Christopher Thompson, MD, MSc, FASGE, FACG, AGAF, FJGES, director of endoscopy and codirector of the Center for Weight Management and Wellness at Brigham & Women’s Hospital, professor of medicine at Harvard Medical School, discusses a session on gastrointestinal (GI) invention at the recent conference, Digestive Disease Week, held May 21-24 in San Diego, California.
Christopher Thompson, MD, MSc, FASGE, FACG, AGAF, FJGES, director of endoscopy and codirector of the Center for Weight Management and Wellness at Brigham & Women’s Hospital, professor of medicine at Harvard Medical School, discusses a session on gastrointestinal (GI) invention at the recent conference, Digestive Disease Week, held May 21-24 in San Diego, California. This is the second part of a 2-part interview; the first part can be found here.
AJMC®: Can you tell us what you discussed in your session, “Who’s Next? The Future of Physician Inspired Invention in GI?”
Thompson: This is exciting; there [were] some very good speakers, and it's all about GI doctors that have started companies and what the inspiration was for doing that—because we're busy, we're working, we're taking care of patients, why do you want to take time out of your already very busy life and start a company? What was the genesis for that? What was the experience like? How has it helped patients? What did you learn from that to help others? I think each one of us is doing that from our own perspective.
I've started 5 companies now. It's great, because I help 1 person at a time at the hospital and I might work with 15 people in a day, depending on what I'm doing—if it's clinic I might see a few more. When you make a device, you can touch hundreds or thousands in a day. It's amazing how many lives you can touch and how many people you can really help improve the quality of their health. We're really in the best position to do that, because we're seeing those kind of problems on a daily basis. You see all sorts of things that that need solutions and because we're right kind of there in the trenches, if you will, right there taking care of the patients. So, we can recognize these limitations to healthcare and the problems. The trick is being able to make that idea, identify the problem and then actually make a solution or reality. I think that’s what’s fun about the session is we’re hearing about, there’s not many of us that have done this, but the ones that have, how we've gone about it and how we've been able to be successful doing it.
AJMC®: Is there anything else from Digestive Disease Week you would like to discuss?
Thompson: My favorite abstract this year was presented at the video forum, and that's the GEM procedure, which is gastroplasty with endoscopic myotomy. It's a new therapy for obesity, a new way to trigger weight loss. It's physiology based, so it's very exciting. It's a one of a kind procedure that we're proud of.
The GEM procedure is based on gastric physiology. Most of our bariatric endoscopic procedures or endoscopic bariatric therapies, EBTs, or EDMTs, metabolic therapies, they were really designed just to replicate or mimic surgical procedures. The ESG we think of, endoscopic sleeve gastroplasty, that kind of replicates a gastric imbrication, which is a surgical procedure where they kind of fold in the fundus and greater curve of the stomach—not so much a sleeve gastrectomy, but there's some similarities maybe there too. That's just one example of something we're doing where we're trying to replicate a surgical procedure. With this new procedure, we're actually coming at it from a different perspective, we're using physiology of the stomach and we're trying to manipulate that to get a desired effect.
So, understanding the different phases of gastric digestion and gastric motility, one thing that's very important is the antral pump. This antral pump is largely responsible for gastric emptying. If you can delay that, which we know intragastric balloons are associated with, delaying gastric emptying, as is the TransPyloric Shuttle which is a device that was recently approved by the FDA. They actually can generate a substantial amount of weight loss. The problem is they are devices that would need to be removed at some point in time, so what's unique about this procedure is we're actually performing a myotomy to incapacitate that antral plump and make it less effective. What we do is we perform a pylorus-sparing antral myotomy, so we do not cut through the pylorus. We leave that intact so it can be relatively nice and tight. Then, we do a myotomy of the antral muscles, especially the circular fibers there, and we'll make a tunnel in a POEM technique, or peroral endoscopic myotomy technique, tunnel in just short of the pylorus. Then we'll do our myotomy along the length of the antrum about 6-7 centimeters long. Then we close it. We'll also—since we're using a suturing device to close the access site—oftentimes do some suturing of the stomach to tighten it down a little bit as well.
We're finding some very impressive results. The gastric emptying seems to just about double, so that's a substantial delay. Additionally, there's something called the Gastroparesis Cardinal Symptom Index score, and there's different sub-domains there. The one that is responsive—that reflects satiety—substantially improves, so they experience a lot of satiety, but they don't have problems with nausea and vomiting. We're very excited about this. It's early kind of first in-human experience, but we're starting some bigger studies. They're kind of getting underway, and we're hoping that this might be something that helps a lot of patients in the future.