Category Archives: Medical

Our Apollo story…..we boldly went

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.

 

China WOW! 40 years on

We are just back from Shanghai, after attending a meeting to celebrate the 50th anniversary of ERCP. It was kindly and brilliantly hosted by Professor Hu Bing (standing behind me at the dinner). I enjoyed sharing the podium with Joseph Leung and Sydney Chung, who founded the Endoscopy unit at Prince of Wales Hospital inContinue Reading

Fifty years of ERCP

In case you might like to read my recent review “Fifty years of ERCP”, here is the link https://authors.elsevier.com/a/1XN~p3mGpVzge

50 years in the Bile duct and Pancreas

If you have 43 minutes to spare, here is a recording of my recent presentation at MUSC Medicine Grand rounds. http://academicdepartments.musc.edu/v/medicine/20171130_Cotton.html    

Down English Memory lanes

Just back from three great weeks in England, visiting our special families, as described in my last blog. I took the opportunity to reconnect with several friends from the (very) distant past, and cannot resist sharing them with you. Joe Clayton and I met 60 years ago, in 1957, when we both represented Cambridge UniversityContinue Reading

Two new medical publications

A survey of credentialing for ERCP in the United States https://doi.org/10.1016/j.gie.2017.03.1530 How much pain relief do patients expect after cholecystectomy? http://em.rdcu.be/wf/click?upn=KP7O1RED-2BlD0F9LDqGVeSMQmWdTq9BpXT-2FFE5lpsKp0-3D_RLjM3EiP19d2W-2BRyiC55StGEdECkMlY3fp4OuMSsuV6A6CyvAgFp7ZpI71eXSVN2jI7O7AlSUceKnPqeNH05tsIaS6TUlFcZUFcc82Z80Z5VbaXFsA09PjLjhtEe0RRGCSF7-2Br0mpAtjZLf3-2BCqRlUWCZXCeTVOR0tdfgf-2FUnxlDoZFCjoXduHYaRfC78Yn6u7-2FIfclrP4UR3k-2F70kMc9ivF2ILxjcv3eAlzsMDmdmD1T5th86GcjvyHrAB6rUxWVfKUA7wYX-2FzPVerSDDRR-2BQ-3D-3D

Enhancing quality in GI health care

  How do you/we choose from all those who wish to serve us, whether restauranteurs, plumbers or doctors? How do we know which or who is good, or even excellent? Locally we can rely on our own experience and the recommendations of friends. But it is more difficult away from home. Some things like restaurantsContinue Reading

A National Health system in USA?

The current bizarre health care “discussions” in Washington prompt me to comment. I grew up with, and served in, the National Health Service in Britain. When initiated in 1947 it was relatively inexpensive, since medical care was much less complex and most people died soon after retirement, if not before. The funding did not keep upContinue Reading

South Africa part three – CapeTown

After the wonderful week in the game parks with family, Marion and I headed to CapeTown, where I was to be visiting professor at Groote Schuur hospital. We splurged by arriving on the famous Blue Train from Pretoria. 36 hours of pampering, with great (too much) food. The landscape was rather monotonous until the mountainousContinue Reading

Our EPISOD research project finishes after 9 years.

  This one is medical, but I will try to make it intelligible. EPISOD stands for “Evaluating Predictors and Interventions in Sphincter of Oddi dysfunction”. That pesky sphincter described by Mr Oddi is the valve that controls the flow of juices from the liver and pancreas into the small intestine (duodenum). If it overacts itContinue Reading