This report originally appeared in the July 2010 issue of DOTmed Business News

There seems to be more excitement in the endoscopy industry today than at any time during the past two decades. OEMs are unleashing high-tech image advancements, service and refurbishment companies are seeing business boom and the health care reform law has served as the catalyst for many heated discussions.

Narrow band imaging, 3-D and high-definition capabilities are the biggest developments in the industry, according to endoscopy experts, and the advancements are helping save more lives and making the lives of the professionals carrying out the procedures easier as well.

"Small improvements like the V-design at the distal tip of the new Olympus duodenoscopes have made life a little easier for doctors performing endoscopic retrograde cholangiopancreatograms," says Michael Riney, a spokesman for Tenacore Holdings, which repairs, refurbishes and sells endoscopy equipment.

"More and more customers worldwide are upgrading their endoscope stocks from the [Olympus] EVIS EXERA I 160 series to the high-definition EVIS EXERA II 180 series," said Alberto Voli, president of Zgrum Medical in a written response to DOTmed News.

Voli's company sells, refurbishes and services flexible video and fiber endoscopes and accessories from Olympus and Pentax. "Other than the high definition features, these scopes from Olympus feature NBI capability, enhancing the visibility of capillaries and other miniscule structures by emphasizing the contrast between small vessels and normal tissue," he said.

Even endoscopy accessories are changing with the times, as better lighting, carting and cabinets are being created. Currently, integrated LED light sources are of increasing popularity and are allowing scopes to be portable and easier to maneuver into hard-to-reach areas.

"In recent years, the most significant technical advancement has been video chips, replacing fiber optic vision bundles," says Craig Vogeley, operations manager for Gulf Medical Fiberoptics, which manufactures replacement fiber optic light cords for endoscopy as well as replacement fiber optic light bundles for third-party flexible endoscope repair facilities. "From our company's perspective, this year and the near future's biggest news is the transition to LED light sources for endoscopy, surgery and microscopy."

Coming down the pipeline

For medical professionals who have been keeping up with the endoscopy buzz at medical conferences and through published papers, two of the more interesting developments are just around the corner.

Some believe the optical coherence tomography (OCT) scope may be this year's biggest endoscopy equipment news. OCT has proven to be of considerable use due to its ability to non-destructively acquire images below the surface of tissue.

"The majority of cancers start about 2 mm below the surface in the epithelium. Scopes today only show a surface picture, they don't reveal what's going on under the surface where tumor development begins," says Scott Townsend, managing partner of Townsend Surgical LLC. "Instead of using a camera, an OCT scope shoots a laser beam to the target tissue. The light that is reflected back produces a 3-D picture. Cancerous tissue reflects light differently than normal tissue and can thus be detected before it manifests on the surface."

The thing is, OCT for endoscopy is currently under patent from two Louisiana State University professors, Martin Feldman and DooYoung Hah, and none of the major manufacturers has made claim to it yet.




"The design is ready and we expect it to be huge," Townsend says. "Everyone in the industry has been keeping an eye on this and someone will definitely pick it up and market it soon."

Endoscopic OCT systems will lead to better medical outcomes in two ways: they reduce the number of cases where biopsies are required and they make biopsies more accurate. OCT probes can also serve as a diagnostic tool to determine disease progression and be functional as a surgical guidance system.

Another huge development in the industry is that Olympus Medical Systems Corp and Siemens Healthcare Diagnostics are co-developing a capsule endoscope that will have its movement in a stomach controlled by magnetic guidance.

According to Dr. Brian Muska, an endoscopy specialist at St. Alexius Medical Center in Illinois, this magnetically guided capsule endoscope system would allow a stomach examination to be done comfortably by having the patient swallow an endoscope in the form of a capsule. Once taken, a patient would simply lie down in a magnetic guidance system and using a joystick-like tool, the specialist will then be able to navigate the capsule easily to the areas of interest and then the capsule will provide real-time, high-resolution images on a display in the examination room.

"Our aim is to create endoscopes that minimize the stress on patients and are user-friendly for physicians," said Haruhito Morishima, president for Olympus Medical Systems in a release sent to DOTmed News. "Capsule endoscopes have excellent potential from these perspectives. We see this joint development project with Siemens as the realization of one of our visions for the future of capsule endoscopes."

