The Interventional Endoscopist

Resetting the Metabolic Setpoint: Duodenal Mucosal Resurfacing (DMR) and the Future of Obesity Care with Dr. Harith Rajagopalan Is the duodenum the "early warning beacon" for metabolic disease? In this episode, we sit down with Dr. Harith Rajagopalan, MD, PhD, Co-Founder and CEO of Fractyl Health, to discuss the revolutionary shift from treating downstream symptoms of diabetes and obesity to addressing the upstream root cause in the gut. We dive deep into the science and technique of Duodenal Mucosal Resurfacing (DMR)—an automated, 45-minute endoscopic outpatient procedure designed to reset the metabolic setpoint. Dr. Rajagopalan explains how high-fat, high-sugar diets pathologically alter the duodenal mucosa and how "resurfacing" this tissue can provide a durable off-ramp for patients on GLP-1 therapies. Key highlights include: The "Reset" Mechanism: How the duodenum acts as the body's nutrient-sensing center and why it becomes dysfunctional. Technical Deep Dive: A look at the automated circumferential saline injection and thermal ablation process (and the future of through-the-scope devices). The "Remain" Trial Data: Breakthrough insights into post-GLP-1 weight maintenance and craving reduction. The Rejuva Platform: A look at the first-in-class EUS-guided gene therapy targeting the pancreas. Whether you are a fellow learning the ropes or an attending looking for the next frontier in interventional GI, this episode explores a future where endoscopists own the management of metabolic disease.

In this episode, I explore the rapidly evolving world of Endobariatrics. As a bridge between lifestyle intervention and invasive surgery, these endoscopic procedures are fundamentally changing how I look at metabolic health and weight loss. In this episode, I discuss: Why I see endobariatrics as the "middle ground" for weight loss. My breakdown of Endometabolic Endoscopy and its impact on Type 2 Diabetes. Identifying the ideal candidate for these "incision-less" interventions. My thoughts on the future of gut-brain signaling and metabolic care. Whether you are a healthcare professional or someone curious about modern weight-loss tech, join me for a comprehensive look at the tools shaping the next decade of medicine. Listen here: https://bit.ly/TheIE-Ep42

EUS gives us phenomenal imaging — but tissue acquisition has historically been the weak link. In this episode of The Interventional Endoscopist, host Mankanwal Sachdev speaks with Dr. Charles Walther, a Swedish interventional cytopathologist and tumor genetics expert who has sampled 15,000+ patients and helped develop a new approach to obtaining high-quality specimens: EndoDrill. Walther shares the “lightbulb moment” that shaped the device: instead of advancing a needle by punching forward (“stabbing”), use high-RPM rotation to advance with low forward force — aiming for one pass and a more cohesive sample. They discuss how EndoDrill works in practical terms (setup, foot pedal activation, specimen expulsion), contamination concerns, compatibility across major scope platforms, and why tissue quality is becoming even more important in an era of precision medicine, molecular profiling, and organoids. They also cover early human experience, the learning curve, optimization for different tumor biologies, and the key cost/value debate: when does a premium tool make sense—especially for cases like nodules, GISTs, and lymphoma where yield can be inconsistent? Plus: Rapid-fire questions, technique pearls, and a reminder to seek help if you’re struggling with mental health. Links: https://bibbinstruments.com/en/

In this episode of The Interventional Endoscopist, host Mankanwal Sachdev sits down with Dr. Dan Marino, a GI fellow at NYU and future advanced endoscopy fellow, to unpack the real-world pathway to a fourth-year advanced endoscopy fellowship. Dan shares his journey from New Jersey soccer goalie to medical student, resident, fellow and ultimately interventional endoscopy fellow. He discussed how early mentorship, showing up in the endoscopy suite, and consistently doing excellent work shaped his trajectory. Together, they walk through how to think about competitiveness, building a portfolio (clinical performance, procedural exposure, research, and leadership), and how to strategically approach the ASGE Advanced Endoscopy Match—from choosing programs and asking for letters to understanding program culture, case volumes, and general GI expectations. They also dive into wellness, boundaries, and the “human side” of a very long training road, including protecting physical health, finding community, and keeping hobbies alive. Dan closes with concrete advice for residents and fellows: be present, do excellent work, say yes early in your career, and leverage mentors who genuinely want to see you succeed. This is a practical, candid roadmap for anyone seriously considering a career in advanced endoscopy. https://www.asge.org/home/education-meetings/training-trainees/advanced-endoscopy-fellowship-(aef)

