Thousands of physicians descended on our hometown of San Diego for Digestive Disease Week, the annual gathering of gastroenterology professionals from around the globe. The sprawling exhibit hall was packed with imaging and endoscope innovations aimed at improving clinical efficiencies and reducing healthcare costs. Here are a few of the technologies that caught our eye.

ConductOR from NDS Imaging
This single point of control is where all standard and high-def video sources and destinations connect, letting you send multiple video sources to monitors located throughout the OR. The system cuts down on the tangle of cords and cables that can cause headaches and trip up members of the surgical team. It's able to stream high-def video to remote locations over a facility's Ethernet, and the unit's compact design lets it fit easily on an endoscopy cart or an equipment boom.

For ERCP applications, we usually send fluoroscopic and endoscopic images to separate monitors, a setup that's inconvenient not only for us, but also for staff who have to work around yet another piece of equipment. Consolidating images onto a single monitor is therefore a valuable ergonomic and space-saving feature. A lot of the devices in the exhibit hall were variations on what we're already working with. This imaging technology, however, is fundamentally different from what we're currently using and was one of the more interesting innovations we saw.

Halo90 Ultra from Covidien
Covidien used to have a single focal device — the Halo90 — for treating residual disease following ablation treatments for Barrett's esophagus. The company introduced the smaller Halo60 earlier this year, and just weeks before DDW it launched the Halo90 Ultra, which is twice as long as the Halo90 and provides 4cm more of ablation area. Physicians now have the option of working with 3 different catheters for attacking various-sized lesions after initial circumferential ablations.

Investing in new technology needs to make financial sense. If you ablate every patient who presents with Barrett's then, yes, adding this device would be profitable. But if you only ablate patients who'll benefit the most — individuals with high-grade dysplasia, according to clinical guidelines — case volumes might not be significant enough to justify the expense.

Stratus CO2 Insufflator from Medivators
A CO2 regulator device that also features a warm infusion pump, the Stratus lets you infuse warm water and warmed CO2 into the colon, which helps prevent fogging of the endoscope's lens and, since several studies have shown that insufflation of CO2 instead of air during colonoscopy often results in less patient discomfort, could result in greater case throughput. The devices are stackable and sold separately or as a set. The insufflator features a built-in water heater, so you can use the warm water feature with your existing infusion pump. An endoscope primer readies any company's scope in about 15 seconds with the push of a button. Priming scopes create a positive pressure in the irrigation tubing, which is important. This seems like a nice system. Warming the water is an interesting concept that might make it easier to pass scopes through a difficult colon. Some centers are using CO2 instead of air to insufflate the colon, which gets resorbed into the body's system faster and could lead to improved patient recoveries.

EVIS EXERA III from Olympus
Olympus's new video endoscopy system helps answer one very important question: How can you save time and money? The system employs the company's proprietary narrow-band imaging technology, but at 4 times the brightness than the system's previous generation, making tissue surfaces clearer and more evident. Improved visualization helps you identify what type of polyp you're working with, including pit patterns. The early detection of cancer, particularly small and flat lesions, is getting a lot of attention in GI circles and anything you can do to enhance your ability to detect those lesions is helpful.

Olympus added "pre-freeze" technology found in its consumer camera line, which takes a series of images and relays back the best image captured so you're able to get a crisp, true picture in a single attempt, which is nice. Physicians can snap a picture, examine the still image on the fly and continue the procedure. If you can use the technology to perform a semi-pathology exam during an endoscopy to identify, for example, small hyperplastic polyps, which aren't considered clinically significant (particularly on the left side of the colon) you'd avoid having to send tissue samples to pathology, which typically cost $100 a bottle, and reduce overall procedure costs.

The system also boasts a new responsive insertion technology, which includes passive bending behind the scope's active bending section and enables a 1:1 transfer of pushing and rotating forces to the distal end. An optional feature provides physicians with a real-time outline of the scope's shape as it's aligned in the body. Every colon reacts and twists differently, difficulties can arise during any procedure and not all endoscopists are created equal, so being able to make adjustments based on what the scope is doing at a particular point in time could be useful. In addition, if you knew which way the colon was being turned and what kind of loop was forming in the scope, you could reverse it. Real-time scope tracking technology and improved insertion technologies are helpful features, but not necessarily priorities.

EC 2990Li Endoscope from Pentax
The company's new scope measures 1,700mm with a 2.8mm working channel and features a tight turning radius that a company rep said will turn through a nearly 4cm diameter arc and let the scope retroflex to 210 ?, which is a nice option. The section that bends is also short, eliminating the large sweeping curves found on other scopes.

A smaller diameter scope is always an advantage when you're trying to get through strictures, but stricturing colon disease is not something we often see. Diverticular disease where the lumen gets compromised, however, is a more common issue when smaller diameter scopes are generally preferable. You might run into problems with looping when using a smaller, more flexible scope, but skilled endoscopists can often avoid that issue. We wondered if the retroflex capabilities would make the scope more fragile, but the company rep said the scope's current users haven't yet reported durability concerns.

Single-Use Colonoscopy System from Invendo Medical
This single-use scope system's inverted sleeve technology — it essentially grows through the colon as it moves — is designed to reduce force on the colon wall. Physicians use a handheld joystick-like device to drive the scope to the cecum. The system, which reportedly showed a 98% cecum rate in an average of 15 minutes and a 96% sedationless rate during its FDA clinical study, has a 3.2mm channel and flexes 180 ? in every direction.

A company rep says the system doesn't require the infrastructure (notably big buildouts for cleaning and disinfecting) and staffing requirements (many patients can tolerate the scope without sedation, eliminating anesthesia recovery room staffing from the cost equation) needed to perform traditional colonoscopy, making procedures performed in satellite centers, mobile units or on Saturday plausible. The device won't change what GI facilities are currently doing, says the rep, but it could permit 2 or 3 more revenue-producing cases to be added at the end of the day after reprocessing and recovery staffs have left. The system's hardware, which is similar in size to a standard colonscopy tower, costs about $35,000. Each scope runs $300, although the rep said per-case costs could be reduced through volume purchasing.

This is a neat system and the potential of sedationless colonoscopy is intriguing. In reality, will the device replace the feel of a conventional colonoscope in a physician's hands, especially when he's lacking tactile feedback during polyp removal? Will having to always buy scopes be more cost effective over the long run than investing in scope reprocessing? That remains to be seen.