Herrmann Requardt, CEO of Siemens Healthcare, also expressed his thoughts on the partnership in a prepared release.

"In cooperation with our partner Olympus, we usher a new era in endoscopy," he said. "We believe that the magnetically guided capsule endoscope will enable quick examinations that are comfortable for the patient. This system will be an excellent addition to current methods in endoscopy, for instance within the scope of aftercare."

The capsule endoscope will be approximately 31 mm long and 11 mm in diameter. The system will utilize camera systems mounted at both ends of the capsule to allow observation inside the stomach. Real-time observation will be made possible by means of captured images transmitted immediately to an image processing system that will provide guidance information on the posture of the capsule endoscope as it is navigated using magnetic force.




A prototype is already in testing, and if all goes as planned, the capsule endoscopes could be rolling into hospitals before the end of 2011.

"This is definitely an exciting thing," says Darius Dziadosz, owner of Surcam, Inc., a direct repair service company for endoscopy cameras. "We are looking forward to it even though it will mean we will have more difficult repairs and [how to] invest in more sophisticated equipment. That's what keeps this business interesting."

Health care law

The impact on the increasing demand for endoscopes directly correlates with the new health care law, which purportedly will provide the funding for more people to undergo endoscopic procedures. To meet this anticipated demand and still keep an eye on finances, more and more health care centers are turning to third-party vendors to purchase their endoscopic equipment.

"The health care [law] is having a positive impact on the [refurbished] endoscopy business both from a repair perspective as well as from equipment sales," said Voli. "As budgets are cut and payments per procedure are reduced, health care facilities are forced to purchase their equipment at lower prices and many times repair their existing equipment instead of upgrading to later generations."

Dennis Leiner, president of Lighthouse Imaging Corporation, believes the health care reform law will stabilize the endoscopy industry.

"I think we'll see less redundancy in product development," he says. "New products will either solve a medical problem that has not been solved or else the product will reduce costs."

More buzz in endoscopy

Endoscopes are primarily a diagnostic tool, but they are used as an alternative to surgery in some cases as several scopes are instrumental in performing biopsies, repairing sports-related injuries and removing polyps and other growths.




"I believe that the biggest news in endoscopy equipment is the continued aging population who will most likely require more medical procedures to stay healthy along with the reported more than 1 million new cases of colon/rectum cancer a year," said Voli. "The new health care law and the aging population needing more preventive endoscopic screenings have proven to be good for business."

As the expansion of endoscopy procedures make it more useful in helping doctors detect more dangers, the number of people who are helped increases every year. In the past few years, endoscopy has evolved into the choice for invasive procedures in a variety of areas including removal of small tumors and extensive therapies like removal of non-essential organs.

"As more people worldwide become educated and aware of colon cancer and other illnesses affecting the gastrointestinal tract, more people are seeking screening and treatment for these illnesses," says Harvey Buxbaum, president of HMB Endoscopy Products, which offers complete endoscope restorations, refurbishments and repairs. "For this reason, the demand for endoscopy procedures is on the rise."

According to Matthew Sens, senior marketing communications manager for Pentax Medical Company, 2010 will be spent continuing to focus on emerging sonoelastography technology for GI, which creates HD and true color images.

Other OEMs such as Stryker and Richard Wolf Medical Instruments Corporation are also focusing on providing better HD images, while Fujinon's double balloon endoscopy system is making it possible for detailed observation and treatment in the small intestine.

The third-party industry has evolved at an incredible rate over the past 10 years to the point where many repair companies and parts vendors are ISO-certified and follow strict quality control measures. However, the smaller scopes being introduced into the market have presented some challenges.

"Scopes are getting small, smaller and, we hope, with the addition of the new 2.2 mm Olympus scopes, smallest," says Townsend. "These scopes present new challenges in the manufacture of parts and development of techniques required for repairing and rebuilding them."

Although the OEMs keep coming out with new twists on technology, the reputable independent service organizations can figure out the systems quickly with reverse engineering and move forward with service and repairs.