In this episode of The Interventional Endoscopist, I sit down with Matt Schwartz, Co-Founder and CEO of Virgo Surgical Video Solutions, a company that transforms procedural video into structured, searchable, AI-ready data. Matt shares the early spark that led him to leave Intuitive Surgical to start Virgo, the challenges of installing early systems in GI units, and how automated, zero-click video capture evolved into a massive national dataset powering the next generation of AI in endoscopy. We dive into: Why video is one of the most overlooked datasets in medicine The medicolegal reality (and why video can actually protect physicians) Foundation models for endoscopy and site-level customization The future of training, credentialing, and outcome prediction from routine colonoscopy and EGD video Leadership lessons from building a healthcare startup If you're interested in digital endoscopy, AI, clinical training, or med-tech innovation, this episode offers a look into the future of how GI will be practiced. Helpful links referenced in the podcast https://virgosvs.comhttps://endoml.aiEndoDINO foundation model manuscript

This conversation traces Dragonfly from an idea “in the back of a cab” to a clinically focused cholangioscopy platform that rotates through the biopsy channel for predictable, millimeter-level control. We delve into the mechanics (≈1.7 mm channel supporting 1.5 mm forceps and 4.5 Fr EHL), exploring how the catheter’s suppleness and internal rigidity enhance distal duct stability and device passability, and why micro-movements and neutral ergonomics are crucial for case efficiency. We map where cholangioscopy shifts the algorithm—medium/large stones, altered anatomy, tight distal duct work, and stricture evaluation with larger bites—and talk learning curve (~3–5 cases), setup tips, and the Medtronic distribution partnership. Finally: adoption math, fair-use evaluations despite contracting realities, and a look toward accessory innovation and AI-aided visualization. Key takeaways Rotation-first control → faster targeting, less wall fighting, better stability in tight anatomy. Larger working channel enables bigger biopsies and higher-energy lithotripsy. Aim for complete fragmentation in session one; repeat procedures should be the exception. Ergonomics: neutral hand position and micro-movements reduce fatigue. Practical adoption requires training support and a fair, multi-case evaluation window. Links Dragonfly Endoscopy: https://dragonflyendoscopy.com Medtronic: https://www.medtronic.com/en-us/healthcare-professionals/products/digestive-gastrointestinal/ercp-devices/dragonfly-pancreaticobiliary-system.html

In this deep-dive, Mankanwal Sachdev explores how cholangioscopy moves us from fluoroscopic silhouettes to direct mucosal visualization—and why that changes diagnosis and therapy across indeterminate strictures, PSC dominant lesions, and difficult stones. We walk through the current platform landscape (SpyGlass™ DS2, eyeMAX™, and Dragonfly™), practical biopsy technique to improve yield, and real-world lithotripsy choices (EHL vs Holmium laser) with a focus on workflow, cost, and verification of clearance. We also look ahead to AI-assisted interpretation, robotic/telerobotic control, and how training is evolving with ESGE 2025 standards and ASGE/ACG guidance. If you’re building or refining a pancreatobiliary program, this episode offers an evidence-based framework you can put to work tomorrow. Key takeaways: Use cholangioscopy when results will change management; pair with EUS for maximal diagnostic yield. Standardize biopsy protocols and specimen handling with pathology. Choose energy based on stone density, access, and resources; confirm clearance by direct inspection. Build a training pathway (simulation + supervised volume) and consider tiered credentialing. Selected references: ESGE 2025 (PMID: 40588224); ACG 2023 biliary strictures; ASGE 2023 malignancy in biliary strictures; Amaral 2023 laser vs EHL (PMID: 37203215); Mauro 2023 review (PMID: 37761300).

