Dr. Aasma Shaukat [Photo courtesy of NYU Langone Health]
Gastroenterology is a field ripe for medical device innovation, and medtech developers know that some of the best ideas come from practicing doctors.
With that in mind, Medical Design & Outsourcing spoke with two gastroenterologists to better understand what device innovations would help them better diagnose and treat gastrointestinal diseases.
Dr. Aasma Shaukat is the director of outcomes research at NYU Langone Health’s Division of Gastroenterology and Hepatology. She’s also the NYU Grossman School of Medicine’s Robert M. and Mary H. Glickman professor of medicine and a professor of population health.
Dr. Bara El Kurdi [Photo courtesy of Dr. Bara El Kurdi]
Dr. Bara El Kurdi is a gastroenterology fellow at University of Texas Health Science Center in San Antonio. He also serves on the
Here are the four device innovations that are on their wishlist.
1. Better devices to repair iatrogenic colonic perforation (ICP)
ICP is a rare but serious complication of endoscopic procedures. The risk increases as the complexity of procedures increases, and ICP is not uncommon with large polyp resection procedures. This limits the safety, availability and access to endoscopic procedures, which can be life-saving in cases of precancerous polyps.
Currently, rudimentary devices such as endoclips, over-the-scope clips and endoscopic suturing are used for perforation closure. However, clips are often small and only work for a limited subset of simple perforations. Endoscopic suturing can work for large perforations, but is technically challenging and time-consuming, thereby limiting its use to a few highly experienced providers.
We need improved, easy-to-use devices which can be utilized for complex perforations and be accessible to endoscopists without extensive training.
2. Sustainable endoscopy devices
Endoscopy is resource-intensive and generates a surprising amount of greenhouse gas (GHG) emissions and waste.
The average colonoscopy produces 18 kg of CO2 equivalent (CO2e), which is equivalent to driving 70 km in a car. Based on recent studies, endoscopy units in England produce about 5,000 tonnes of waste per year, which is equivalent to filling 500 double-decker buses.
Additionally, most endoscopic tools are single-use plastic devices and accessories such as endoscopes, biopsy forceps, snares, polyp traps, mouthguards, oxygen tubing, etc. These devices are often made from non-recyclable materials and require energy-intensive manufacturing and disposal processes.
And recently, there has been a push for the adoption of single-use endoscopes to reduce risk of infection.
Therefore, we need green endoscopy products to reduce the environmental impact of endoscopy procedures. Green endoscopy products are products that use less energy, water and materials, or use renewable, recyclable, or biodegradable resources.
3. Automated defecation training using a pressure-sensing kegel weight for patients with dissynergic defecation
Dyssynergic defecation is a condition where the pelvic floor muscles do not coordinate properly during bowel movements, resulting in incomplete evacuation of feces. This can cause chronic constipation, abdominal pain, bloating, and other symptoms.
We often treat dyssynergic defecation with biofeedback therapy, which involves teaching patients how to relax and contract their pelvic floor muscles in response to sensory feedback from their rectum. This usually requires multiple sessions with a trained therapist who monitors the patient’s muscle activity using special sensors. However, biofeedback therapy can be costly, time-consuming, and inconvenient.
Therefore, there is a need for alternative methods that can provide similar benefits without requiring professional supervision. One possible solution is automated defecation training using a pressure-sensing kegel weight. A kegel weight is a device that can be inserted into the vagina or anus to strengthen the pelvic floor muscles by providing resistance. A pressure-sensing kegel weight can also measure the pressure inside the rectum and provide feedback to the patient through vibrations or sounds. The patient can use this feedback to learn how to relax and contract their pelvic floor muscles during defecation.
4. Polyp screening test that does not require a bowel preparation
Currently, colonoscopy remains the gold standard in colon cancer and colon polyp screening. However, it is limited by cost and need for bowel preparation prior to procedures.
Bowel preparation entails drinking large amounts of laxatives to clean out the colon prior to visual inspection by the endoscopist. This is often very difficult and is poorly tolerated by patients. Failure to clean the colon results in poor visualization during the test and missed lesions, which could be cancerous or precancerous.
Alternatives to colonoscopy, such as stool-based tests, perform well in detecting cancer but not in detecting precancerous lesions such as polyps. Therefore, there is a need for polyp screening tests that can detect precancerous lesions without requiring bowel preparation.
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