Developing new endoscopic technologies across Mayo Clinic’s gastroenterology (GI) teams

Developing New Endoscopic Technologies Across Mayo Clinic’s Gastroenterology Teams

July 2, 2021 – By Jared Mueller, Director – Mayo Clinic Innovation Exchange

As a patient who has had three endoscopies outside the walls of Mayo Clinic — one of which was a “redo,” following an inadvertent omission in a prior endoscopy — endoscopic innovation is an area of deep personal interest.

Mayo Clinic has academic medical centers in leading medical device hubs such as Minnesota and Northeast Florida, and gastroenterology has long been a focal area in Mayo Clinic’s practice. These assets have contributed to Mayo innovators’ efforts to double down on endoscopic innovation. Elizabeth Rajan, M.D. and Vivek Kumbhari, M.B.Ch.B., Ph.D. are among Mayo’s current faculty leaders in developing cutting-edge gastrointestinal (GI) endoscopic techniques.

Dr. Rajan is a gastroenterologist and the director of the Developmental Endoscopy Laboratory, specializing in preclinical and clinical studies related to innovation in technology and devices in the field of gastrointestinal endoscopy at Mayo Clinic’s campus in Rochester, Minnesota.

Her current research is based on finding deficiencies in current endoscopic practices, and developing novel endoscopic devices and techniques for minimally invasive procedures in areas from colorectal cancer to esophageal structure. Dr. Rajan’s medical training began at the Royal College of Surgeons in Ireland before she completed fellowships in advanced endoscopy research and techniques at Mayo Clinic. Dr. Rajan has contributed to over 165 peer-reviewed publications and invited reviews.

Dr. Kumbhari is the chair of gastroenterology and hepatology at Mayo Clinic’s campus in Jacksonville, Florida. Dr. Kumbhari graduated with a medical degree from Otago University in Dunedin, New Zealand, in 2005. He completed his medical residency and GI fellowship in Australia before undertaking an advanced endoscopy fellowship at Johns Hopkins from 2013-2015. He joined the faculty at Johns Hopkins in 2015 and held multiple leadership roles there. In 2019, he was awarded a Ph.D. from the University of Sydney, Australia.

He is board certified in internal medicine, gastroenterology, and obesity medicine. As a physician scientist, Dr. Kumbhari has a national and international reputation as one of the leading researchers in advanced endoscopy and endoscopic innovations. His h-index is 40 with over 240 publications and his work has been cited in over 5,000 citations in the last five years.

Dr. Kumbhari’s research focuses span translational and clinical research. His basic science focus is on eliciting the underlying mechanisms of metabolic change observed after bariatric surgery and methods of liver-directed gene delivery. Dr. Kumbhari’s clinical research has focused on novel endoscopic techniques to treat patients with obesity and complications of bariatric surgery. He has been the principal investigator on multiple active and completed research grants.

Q: Can you share an overview of endoscopic innovation activities within Mayo Clinic?

ER: Mayo Clinic is proud to incorporate endoscopic innovation into each of its “three shields” — the shields in Mayo Clinic’s logo representing clinical practice, education, and research. To use education as an example: partnering with our program director, Douglas Simonetto, M.D., gastroenterology fellows at Mayo Clinic in Rochester are now able to enroll in a comprehensive “endoscopy innovation” elective.

Through that course, they are charged with discovering unmet needs and envisioning solutions in current practice; advancing and testing their own novel solutions, to the point where they can be tested in an animal lab; and even pitching their ideas to selected medical device company experts in concert with our colleagues at Mayo Clinic Ventures. This structured training for rising medical leaders is essential to ensuring endoscopic innovation continues at a rapid pace.

Q: How does Mayo Clinic’s endoscopic innovation infrastructure differ from that of other academic health systems?

VK: Having joined Mayo Clinic from another academic medical center, and seen the process for endoscopic innovation within many other top institutions, the infrastructure Dr. Rajan and Christopher J. Gostout, M.D., have built upon since 1998 truly stand apart. The Developmental Endoscopy Lab offers extraordinary opportunities to clinicians, major device firms, and entrepreneurs to collaborate more efficiently.

Basic “collaboration start-up” processes that may consume hundreds of emails and many conference calls at most institutions are streamlined at Mayo Clinic. This is by design. Promising collaborations in medicine sometimes do not get off the ground when busy entrepreneurs and clinicians get side-lined by extraneous hurdles and paperwork, processes that have not been value-engineered for efficiency.

Q: Dr. Kumbhari, you joined Mayo Clinic in Florida in 2021 and serve as both your department’s chair and its point person for endoscopic innovation. Which innovation opportunities are at the top of your radar screen?

VK: We at Mayo Clinic work across specialties to ensure that innovative ideas and procedures from a given field can cross-pollinate other areas of medicine — benefiting patients across multiple disease areas. I spend many hours brainstorming with colleagues such as Sebastian Fernandez-Bussy, M.D., an interventional pulmonologist who is one of my close collaborators on Mayo Clinic’s Procedural Innovation Team (or “PIT”). We and our PIT colleagues work with seasoned engineers, intellectual property experts, and in many cases startups to scan the landscape of procedures and medical devices, identifying “white space” where innovations are likely to benefit unmet patient needs.

Within my own field, I spend significant time collaborating with other clinicians, entrepreneurs, and technologists working on a wide set of opportunities. These range from therapies to treat cancerous and benign conditions involving the gastrointestinal tract; innovations that can help manage the complications of surgery; and minimally invasive, non-surgical therapies to facilitate weight loss and the treatment of obesity-related diseases.

Q: What breakthrough innovations in healthcare delivery or technology excite you most?

ER: There is tremendous excitement and forward movement with artificial intelligence and robotics that have garnered much support and attention. What excites me just as much is predicting or anticipating the next space for innovation. To me, there are two areas that stand out.

One is remote patient care — how can we deliver “virtual endoscopic care”: what are the tools of the future to allow remote endoscopy where patients and physicians are in different locations? The other area is personal to many of us who know colleagues who have been directly impacted by COVID-19. As vaccination rates increase, our risk of exposure diminishes, however developing an armamentarium or portfolio of personal protective equipment (PPE) to address preparedness for future pandemics is an area that requires innovation and focus. This will ensure our healthcare staff can safely perform endoscopic procedures.

VK: The three particular areas of interest that excite me are: (1) incorporating the progress in basic and translational research towards flexible endoscopic surgery, particularly endoscopic weight loss and metabolic therapies (2) artificial intelligence to improve quality in endoscopy (detecting dysplasia in Barrett’s esophagus during upper endoscopy, precancerous polyp detection and risk stratification during colonoscopy for example, and risk stratification of pancreatic cysts during endoscopic ultrasound) and (3) technologies to create luminal anastomosis.

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