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2010 NOTES 2010 NOTES ® ® Summit Summit Working Group Report Working Group Report Endolumenal Endolumenal July 8-10, 2010 Chicago, IL

2010 NOTES ® Summit Working Group Report Endolumenal July 8-10, 2010 Chicago, IL

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Page 1: 2010 NOTES ® Summit Working Group Report Endolumenal July 8-10, 2010 Chicago, IL

2010 NOTES2010 NOTES® ® SummitSummitWorking Group ReportWorking Group Report

EndolumenalEndolumenal

July 8-10, 2010Chicago, IL

Page 2: 2010 NOTES ® Summit Working Group Report Endolumenal July 8-10, 2010 Chicago, IL

Endolumenal Working Group

Procedures Obesity – most impact, most difficult to solve GERD – 2nd most impact, 2nd easiest to solve Full thickness resection – 3rd most impact, easiest to solve Myotomy Drainage Perforations/Leaks

Page 3: 2010 NOTES ® Summit Working Group Report Endolumenal July 8-10, 2010 Chicago, IL

Endolumenal Working GroupObesity

Gastric reduction Malabsorption Combined Implant Revision

Applications > 35 BMI + co-morbid, > 40 BMI Bridge to surgery Metabolic Cosmetic

Page 4: 2010 NOTES ® Summit Working Group Report Endolumenal July 8-10, 2010 Chicago, IL

Endolumenal Working GroupObesity - Barriers

Durability Need for restriction and malabsorption Reversibility – necessary for cosmetic market Environment to practice

morbid obese – certified bariatric center cosmetic – need for comprehensive approach – diet, exercise, follow-up

Reimbursement Enabling technologies – suturing, stapling

Page 5: 2010 NOTES ® Summit Working Group Report Endolumenal July 8-10, 2010 Chicago, IL

Endolumenal Working Group

GERD Mimic surgery – Nissen New approach

stem cell augmentation of LES remote electrical stimulation of LES

Page 6: 2010 NOTES ® Summit Working Group Report Endolumenal July 8-10, 2010 Chicago, IL

Endolumenal Working Group GERD - Barriers

Reimbursement Durability Safety Efficacy – decrease acid exposure

GERD - Solution Target population with unmet need

inadequate response to PPI non acid reflux Nissen failures Non surgical candidates

Page 7: 2010 NOTES ® Summit Working Group Report Endolumenal July 8-10, 2010 Chicago, IL

Endolumenal Working Group

Myotomy Crossing the GE junction Compare with laparoscopic approach Technical difficulty? Not a large patient population Comparison with balloon dilation

Page 8: 2010 NOTES ® Summit Working Group Report Endolumenal July 8-10, 2010 Chicago, IL

Endolumenal Working Group

Full thickness resection Limited applicability (not for cancer because of need for LN harvesting) Closure

Stapling seems most straight-forward approach vs pre-placed purse-string suture

Identificaton and control of serosal vessels Not a large patient population Large right colon polyps but engineering staple system in right colon Specimen retrieval