. DeFonzo said. “One of the major themes will be the need to accelerate technical capabilities in endoscopy. Noninvasive treatment is quite challenging for interventional endoscopists. They generally don’t have the tools they need to reach where they need to reach, see where they need to see, and perform complex tasks, at least not at scale.”

This is all changing thanks to the work of companies like Auris Health, which is working to advance endoscopy through flexible robotics. Auris Health, which was recently acquired by Johnson & Johnson, is offering robotic endoscopy to pulmonologists and developing it for gastroenterology.

The challenges of existing endoscopic technology, Mr. DeFonzo said, revolve around the limitations of access. “In the world of GI, it’s not difficult to get to polyps or cancerous lesions. It’s harder to do something when you’re there,” he said. “In the colon, stomach, and esophagus, you’re in a cylindrical hallway with a cylindrical device, and both are moving. You don’t have the stability to achieve traction, and you are usually limited to a single hand and single working channel.”

Robotic endoscopic technology offers physicians the ability to overcome these barriers through two-handed control and other advances. “It’s all about reach, vision, control, and the ability to perform tasks as a result of those three things,” he said. “The hope is empower endoscopists with more tools and capabilities to prevent patients from having to undergo surgery.”

Within the next 5 years, he predicts, physicians will be able to use robotic endoscopy to remove potentially cancerous lesions during colonoscopy instead of referring patients for colectomy. And over the longer term, perhaps over more than a decade, he expects patients will be able to undergo endoscopic removal of those lesions during colonoscopy instead of being referred.

Meanwhile, he said, scientists are advancing areas such as two-handed robotic control, Google Maps-style navigation based on preoperative scans, and pattern recognition to detect abnormalities such as lesions.

Think about what a puppet can do: Not much, since it’s typically controlled by a single hand. Then consider the skills of a marionette in the hands – both of them – of a talented performer: It can gesture and jump and even dance. A whole new world of movement opens up thanks to the capacity for fine-tuned control.

When it comes to GI endoscopy, revolutionary two-handed marionette-style control beckons on the horizon thanks to robotics. That’s the word from Josh DeFonzo, chief operating officer of Auris Health, who will present a keynote speech on “Opportunities in GI Over the Next Decade” at the 2019 AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology.

“I’ll be talking about where opportunities will lie in the GI space over the next decade,” Mr. DeFonzo said. “One of the major themes will be the need to accelerate technical capabilities in endoscopy. Noninvasive treatment is quite challenging for interventional endoscopists. They generally don’t have the tools they need to reach where they need to reach, see where they need to see, and perform complex tasks, at least not at scale.”

This is all changing thanks to the work of companies like Auris Health, which is working to advance endoscopy through flexible robotics. Auris Health, which was recently acquired by Johnson & Johnson, is offering robotic endoscopy to pulmonologists and developing it for gastroenterology.

The challenges of existing endoscopic technology, Mr. DeFonzo said, revolve around the limitations of access. “In the world of GI, it’s not difficult to get to polyps or cancerous lesions. It’s harder to do something when you’re there,” he said. “In the colon, stomach, and esophagus, you’re in a cylindrical hallway with a cylindrical device, and both are moving. You don’t have the stability to achieve traction, and you are usually limited to a single hand and single working channel.”

Robotic endoscopic technology offers physicians the ability to overcome these barriers through two-handed control and other advances. “It’s all about reach, vision, control, and the ability to perform tasks as a result of those three things,” he said. “The hope is empower endoscopists with more tools and capabilities to prevent patients from having to undergo surgery.”

Within the next 5 years, he predicts, physicians will be able to use robotic endoscopy to remove potentially cancerous lesions during colonoscopy instead of referring patients for colectomy. And over the longer term, perhaps over more than a decade, he expects patients will be able to undergo endoscopic removal of those lesions during colonoscopy instead of being referred.

Meanwhile, he said, scientists are advancing areas such as two-handed robotic control, Google Maps-style navigation based on preoperative scans, and pattern recognition to detect abnormalities such as lesions.

An ingestible electronic capsule that measures intestinal gas. A talented toilet. Obesity subtype biomarkers, improved endoscopies, and an IBD wellness app. Could any of these five innovations transform medicine and lead to gastrointestinal glory?

