2010 NOTES2010 NOTES® ® SummitSummitWorking Group ReportWorking Group Report

EndolumenalEndolumenal

July 8-10, 2010Chicago, 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

Endolumenal Working GroupObesity

Gastric reduction Malabsorption Combined Implant Revision

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

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

Endolumenal Working Group

GERD Mimic surgery – Nissen New approach

stem cell augmentation of LES remote electrical stimulation of LES

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

Endolumenal Working Group

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

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