At the end of my first day at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) conference in Baltimore, Maryland, it was easy to see that the hot topic among endoscopic and gastrointestinal surgeons is reducing the invasiveness of the (already minimally invasive) procedures they offer their patients. Fortunately for those in the medtech industry, much of the talk involved managing diseases with implantable or endoscopically deployed medical devices, rather than simply changing techniques or instituting procedures with limited device usage.
The day started off with a learning session on treatments for gastroesophageal reflux disease (GERD). I learned that only 1% of patients with GERD are treated with a surgical intervention, even though 85% of patients treated pharmaceutically with proton-pump inhibitors (PPIs) still have symptoms, and 40% are dissatisfied with their treatment. Part of the reason for this is that Nissen fundoplication has its own shortcomings, including the risks associated with any serious surgical procedure, as well as the potential for side effects like dysphagia, discomfort and bloating from built-up gas, and recurrence of symptoms. The message was loud and clear?surgeons want to offer their patients an option that is more effective than PPIs, but less invasive than Nissen fundoplication. The main devices up for discussion were the LINX system by Torax Medical, EndoStim's electrical stimulation device (which delivers tiny electrical pulses to stimulate the lower esophageal sphincter to restore its function), and the Stretta procedure by Mederi Therapeutics. In turn, several speakers offered compelling clinical evidence that these devices may have a place in the routine management of GERD.
I spent the afternoon learning about innovations in bariatrics. One segment focused specifically on innovative devices that have been developed to treat obesity. In one particularly interesting example, a surgeon presented a study of the Full Sense endoscopic stent showing that patients lost 75% of their excess body weight over the observation period, with most maintaining it successfully. That's a huge number for an obesity intervention device, on par with serious surgical interventions like gastric bypass and sleeve gastrectomy. Other devices that were discussed included the Abiliti device, EnteroMedic's VBLOC device, the EndoBarrier by GI Dynamics, the Overstitch by Apollo EndoSurgery, and the Spatz balloon. The mood in the room seemed to be one of optimism for further study and refinement of these devices, however, rather than an all-out recommendation to change how patients are treated (which was definitely the case for GERD intervention devices).
Overall, I witnessed a renewed enthusiasm among surgeons for interventions that make use of medical devices to decrease the invasiveness of the procedure for the patient. In some cases, the technology is already there, whereas as in others, there's still some improvements to be made. Regardless, medtech companies that are not already in these markets should definitely consider making an entrance. 

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