Five companies will present their innovations to a panel of experts at this week's AGA Tech Summit Shark Tank event, brought to you by the AGA Center for GI Innovation and Technology. Stay tuned to GI & Hepatology News for the AGA Tech Summit Report, where we will provide more information on each product and announce the winner as decided by a panel of judges and the AGA Tech Summit audience. But first, check out the contestants and their products:

1. TrueLoo: Excreta-examining toilet

“TrueLoo is a replacement for a conventional toilet seat,” said Vikram Kashyap, CEO of Toi Labs. “The device acquires time-lapse images of a bowel movement or urination event automatically and under controlled conditions. These images are transmitted to a remote cloud server and analyzed to measure various properties related to the toilet event.”

According to Mr. Kashyap, the firm is developing a way to conduct fecal occult blood tests on the platform without requiring contact or direct sample handling.

2. Ultivision: Video endoscopy booster

“The Ultivision technology will be integrated seamlessly into the endoscopy workflow and provide feedback in real-time,” said University of California at Irvine gastroenterologist Jason B. Samarasena, MD, cofounder of DocBot. “As the endoscopist is performing the upper endoscopy, a lag-free video overlay will display boxes over suspicious lesions that the endoscopist should draw their attention to. When the area is more closely examined, the algorithm will deliver a prediction as to the likelihood that this tissue harbors dysplasia.”



3. Pheno Test: Know your obesity subtype

The Pheno Test aims to unveil obesity biomarkers which “are supported by a diagnostic algorithm... which has already been validated to predict weight response to obesity pharmacotherapy,” said Phenomix Sciences CEO Andres J. Acosta, MD, PhD, assistant professor of medicine and consultant in gastroenterology and hepatology at Mayo Clinic.

According to Dr. Acosta, a separate trial tracked patients with obesity, including some who were treated differently based on their phenotype. Those patients lost more than double their body weight compared with those who received standard of care and had fewer adverse effects linked to treatment.
 

4. Oshi: Meet the “all in one” IBD app

The Oshi app, which is now available for Apple iOS and Android, allows patients with IBD to track their symptoms and “uncover hidden patterns affecting wellness,” said Dan Weinstein, MBA, CEO of Oshi Health.

Patients can also read about IBD news, hear from other patients about their experiences, and ask questions of health professionals. “We are expanding to include proven digital tools to enhance IBD care such as medication adherence, treatment history logs, at-home fecal calprotectin testing, and more,” Mr. Weinstein said.
 

5. Atmo Gas Capsule: Swallow your way to GI insights

An ingestible electronic capsule the size of a large vitamin tablet gathers “digital health data in the form of gas concentrations as it passes through the gut for the screening and diagnosis of gastrointestinal disorders and for assessing effects of dietary treatments on the gut,” said Malcolm Hebblewhite, MBA, CEO of Atmo Biosciences.

The capsule transmits data to a small receiver and on to a smartphone, Mr. Hebblewhite said. “The real-time data is displayed for the user with more complex information accessible by the practitioner remotely via the cloud.”

An ingestible electronic capsule that measures intestinal gas. A talented toilet. Obesity subtype biomarkers, improved endoscopies, and an IBD wellness app. Could any of these five innovations transform medicine and lead to gastrointestinal glory?

Five companies will present their innovations to a panel of experts at this week's AGA Tech Summit Shark Tank event, brought to you by the AGA Center for GI Innovation and Technology. Stay tuned to GI & Hepatology News for the AGA Tech Summit Report, where we will provide more information on each product and announce the winner as decided by a panel of judges and the AGA Tech Summit audience. But first, check out the contestants and their products:

1. TrueLoo: Excreta-examining toilet

“TrueLoo is a replacement for a conventional toilet seat,” said Vikram Kashyap, CEO of Toi Labs. “The device acquires time-lapse images of a bowel movement or urination event automatically and under controlled conditions. These images are transmitted to a remote cloud server and analyzed to measure various properties related to the toilet event.”

According to Mr. Kashyap, the firm is developing a way to conduct fecal occult blood tests on the platform without requiring contact or direct sample handling.

2. Ultivision: Video endoscopy booster

“The Ultivision technology will be integrated seamlessly into the endoscopy workflow and provide feedback in real-time,” said University of California at Irvine gastroenterologist Jason B. Samarasena, MD, cofounder of DocBot. “As the endoscopist is performing the upper endoscopy, a lag-free video overlay will display boxes over suspicious lesions that the endoscopist should draw their attention to. When the area is more closely examined, the algorithm will deliver a prediction as to the likelihood that this tissue harbors dysplasia.”