In this episode of The Interventional Endoscopist Podcast, I dive into how AI-powered scribing has transformed my clinical workflow. Using Doximity’s AI scribe, I share step-by-step insights into documentation, patient engagement, and time savings in daily practice. I outline the advantages, limitations, and customization strategies while reflecting on the broader role of AI in reducing burnout and enhancing the physician–patient connection. Whether you’re an interventionalist, general GI, APP, or any healthcare professional curious about real-world AI integration, this episode offers a practical look at how scribing can change the way we practice medicine. https://blog.doximity.com/articles/meet-doximity-scribe

Description: In this episode of The Interventional Endoscopist, I dive divs into one of the most impactful developments in advanced GI care: the approval of dedicated Category I CPT codes for Endoscopic Submucosal Dissection (ESD). These long-awaited codes, one for upper GI and one for lower GI, go into effect on January 1, 2027 — and could finally unlock broader access, adoption, and reimbursement for ESD in the U.S. I discuss: The clinical value of ESD and why adoption has been slow How reimbursement barriers have held the technique back What Category I CPT code approval by the AMA actually means A detailed timeline of what happens between now and 2027 The role of the RUC, CMS, and commercial payers How GI practices, hospitals, ASCs, and coders should prepare Why this could signal a tipping point for training, education, and device innovation If you’re performing ESD, planning to learn, or managing coding and billing for a GI practice, this episode is your roadmap. 📬 Be sure to subscribe, follow on LinkedIn, and share this episode with colleagues in advanced GI

In this episode of The Interventional Endoscopist, I sit down with Dr. Jessica Widmer—Division Chief of Gastroenterology at NYU Langone Hospital–Long Island—for an honest, insightful, and inspiring conversation. Dr. Widmer shares her journey from a small town in Pennsylvania to becoming a leader in interventional endoscopy. We discuss her training path, early exposure to ERCP and cholangioscopy, and her decision to pursue advanced training at Cornell. She reflects on mentors who shaped her career, including Dr. Stavros Stavropoulos and Dr. Michel Kahaleh, and offers practical tips on teaching and performing cholangioscopy and pancreatoscopy. The episode also touches on the evolution and future of GI, training Challenges women face in interventional endoscopy, and balancing demanding careers with family life. We discuss the value of mentorship and society involvement Whether you're an advanced fellow, practicing endoscopist, or simply curious about the human side of medicine, this conversation delivers wisdom, humor, and heart. Subscribe, rate, and share—and stay tuned for more episodes exploring the minds shaping the future of GI. Link to the GOLD program: https://www.asge.org/home/education/advanced-education-training/leadership-development/gi-organizational-leadership-development-program

Join me as I welcome Fritz Haller, CEO and co-founder of Endolastic, to the podcast. Discover the fascinating journey of this medical device innovator, a former world champion, and Olympic coach in whitewater slalom. Fritz discusses his transition from a decorated athletic career and early experiences in medical devices at Cook Medical to founding Endolastic. Learn about Endolastic's core technology: a customized band ligation device designed to tackle new applications in interventional endoscopy. Fritz explains how Endolastic is using this "rubber band gun" to address conditions like GERD, Obesity (Band Gastroplasty), and Type 2 Diabetes (Duodenal Mucosal Resurfacing), offering simpler, more affordable, and accessible alternatives to existing procedures. Hear about the technical differences of Endolastic's bands and barrels, including the innovative "window lock" design and calibrated compression. Fritz shares insights into the company's regulatory strategy, aiming for specific treatment indications after an initial launch. Drawing on his diverse background, Fritz reflects on the nature of innovation, the lessons learned from past failures like the "scope doc," and the disruptive power of simple, effective solutions. He offers valuable advice for physicians and industry professionals looking to bring their innovative ideas to market, including navigating industry relationships, securing patents, and utilizing contract manufacturers. The conversation also delves into his perspective on leadership, emphasizing enthusiasm and coaching over traditional titles. This episode is a must-listen for anyone interested in the future of interventional endoscopy, medical device innovation, unique career paths, and the intersection of athletic discipline and entrepreneurial spirit.