"With the smaller scopes, we learn new things with our research and development and it doesn't take too long," says David Johnston, president of EndoTechnologies, Inc., which sells and repairs video endoscopy and endoscopic hardware. "We are seeing as a result of things getting smaller, that they are not lasting as long as they used to because they are more delicate," he says. "We are seeing the repair business increasing tremendously as a result of that."

EndoTechnologies will be launching a new filter line this summer and has recently moved to a larger facility in preparation for its growth in this area.

Final thoughts

Further advantages of endoscopic surgery include lower costs, quicker recovery and healing time, lower risk of surgical complications and reduced trauma. Specialists and general practitioners can also perform many diagnostics and procedures in their offices, rather than having to constantly use hospital operating rooms.

With so much on the horizon in the field of endoscopy, the sector is something that many health care professionals are keeping a watchful eye on.

"The endoscopy industry is a really good place to be right now," Townsend says. "With an aging demographic and the technology that is being used to see inside the body, the future is bright."

Keith Loria can be reached by e-mail at kloria@dotmed.com.

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DOTmed Registered Endoscopy Equipment Sales & Service Companies
Names in boldface are Premium Listings.

Domestic
Alberto Voli, Zgrum Medical, AZ
DOTmed certified
Gayle Butler, Endoscopy Superstore, CA
Arnold Wiesel, MFI Medical Equipment, Inc., CA
DOTmed certified
Dennis Maro, DEMMCO, CA
Info Tenacore, Tenacore, CA
Edward Mukai, EndoEx, CO
DOTmed certified
David Murray, Surgical Direct, FL
DOTmed certified
DM100
Adrian Bias, Advanced Endoscopy, Inc., FL
DOTmed certified
Scott Scholl, Clear Choice Medical, FL
Samir Dahdah, Doral Medical Equipment & Supplies, Inc., FL
Sergio Tkachuk, T&V Surgery, FL
Craig Vogeley, Gulf Fiberoptics, Inc., FL
Jacob Glaser, Endoscopy Specialists, Inc., FL
DOTmed certified
DM100
Cesar Martin, ProEndoscopy, FL
DOTmed certified
Gary Gross, S.R.I., IL
Darius Dziadosz, SURCAM, Inc., IL
DOTmed certified
Robert Gaw Jr., Physicians Resource Network, MA
DM100
Dennis Leiner, Lighthouse Imaging Corporation, ME
Mark Charaf, Global Medical Equipment, Inc., MI
DOTmed certified
Sam Kanaan, Laproman, MI
DOTmed certified
DM100
Jay Hachem, Medical Group Resources, Inc., MI
Shannon Kennedy, Stanley InnerSpace, MI
Gamal Shanbaky, Gamma Medical Equipment, Inc., MI
Dalia Husseiny, EndocorpUSA, MI
Kurt Nierengarten, Medical Recovery Company Inc., MN
Michael Fitzgerald, MaxMed, Inc., MN
Marcus Rosenberg, Endoscopy Development Company, MO
Rafael Mendonca, Life Systems, Inc., MO
DOTmed certified
Robert Harris, Imaging Associates Inc., NC
Edward Soto, SterilMed, Inc., NC
Adam Gessner, Arcadian Medical, NC
DOTmed certified
Chris Skelley, Skelley Medical, LLC, NH
DOTmed certified
Adam Rudinger, Lex-Tech, Inc., NY
Meghan Longenderfer, Olympus America, Inc., PA
Tom Boston, US Medical Systems, SC
Troy Appleton, M.T.M.E., TN
Scott Townsend, Townsend Surgical, TN
DOTmed certified
DM100
David Johnston, Endo Technologies, Inc., TN
Robert Saunders, Medical Technology Services, TX
Philip Mothena, Simple Solutions, Inc., VA
Scott Haas, H+H Surgical Technologies, LLC, WI
DOTmed certified
DM100

International
Juan Carlos-Liga, EndoMedical Group SRL, Argentina
Rami Wahba, Scope Care, Egypt
Pravin Rane, Rane Corporation, India
Vasant Sohoni, Vasant Sohoni & Associates, India
Manish Srivatsava, Genuine Medica Privte Limited, India
Koutarou Seki, Green Medical Co. Ltd., Japan
Gustav Wassermann, High Tech Medical, South Africa
Tarkan Kizilaslan, Endo-24, Turkey

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