December - 202019Marlborough, MA) that is food and drug administration (FDA) approved and available in the United States. Multiple other LAMS are available worldwide including the NAGI and SPAXUS stents (Taewoong Medical, Gyeonggi-do, South Korea). B) Endoluminal therapies for Gastroesophageal reflux disease: A variety of endoscopic treatment modalities have been developed that are less invasive and safer than surgical fundoplication. The EsophyX device (Transoral incisionless fundoplication -TIF) creates a valve at the gastroesophageal junction and has been shown to be safe and effective. Other endoscopic therapies such as MUSE and Stretta are also gaining popularity after showing adequate safety profile and efficacy in several thousand patients.C) Per-oral esophageal myotomy (POEM) and per-oral pyloromyotomy (POP or G-POEM): POEM as an endoscopic therapy for achalasia has been shown to equally efficacious with decreased morbidity and mortality compared to surgical Heller's myotomy. More recently POP (G-POEM) is gaining popularity for the treatment of selected cases of gastroparesis, which has typically been a very difficult disease to manage.D) Endoflip: A newer technological, minimally invasive device is being used in conjunction with high resolution esophageal manometry and barium swallow to diagnose motility disorders of esophagus such as achalasia. Endoflip has the added advantage of measuring the cross-sectional area and intraluminal pressure of the esophagus while under distension. Endoflip can also be used for pneumatic dilation of achalasia without the use of fluoroscopy. In future, it is predicted to diagnose different phenotypes of achalasia for specific management.E) Artificial intelligence (AI): AI has revolutionized the field of gastroenterology and future will witness a surge in applications of AI. Researchers have shown how deep learning can assist in a variety of skills that physicians have been required to perform. An important application that is being tested worldwide is identifying polyps in a colonoscopy. Once a lesion is detected, computational alogrithms can predict polyp histology without the need for resection. AI is also being tested for early diagnosis of upper GI cancers, improving yield of wireless video capsule endoscopy to detect celiac disease, GI bleeding, Crohn's disease, tumors, and ulcers. F) Self-propelled colonoscopies: The Aer-O-scope (GI View Ltd, Ramat Gan, Israel) is a user-independent, self propelled, self-navigating colonoscope that is being developed for screening colonoscopies. Another self-propelled colonoscope, the ColonoSight (Stryker Corp, Kalamazoo, MI) uses air assisted propulsion to create the forward force while the operator directs the scope using handles. This scope has disposable working channels. A pilot study has shown the safety and efficacy of these scopes.G) Advances in imaging: A variety of newer techniques is developed in recent years to assist in early detection of dysplasia and neoplasia. Some of these techniques such as chromoendoscopy, narrow band imaging is widely being used. Others such as confocal laser endomicroscopy, autofluoroscence, light scattering spectroscopy, optical coherence tomography have shown promising results and will likely find a niche in routine endoscopy in near future.These and several other technological advances in the field of endoscopy will bring a paradigm shift in the management of gastrointestinal disorders. Unfortunately, cost is still a prohibitive factor that limits the routine use of some or most of these therapies or devices, which is also one of the prime reasons for poor reimbursements. It is expected that with availability of more data regarding safety and efficacy and likely decrease in the cost of production of these devices, they will find a more mainstream use in the endoscopy space. Dalbir Sandhu
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