Hitting the road: Making endoscopy training tech mobile

When the pandemic hit training for GI doctors on advances in endoscopy, Fujifilm created a mobile hub to take the latest tech to them. Jacqui Thornton talks to Fujifilm’s European marketing manager Dominik Vollbach. 

Endoscopy is a highly skilled, technical, and complex area of medicine involving incredible manual dexterity. Doctors have huge responsibilities as a wrong move can have a dramatic effect on patients’ quality of life. It’s a constantly evolving field: keeping up to date is vital.

When COVID hit, gastroenterologists specialising in diagnostic and therapeutic endoscopy – diagnosing and treating abnormalities in the gullet, stomach, and bowel – were affected in two significant ways. 

First, training was impacted. Conferences that gave them opportunities for learning about the latest techniques with hands-on training sessions were cancelled, and medical education provided by commercial companies was curtailed to online sessions.

Secondly, with healthcare services, dominated by the pandemic and clinics, closed for all but the most urgent cases, patients were being diagnosed later than normal, making diseases including cancer potentially more difficult to treat.

So, in 2022, these specialists face fewer training opportunities but more complex cases to deal with. In a recent survey of 302 endoscopists and nurses from five countries, 78% said this was a concern; 82% said they would value the chance to see more live demonstrations from manufacturers. 

Fujifilm, which has increasingly focused on healthcare in the last decade, decided to address both issues with the creation of the EndoRunner – a high tech mobile hub containing its latest advances in endoscopy.

The 8m x 2.5m sized van weighing 3.49 tonnes has just begun travelling from hospital to hospital, starting in Sweden, training doctors, nurses, and technicians where they are. It was launched at the European Society for Gastrointestinal Endoscopy’s ESGE Days 2022 conference in Prague on April 28. 

Fujifilm has a long heritage in health. Starting as a photographic company, it began manufacturing cinema and photographic film but also X ray film as early as 1936, followed by cameras, lenses, and optical technology. It was an innovator in radiology with developments in Ultrasound, CT, and MRI scans, creating the world’s first digital X ray system in 1983.

As early as 1971 it had begun developing flexible fibre endoscopes and then video endoscopes – long flexible tubes with attached cameras and lighting that allow doctors to see high-res images from inside the body.

Fujifilm is committed to constant innovation and its latest products, all included in the EndoRunner, demonstrate these advances.

For example, with its Cad Eye system, developed at Fujifilm’s global Artificial Intelligence technology centre in Tokyo, a doctor carrying out a colonoscopy can benefit from Artificial Intelligence acting as a second pair of eyes to spot polyps, some of which can be flatter or hidden in the colon, and therefore hard to spot.

But significantly, the Eluxeo Ultra platform can also characterise the severity of those polyps – whether they are hyperplastic (harmless) or neoplastic, which can lead to cancer. Fujifilm’s has been the first product being launched in Europe to be able to characterise lesions in this way. If it is of concern, the doctor can cut off the polyp using, for example, a therapeutic snare threaded through the endoscope.

Another advance is the Rockstar therapeutic device, which enables an extraction basket to be threaded through the endoscope. It is so small it can enter the bile duct to remove stones or crush them if removal is impossible due to their size. This is one of Fujifilm’s huge range of endoscopic therapeutic products – around 500 – following its acquisition of Medwork in 2019, making it a broad provider of endoscopy care from screening to treatment.

All of these things and many more can be demonstrated on the EndoRunner. Bespoke training can last as little as a 30-minute hands-on session, but they can also last up to several hours if needed. 

Dominik Vollbach, European marketing manager for Fujifilm’s Endoscopy Systems, who is currently travelling with the EndoRunner, said the launch was an exciting time.

He said: “We saw all the hospitals and private clinics being closed and colonoscopies cancelled. So, from a business perspective, it was very difficult for us, but also the education which is highly important in endoscopy because these are really difficult procedures.

“A survey by SERMO that we commissioned of healthcare professionals from the UK, France, Italy, Spain and Germany showed they are really concerned about having to deal with more advanced cancers – they describe it is as a ticking time bomb.

“We thought – what can we do to help the doctors? So, we developed the EndoRunner, which contains all our latest developments. It’s not a roadshow – it’s an educational opportunity.” 

The EndoRunner has three workstations, one for Core GI, one for HPB (hepato-pancreato-biliary diseases), and one for Pulmonology, each with its own stack of processors and monitors.

In drawers below are 20 different endoscopes, including the latest generation gastroscopes, enteroscopes, colonoscopes, duodenoscopes, ultrasound endoscopes and bronchoscopes plus the smaller trans-nasalscopes which are less than 6mm wide. 

Each can enable four people to be trained at the same time, but with Covid measures taken into consideration one person can use each station and comfortably be a metre apart.

The hub has a heating and cooling system so it can be used in any climate and its front panel can be completely opened up as a hatch with a stage for live demonstrations. A tent can be placed over the van to protect from elements and enable more people to attend.

The Core GI system enables doctors to examine the oesophagus and stomach (gastroscopy), the small bowel (enteroscopy) and the colon (colonoscopy). It uses ColoAssist Pro, a navigation system offering a real-time endoscope visualisation. Its USP is that the onscreen display of the endoscope is colour graded so clinicians can clearly see how the colonoscope is positioned inside the intestine. 

It includes a device placed on the hand of the nurse which, when held over the patient’s body, shows up as a white mark on the screen, enabling the hand marker to locate potential loops in the intestine. The nurse then knows where to push on the body to guide the endoscope. This is the latest innovation in the Eluxeo Ultra platform.

The EndoRunner starts its tour in May visiting five hospitals in Sweden over two weeks, followed by Denmark, Germany and then Portugal.

One of the first people to examine it was Helmut Messman, a clinical gastroenterologist in Germany and the President of ESGE, who described it as a ‘fantastic innovation.’

He said: “It’s a beautiful idea especially for the younger generation. Training is always necessary. In the past it became difficult to train due to lockdown. The pandemic has one positive in that we have to think of new ideas.”

Mariana Arvanitakis, a Belgian gastroenterologist specialising in advanced endoscopy therapeutic endoscopy such as ERCP, says that all doctors can benefit from the EndoRunner as techniques are constantly evolving.

She said the EndoRunner would be particularly useful in countries where there were long distances to travel to conferences or training centres, or in small centres with few specialists where it was difficult for them to be away from their clinics for long periods of time.

She said: “We learn from when we come into this world until we die - it's a continuous learning procedure. For the young doctors, of course, it's crucial, but we learn throughout our life - even the experts can always learn.”