AGA Clinical Congress and Hands-On Course - Miami, Fla.

The American Gastroenterological Association (AGA) held their recent Clinical Congress in Miami. The event was well attended, the programs offered were diverse and South Beach was as always, entertaining.

Dr. Mark DeLegge chaired and moderated the Practice Management Course. This course described to physician practice leadership the “coming” role of Accountable Care Organizations and Health Care Reform on the practice of gastroenterology in the United States. Dr. DeLegge also lectured in this forum on the future of endoscopy in ambulatory surgery centers, hospital outpatient endoscopy suites and office-based endoscopy facilities with the advent of healthcare reform.

Dr. DeLegge also co-chaired the AGA practice skills workshop, a forum for gastroenterology fellows plotting out their future careers to understand the career opportunities available to them in academic medicine and private practice. With his career experience in academic medicine, private practice and hospital leadership, Dr. DeLegge’s primary message was “find a mentor and listen.”

There was also a hands-on-endoscopy course offered for the first time by the AGA. Course attendance was completely booked and Robin Murray from DeLegge Medical assisted the AGA in putting on this inaugural course using table-top models and ex-vivo pig stomachs and intestines. Experience was received by attendees from “expert endoscopists” in the areas of tissue ablation, stenting, micro-endoscopy and endoscopic mucosal resection amongst other topics. Robin organized a first-rate course that was a smashing success. The new “pig trays” that were unveiled by Robin were very versatile and created a “real life” endoscopic experience.

DeLegge Medical is committed to excellence in physician education and the development of new medical technology. We are continuously exploring the means to put the right tools into the physician’s hands with the right training experience to ensure procedure success and patient safety.

Early Enteral Feeding at Forrest General Hospital

Dr. Mark DeLegge recently traveled to Hattiesburg, Miss., where he presented on the topic of early enteral feeding to a group of pharmacists, physicians, nurses and dietitians at Forrest General Hospital. This was an invited lecture at the request of the hospital’s dietitians and nutrition support team.

 

The highlight of the presentation focused on the use of gut, specifically stimulating the imbedded immune system by the use of enteral nutrition.  Discussed in the presentation were early enteral feeding’s impact on clinical outcomes, impediments to delivering enteral feeding in the intensive care unit and the science of enteral access. Dr. DeLegge stressed that “there needs to be a major shift in the perception of nutrition, specifically enteral nutrition, and its importance to maximizing clinical outcomes. Dietitians and nutrition specialists need to take the lead role in driving their patient care teams down the road of early enteral access and early enteral nutrition. Frankly, there are drugs that don’t achieve the same level of improvement in clinical outcomes in the critically ill patients that can be achieved with early enteral nutrition.”

There was quite a bit of discussion about the need for a feeding protocol in the ICU to encourage the use of early enteral nutrition and the need for clinicians to stop using gastric residual volumes below 500 cc as a reason to withhold or terminate the delivery of enteral nutrition.  All in attendance agreed that the ASPEN/SCCM guidelines certainly set the groundwork for earlier, more aggressive use of enteral nutrition.

The Road Map to the Finish Line

The pending sale of Satiety's Intellectual Property is another example of the problem in the United States with regards to new technology introduction into the United States. Satiety was one of a number of transoral GI devices that is meant to treat obesity; a problem that was in pandemic form the last time I checked. Venture capital was the economic push to get it to market. As usual, the finish line... FDA approval and insurance reimbursement remained elusive, as the goals of what needed to be obtained in clinical and safety results were either never clearly defined or set at a level that no therapy, other those achieved short-term with a major operation for weight loss, could achieve. I have to believe there is some concession given to the fact that we cannot treat all obesity with surgery given the costs and risks of the procedures.

This is a prime example of the disconnect currently between the inventor, capital, the FDA and reimbursement. There are 4 pots of money for an inventor or start-up:

1. Grants (good luck)  
2. Angel investment (limited in amount)
3. Venture capital
4. Friends, families and fools (Bill Gates is not my dad or cousin)

If you look at that, it is quite clear that there has to be a roadmap to get to the finish line (FDA clearance/reimbursement) that is known and achievable, if we hope to bring anything new to the GI physician and GI patients that is not a "me to" product. People funding projects want to know they have a reasonable chance for success or, they could as effectively burn $20 dollar bills in the backyard on their grill. That's where the DeLegge Medical Technology Accelerator can be so helpful; as a broker and director. Taking technology and having a clear pathway to success has to be established before the first prototype is conceived. I have to think that everyone involved (FDA, payors, inventors) actually wants patients to get better with the help of new technology at some point. If not, then we are in real trouble. It might take a coordinated patient "uprising" to change the playing field with the FDA and payors if those goals cannot be predetermined and achievable through "reasonable" means.