Episode 31, In this episode, we look at redefining Gastroenterology: Mentorship, Innovation, and the Future of Interventional Endoscopy with Dr. Srinadh Komanduri Episode Summary: In this episode of The Interventional Endoscopist, host Dr. Mankanwal Sachdev reconnects with his longtime mentor, Dr. Srinadh Komanduri of Northwestern University. The two dive into Dr. Komanduri’s unique training path, his role in building Northwestern’s interventional endoscopy program, and how the field of GI is shifting away from traditional definitions toward a more therapeutic and innovation-driven future. The conversation covers the launch of Northwestern’s system-wide GI integration, the impact of tools like TissueCypher for risk stratification in Barrett’s esophagus, and the critical need to rethink GI fellowship structure. They also touch on barriers to technology adoption, the role of AI in operational efficiency, and how innovation can (and must) scale beyond a few experts to change care across systems. Topics Covered: Dr. Komanduri’s mentorship and hybrid fellowship experience Building an interventional GI network across 11 hospitals Moving beyond the “general GI” label Risk stratification and innovations in Barrett’s esophagus care AI’s role in reducing burnout and boosting clinical efficiency Future models for GI training and specialization Barriers to adoption and how to drive systemic innovation Sponsored by: Castle Biosciences – maker of TissueCypher®, a test to predict esophageal cancer risk in Barrett’s esophagus

I am excited to share insights from the Interventional Endoscopist podcast featuring Dr. Sachin Wani! The discussion centered on Barrett's esophagus, and strategies to improve detection and risk stratification Key takeaways: • The rising incidence of esophageal adenocarcinoma makes early detection crucial. Yet, survival rates remain low, highlighting the need for improved strategies • PEEC and PEEN underscore the issue of missed lesions during endoscopy, emphasizing the need for high-quality exam. • PEEC (postendoscopy esophageal adenocarcinoma) refers to cancer detected before the next recommended surveillance endoscopy in patients with non-dysplastic Barrett's esophagus. • PEEN (postendoscopy esophageal neoplasia) is a composite endpoint of high-grade dysplasia or cancer detected before the next recommended surveillance exam • A high-quality endoscopic exam is paramount, including meticulous inspection, standardized classification, and advanced imaging techniques like chromoendoscopy. • A 10-step approach to a high-quality exam includes identifying landmarks, spending adequate time inspecting the Barrett's segment, cleaning the distal esophagus, and using high-definition white light endoscopy and virtual chromoendoscopy • While the Seattle biopsy protocol is standard, it has limitations due to sampling errors • WATS (Wide Area Transepithelial Sampling) can enhance neoplasia detection as an adjunct to the Seattle protocol by sampling the entire Barrett's segment. • AI (artificial intelligence) holds promise for lesion detection, improved diagnostic accuracy, and quality assessment of endoscopic exams. AI platforms may help identify visible lesions and predict histology, as well as assess the quality of the endoscopic examination. • The Tissue Cypher test can aid in risk stratification by analyzing biomarkers to predict the risk of progression to high-grade dysplasia. It can also predict prevalent high-grade dysplasia or cancer. • Dr. Wani also shared his journey into medicine, influenced by his family, and the challenges faced by foreign medical graduates. A key message was the importance of continuous improvement in endoscopic techniques and the integration of new technologies to combat esophageal adenocarcinoma This episode was sponsored by Castle Biosciences the makers of the TIssue Cypher Test.

Join us for a deep dive into the world of endoscopic oncology with Dr. Toufic Kachaamy! This episode explores the rapidly evolving field of endoscopic oncology, highlighting its importance in cancer care and the need for multidisciplinary collaboration. In my second visit with Dr. Kachaamy discusses his innovative endoscopic oncology course, now in its fourth year, designed to bridge the gap between gastroenterology and oncology. Learn about the course's unique format, diverse faculty, and focus on cutting-edge topics, including early cancer detection, multidisciplinary strategies for managing metastasis, and organ preservation techniques. Don't miss this insightful conversation with a leader in the field! If you want to join us at the course here is the registration link : https://cme.cityofhope.org/content/2025-annual-advances-and-innovations-endoscopic-oncology-and-multidisciplinary#group-tabs-node-course-default6

In episode 29 of the Interventional Endoscopist Podcast, join us for an insightful conversation with Dr. Legett from the Mayo Clinic, Rochester. We delve into his extensive experience in treating esophageal disorders, focusing on Barrett's esophagus. Dr. Legett shares his journey and training at Mayo Clinic, highlighting his expertise in leveraging artificial intelligence and precision medicine, such as the TissueCypher test, to enhance early detection and management of Barrett's esophagus and esophageal cancer. The episode explores the challenges of diagnosing dysplasia, the transformative potential of AI in standardizing pathology, and improving patient care. Additionally, we discuss the role of molecular profiling in risk stratification and emphasize the critical need for ongoing research to optimize management strategies for Barrett's esophagus. This episode is proudly sponsored by Castle Biosciences, the innovators behind TissueCypher, a test designed to predict esophageal cancer risk in patients with Barrett’s esophagus.