3. Pheno Test: Know your obesity subtype

The Pheno Test aims to unveil obesity biomarkers which “are supported by a diagnostic algorithm... which has already been validated to predict weight response to obesity pharmacotherapy,” said Phenomix Sciences CEO Andres J. Acosta, MD, PhD, assistant professor of medicine and consultant in gastroenterology and hepatology at Mayo Clinic.

According to Dr. Acosta, a separate trial tracked patients with obesity, including some who were treated differently based on their phenotype. Those patients lost more than double their body weight compared with those who received standard of care and had fewer adverse effects linked to treatment.
 

4. Oshi: Meet the “all in one” IBD app

The Oshi app, which is now available for Apple iOS and Android, allows patients with IBD to track their symptoms and “uncover hidden patterns affecting wellness,” said Dan Weinstein, MBA, CEO of Oshi Health.

Patients can also read about IBD news, hear from other patients about their experiences, and ask questions of health professionals. “We are expanding to include proven digital tools to enhance IBD care such as medication adherence, treatment history logs, at-home fecal calprotectin testing, and more,” Mr. Weinstein said.
 

5. Atmo Gas Capsule: Swallow your way to GI insights

An ingestible electronic capsule the size of a large vitamin tablet gathers “digital health data in the form of gas concentrations as it passes through the gut for the screening and diagnosis of gastrointestinal disorders and for assessing effects of dietary treatments on the gut,” said Malcolm Hebblewhite, MBA, CEO of Atmo Biosciences.

The capsule transmits data to a small receiver and on to a smartphone, Mr. Hebblewhite said. “The real-time data is displayed for the user with more complex information accessible by the practitioner remotely via the cloud.”

An ingestible electronic capsule that measures intestinal gas. A talented toilet. Obesity subtype biomarkers, improved endoscopies, and an IBD wellness app. Could any of these five innovations transform medicine and lead to gastrointestinal glory?

Five companies will present their innovations to a panel of experts at this week's AGA Tech Summit Shark Tank event, brought to you by the AGA Center for GI Innovation and Technology. Stay tuned to GI & Hepatology News for the AGA Tech Summit Report, where we will provide more information on each product and announce the winner as decided by a panel of judges and the AGA Tech Summit audience. But first, check out the contestants and their products:

1. TrueLoo: Excreta-examining toilet

“TrueLoo is a replacement for a conventional toilet seat,” said Vikram Kashyap, CEO of Toi Labs. “The device acquires time-lapse images of a bowel movement or urination event automatically and under controlled conditions. These images are transmitted to a remote cloud server and analyzed to measure various properties related to the toilet event.”

According to Mr. Kashyap, the firm is developing a way to conduct fecal occult blood tests on the platform without requiring contact or direct sample handling.

2. Ultivision: Video endoscopy booster

“The Ultivision technology will be integrated seamlessly into the endoscopy workflow and provide feedback in real-time,” said University of California at Irvine gastroenterologist Jason B. Samarasena, MD, cofounder of DocBot. “As the endoscopist is performing the upper endoscopy, a lag-free video overlay will display boxes over suspicious lesions that the endoscopist should draw their attention to. When the area is more closely examined, the algorithm will deliver a prediction as to the likelihood that this tissue harbors dysplasia.”



3. Pheno Test: Know your obesity subtype

The Pheno Test aims to unveil obesity biomarkers which “are supported by a diagnostic algorithm... which has already been validated to predict weight response to obesity pharmacotherapy,” said Phenomix Sciences CEO Andres J. Acosta, MD, PhD, assistant professor of medicine and consultant in gastroenterology and hepatology at Mayo Clinic.

According to Dr. Acosta, a separate trial tracked patients with obesity, including some who were treated differently based on their phenotype. Those patients lost more than double their body weight compared with those who received standard of care and had fewer adverse effects linked to treatment.
 

4. Oshi: Meet the “all in one” IBD app

The Oshi app, which is now available for Apple iOS and Android, allows patients with IBD to track their symptoms and “uncover hidden patterns affecting wellness,” said Dan Weinstein, MBA, CEO of Oshi Health.

Patients can also read about IBD news, hear from other patients about their experiences, and ask questions of health professionals. “We are expanding to include proven digital tools to enhance IBD care such as medication adherence, treatment history logs, at-home fecal calprotectin testing, and more,” Mr. Weinstein said.
 

