In 1994, Rob Hawes and I joined the faculty at the Medical University of South Carolina, in Charleston, to found a multi-disciplinary Digestive Disease Center. We were both experts in minimally invasive treatments, using endoscopes through the mouth or anus to manage clinical problems that previously required open surgery. While the endoscopes themselves were well developed, the treatment devices to pass through them were not. We had the idea to assemble a group of like-minded friends to talk about the tools we needed and how to develop them.

So, just 20 years ago, in 1998, we set up a meeting at Kiawah Island, SC. The following friends joined us and formed the Apollo group: Chris Gostout from Mayo Clinic, Tony Kalloo and Sergey Kantsevoy from Johns Hopkins, Jay Pasricha from (then) University of Texas SW branch in Galveston, and Sydney Chung from the Chinese University of Hong Kong. The meeting was supported by the Olympus company, the manufacturer of the endoscopes.

It was (and still is) rather unusual for opinion leaders and such prominent academic centers to collaborate so closely, and to share valuable intellectual property. Our principal was “all for one and one for all”.

We talked about our disease targets and necessary tools, including tissue apposition (sutures, clips, T bars), tunneling beneath the mucosa, and methods for preventing gastro-esophageal reflux. We even discussed the revolutionary idea of perforating the gut wall intentionally to gain access to a whole new field, the abdominal cavity. That vision became NOTES (natural orifice trans luminal endoscopic surgery)

We challenged Olympus to come up with prototypes. One was an endoscopic suturing device, provisionally called the “Eagle Claw” because of its opposing talons.

The efforts persisted for several years, but achievedfull lift-off in 2005 when we partnered with a Texas entrepreneur, Dennis McWilliams. He helped us to form the Apollo Endosurgery company, not without significant hurdles and efforts. Sorting out intellectual property with Olympus was challenging, and getting five major Academic Centers to embrace an unique formal collaboration was even more so. Dennis nailed it, and Apollo Endosurgery was off and running with seed financing and a great team of engineers. The Eagle Claw was refined multiple times and became the Overstitch suturing device that is now FDA approved and being used in over 60 countries. Experiments with tunneling devices opened up (literally) the sub mucosal space, leading to ESD (Endoscopic Submucosal Dissection), and POEM (PerOral Endoscopic Myotomy) for treatment of Achalasia. There is now a whole new world of “third space endoscopy”, with enormous potential for both resections and implantations. NOTES has been slow to find a killer clinical application, but has stimulated development of many products usable in other areas (like the huge spin-off from the Apollo moon program).

Apollo Endosurgery has branched out into other fields, most notably the Bariatric space, where less-invasive interventions are now challenging current major surgical options. The company is now listed on NASDAQ as APEN.

These reminiscences are written a few days after the Apollo members had a reunion at Johns Hopkins at Tony Kalloo’s kind invitation. It was fun and rewarding to reflect on our journey.

It is also a reminder of the importance of collaboration in making progress in medicine as well as other fields.