In this episode of The Interventional Endoscopist Podcast, Dr. Stuart Akerman joins host Dr. Mankanwal Sachdev to explore the evolving role of AI in gastroenterology and endoscopy. They dive into AI's impact on polyp detection, note writing, and patient engagement, and how it enhances both efficiency and care quality. Dr. Akerman reviews leading AI systems like GI Genius, Magenta, and Scalp, while discussing their potential to improve adenoma detection rates and reduce withdrawal times. Together, they address ethical concerns, AI fatigue, and the importance of balancing technology with human touch. Tune in to hear how AI is reshaping the future of GI practice.

In this episode of The Interventional Endoscopist, Dr. Mankanwal Sachdev and Dr. Stuart Akerman explore the pivotal role of endoscopic ultrasound (EUS) in ambulatory surgical centers (ASCs) and its impact on both patient care and physician work-life balance. Dr. Akerman, a physician advisor for Endosound, shares how EUS has transformed his practice. He also reflects on his unique journey from a career in finance to becoming a physician, his mentorship under Dr. Mickey Goldschmidt, and his current role at Digestive Health Associates of Texas (DHAT), where he balances general gastroenterology with interventional endoscopy. This episode highlights the value of mentorship and the evolving role of medical technology in enhancing patient outcomes This is part one of a special two part episode

In this episode of The Interventional Endoscopist Podcast, I sit down with Dr. Doug Adler, Director of the Center for Advanced Therapeutic Endoscopy at Porter Adventist Hospital. We discuss his transition from a 20-year academic career to a hybrid practice model, blending private practice with academic responsibilities—a trend gaining traction among interventional endoscopists. Dr. Adler shares his journey from medical training at Cornell and the Mayo Clinic to becoming a leader in therapeutic endoscopy. He reflects on his mentors, his passion for procedural medicine, and the future of the field, including exciting new techniques like endoscopic retrograde appendiceal therapy (ERAT). This episode offers valuable insights for young physicians navigating career transitions, mentorship, and the evolving landscape of interventional endoscopy.

In the latest episode of The Interventional Endoscopist Podcast, Dr. Jason B. Samarasena, a prominent figure in the field of endohepatology, shares insights into his background and the innovative developments in this emerging specialty. Dr. Samarasena delves into the evolution of endohepatology, highlighting the potential it holds for transforming patient care. A significant portion of the discussion focuses on Endoscopic Ultrasound-guided Portal Pressure Gradient (EUS-PPG), a cutting-edge procedure that Dr. Samarasena helped to pioneer. He explains the technique, its clinical applications, and its importance in assessing portal hypertension non-invasively. This conversation offers valuable perspectives on the future of endoscopic interventions in hepatology, emphasizing the role of interdisciplinary collaboration and technological advancements in improving patient outcomes. Links: Dynamic suction: a novel technique to optimize EUS-guided liver biopsy My method for liver biopsy processing Dr. Samarasena's Linkedin profile EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study Youtube Video of Podcast

In this exciting episode of "The Interventional Endoscopist," I sit down with Scott Haack, a renowned inventor and innovator in the gastrointestinal (GI) space. With a career dedicated to advancing endoscopic technology and improving patient outcomes, Scott shares his journey, the challenges he has faced, and his vision for the future of GI procedures. Tune in as Scott delves into the intricacies of his groundbreaking work, offering insights into the latest innovations and the impact they have on both practitioners and patients. Whether you're an endoscopist, a medical professional, or simply fascinated by medical technology, this episode promises to be an enlightening and inspiring listen. Join me for a deep dive into the world of GI innovation and discover what drives the passion behind Scott Haack's remarkable contributions to the field. Video of Podcast: https://youtu.be/p2p0gGiVLHI for those who transitioned to the video to watch the innovations discussed by Scott, please forward to 38:00