5. Atmo Gas Capsule: Swallow your way to GI insights

An ingestible electronic capsule the size of a large vitamin tablet gathers “digital health data in the form of gas concentrations as it passes through the gut for the screening and diagnosis of gastrointestinal disorders and for assessing effects of dietary treatments on the gut,” said Malcolm Hebblewhite, MBA, CEO of Atmo Biosciences.

The capsule transmits data to a small receiver and on to a smartphone, Mr. Hebblewhite said. “The real-time data is displayed for the user with more complex information accessible by the practitioner remotely via the cloud.”

Although the gastroenterology specialty relies heavily on technology, only incremental advances have been made in this space in the last several decades. “While the potential for innovation is huge, we need to overcome structural and conceptual barriers to realize its true potential,” said Pankaj Jay Pasricha, MD, vice chair of the department of medicine at Johns Hopkins University, Baltimore. Dr. Pasricha will discuss what barriers exist and how to overcome them in his keynote presentation at 2019 AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology.

Some barriers are risk aversion, reimbursement challenges, and failure to understand true unmet needs. “We need to find practical solutions that are technologically innovative that can get to market,” he said. The general concepts that Dr. Pasricha talks about will be discussed in detail with specific examples during the summit’s sessions.

When looking to bring innovative ideas to market, Dr. Pasricha recommends learning from individuals who have already done this successfully and from those who have tried and failed. One way to do this is to connect with inventors, entrepreneurs, investors, health care providers and institutions, and regulatory and reimbursement stakeholders through the AGA Center for GI Innovation & Technology (CGIT), which he helped found 10 years ago and served as the center's first chair.

The center supports innovation and developing new technology in gastroenterology, hepatology, nutrition, and obesity by guiding medical device and therapeutics innovators through the technology development and adoption process, according to CGIT’s website. It serves as a key resource for industry and physician innovators developing new technology in gastroenterology, and provides guidance to the Food and Drug Administration and other regulatory groups to expedite the device development process.

“CGIT’s purpose is to provide education on how to identify needs, find solutions, and provide roadmaps for connecting ideas and bringing them to the real world,” Dr. Pasricha said. “We need to create disruptive technologies that will address unmet needs at every level from the average gastroenterologist in practice, to advanced endoscopists, and even advanced surgeons who perform gastroenterology procedures.”

CGIT also provides guidance for bringing new technologies into clinical trials through the creation of registries and other means. You can learn more about the center at www.gastro.org/CGIT. 

Regarding recent advances in technologies, Dr. Pasricha said there are now better ways to ablate tissue, do tissue anastomosis, prevent reflux, promote weight loss, and resect locally advanced cancer. “Platform” technologies such as new ways to deliver energy, flexible robotics, and artificial intelligence are also beginning to emerge in our specialty.

Dr. Pasricha is quite experienced in bringing new technologies to market. He holds more than 50 patents that have either been issued or are in process by The United States Patent and Trademark Office and has cofounded several companies within both the medtech/endoscopy and biotech gastroenterology spaces.

His contributions to endoscopy include the use of botulinum toxin for gastroenterology disorders, cryotherapy, novel stents, and the POEM procedure. He is currently working with Galvani Bioelectronics to develop a novel neuromodulation therapy for type 2 diabetes, which has become a worldwide scourge.

Dr. Pasricha discloses being a consultant for several pharmaceutical companies.

Although the gastroenterology specialty relies heavily on technology, only incremental advances have been made in this space in the last several decades. “While the potential for innovation is huge, we need to overcome structural and conceptual barriers to realize its true potential,” said Pankaj Jay Pasricha, MD, vice chair of the department of medicine at Johns Hopkins University, Baltimore. Dr. Pasricha will discuss what barriers exist and how to overcome them in his keynote presentation at 2019 AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology.

Some barriers are risk aversion, reimbursement challenges, and failure to understand true unmet needs. “We need to find practical solutions that are technologically innovative that can get to market,” he said. The general concepts that Dr. Pasricha talks about will be discussed in detail with specific examples during the summit’s sessions.

When looking to bring innovative ideas to market, Dr. Pasricha recommends learning from individuals who have already done this successfully and from those who have tried and failed. One way to do this is to connect with inventors, entrepreneurs, investors, health care providers and institutions, and regulatory and reimbursement stakeholders through the AGA Center for GI Innovation & Technology (CGIT), which he helped found 10 years ago and served as the center's first chair.

The center supports innovation and developing new technology in gastroenterology, hepatology, nutrition, and obesity by guiding medical device and therapeutics innovators through the technology development and adoption process, according to CGIT’s website. It serves as a key resource for industry and physician innovators developing new technology in gastroenterology, and provides guidance to the Food and Drug Administration and other regulatory groups to expedite the device development process.

“CGIT’s purpose is to provide education on how to identify needs, find solutions, and provide roadmaps for connecting ideas and bringing them to the real world,” Dr. Pasricha said. “We need to create disruptive technologies that will address unmet needs at every level from the average gastroenterologist in practice, to advanced endoscopists, and even advanced surgeons who perform gastroenterology procedures.”

CGIT also provides guidance for bringing new technologies into clinical trials through the creation of registries and other means. You can learn more about the center at www.gastro.org/CGIT. 

Regarding recent advances in technologies, Dr. Pasricha said there are now better ways to ablate tissue, do tissue anastomosis, prevent reflux, promote weight loss, and resect locally advanced cancer. “Platform” technologies such as new ways to deliver energy, flexible robotics, and artificial intelligence are also beginning to emerge in our specialty.

Dr. Pasricha is quite experienced in bringing new technologies to market. He holds more than 50 patents that have either been issued or are in process by The United States Patent and Trademark Office and has cofounded several companies within both the medtech/endoscopy and biotech gastroenterology spaces.

His contributions to endoscopy include the use of botulinum toxin for gastroenterology disorders, cryotherapy, novel stents, and the POEM procedure. He is currently working with Galvani Bioelectronics to develop a novel neuromodulation therapy for type 2 diabetes, which has become a worldwide scourge.

Dr. Pasricha discloses being a consultant for several pharmaceutical companies.

Although the gastroenterology specialty relies heavily on technology, only incremental advances have been made in this space in the last several decades. “While the potential for innovation is huge, we need to overcome structural and conceptual barriers to realize its true potential,” said Pankaj Jay Pasricha, MD, vice chair of the department of medicine at Johns Hopkins University, Baltimore. Dr. Pasricha will discuss what barriers exist and how to overcome them in his keynote presentation at 2019 AGA Tech Summit, sponsored by the AGA Center for GI Innovation and Technology.

Some barriers are risk aversion, reimbursement challenges, and failure to understand true unmet needs. “We need to find practical solutions that are technologically innovative that can get to market,” he said. The general concepts that Dr. Pasricha talks about will be discussed in detail with specific examples during the summit’s sessions.

When looking to bring innovative ideas to market, Dr. Pasricha recommends learning from individuals who have already done this successfully and from those who have tried and failed. One way to do this is to connect with inventors, entrepreneurs, investors, health care providers and institutions, and regulatory and reimbursement stakeholders through the AGA Center for GI Innovation & Technology (CGIT), which he helped found 10 years ago and served as the center's first chair.

The center supports innovation and developing new technology in gastroenterology, hepatology, nutrition, and obesity by guiding medical device and therapeutics innovators through the technology development and adoption process, according to CGIT’s website. It serves as a key resource for industry and physician innovators developing new technology in gastroenterology, and provides guidance to the Food and Drug Administration and other regulatory groups to expedite the device development process.

“CGIT’s purpose is to provide education on how to identify needs, find solutions, and provide roadmaps for connecting ideas and bringing them to the real world,” Dr. Pasricha said. “We need to create disruptive technologies that will address unmet needs at every level from the average gastroenterologist in practice, to advanced endoscopists, and even advanced surgeons who perform gastroenterology procedures.”

CGIT also provides guidance for bringing new technologies into clinical trials through the creation of registries and other means. You can learn more about the center at www.gastro.org/CGIT. 

Regarding recent advances in technologies, Dr. Pasricha said there are now better ways to ablate tissue, do tissue anastomosis, prevent reflux, promote weight loss, and resect locally advanced cancer. “Platform” technologies such as new ways to deliver energy, flexible robotics, and artificial intelligence are also beginning to emerge in our specialty.

Dr. Pasricha is quite experienced in bringing new technologies to market. He holds more than 50 patents that have either been issued or are in process by The United States Patent and Trademark Office and has cofounded several companies within both the medtech/endoscopy and biotech gastroenterology spaces.

His contributions to endoscopy include the use of botulinum toxin for gastroenterology disorders, cryotherapy, novel stents, and the POEM procedure. He is currently working with Galvani Bioelectronics to develop a novel neuromodulation therapy for type 2 diabetes, which has become a worldwide scourge.

Dr. Pasricha discloses being a consultant for several pharmaceutical companies.