Gastrointestinal Endoscopy -Landscape Report

Contents

Overview

Introduction

Gastrointestinal Tract

Gastrointestinal Endoscopy deals with the endoscopic examination, therapy or surgery of the gastrointestinal tract. Gastrointestinal Tract generally refers to the digestive structures stretching from the mouth to anus, but does not include the accessory glandular organs such as liver, billary tract, panceras. The gastrointestinal tract is categorized into various sections, these include:

(Source: MeSH Database)


Procedures

Currently, the most commonly used imaging methods for detection of gastrointestinal disorders, including disorders of the small intestine, are endoscopy and radiological imaging.
A traditional endoscope is a device consisting of a flexible tube and an optical system. There are several types of endoscopic procedures used to identify disorders in the gastrointestinal tract. The basic endoscopic procedures available include:


GI Imaging

Gastrointestinal endoscopy is undergoing major improvements, which are driven by new available technologies and substantial refinements of optical features. Detection, characterization and confirmation are essential steps required for proper endoscopic diagnosis. Optical and nonoptical methods can help to improve each step; these improvements are likely to increase the detection rate of neoplasias and reduce unnecessary endoscopic treatments. Furthermore, functional and molecular imaging are emerging as new diagnostic tools that could provide an opportunity for personalized medicine, in which endoscopy will define disease outcome or predict the response to targeted therapy.


Several new technologies are now available for each step, some of them include:


Classification of GI Imaging



Product Portfolio Heat Map

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Market Size

Source: Business Insights, Global Industry Analysts, Inc.

Major Players

Detailed Company Profile

Olympus Corporation

Snapshot Profiles


Source: Kalorama, Company website, Company SEC filings

M&A Activity

S.No. Date Details
1 Oct-10 Cook Medical Receives Two Contract Awards with HealthTrust Purchasing Group for Enteral Feeding and GI Endoscopic Supplies
2 Apr-10 Given Imaging Ltd acquires Sierra Scientific Instruments from Water St Healthcare Partners
3 Apr-10 Fujifilm signs a comprehensive Joint R&D aagreement with Fox Chase cancer center
4 Mar-09 KARL STORZ Acquires Global Care Quest
5 Jan-09 Given Imaging Inks Distribution Agreement with FUJIFILM
6 Dec-08 Given Imaging Ltd. Acquires Medtronic Bravo(R) pH Monitoring Business
7 Nov-08 Smiths Group Acquires Zhejiang Zheda Medical Instrument
8 Nov-08 Visage Imaging Inks Marketing Agreement with Viatronix
9 Jul-08 FUJIFILM Merges Fujinon?s Endoscope Business into Medical System Business Division
10 Jun-08 ICAD and ACR Image Form Partnership to Initiate Colon-CAD Clinical Study
11 Mar-08 Karl Storz Inks Deal with EndoGastric for Marketing EsophyX and StomaphyX
12 Mar-08 Given Imaging Bags a 5-Year FSS Contract
13 Nov-07 Olympus Takes Over Gyrus Group
14 Aug-07 PENTAX and HOYA Merge
15 Apr-07 Boston Scientific to acquire Remon Medical Technologies


Procedure Volumes

The three main areas where GI Endoscopy has considerable applications are Colon/Rectum cancer, Obesity (gastric bypass/gastric banding) and Digestive system disorders.

Colon/Rectum cancer

Tumors or cancer of the colon or the rectum or both. Colorectal cancer starts in the large intestine (colon) or the rectum (end of the colon). Risk factors for colorectal cancer include chronic ulcerative colitis; familial polyposis coli; exposure to asbestos; and irradiation of the cervix uteri. (MeSH) Colorectal cancer is the third most commonly diagnosed cancer in the world, but it is more common in developed countries.
Stages of colon cancer are:

(For more information on colon cancer click here)

Volumes, Prevalence and Incidence

(Source: Colorectal cancer association of Canada & American cancer society)

Survival Rates

Incidence rates

The estimated incidence rate of colorectal cancer in 2007 is expressed geography wise below:

Area Incidence per 100,000 people
North America 17-33.5
Europe 17-33.6
Asia 17-33.7
South America 17-33.4
Africa 3.2-17

Source: Kalorama Information Report

Obesity (Gastric bypass/Gastric banding)

A status with body weight that is grossly above the acceptable or desirable weight, usually due to accumulation of excess fats in the body. The standards may vary with age, sex, genetic or cultural background. In the Body mass index, a BMI greater than 30.0 kg/m2 is considered obese, and a BMI greater than 40.0 kg/m2 is considered morbidly obese (morbid obesity).

The two most common weight-loss surgeries are:

Volumes, Prevalence and Incidence

Digestive system disorders

Diseases in any part of the gastrointestinal tract or the accessory organs (liver; biliary tract; pancreas). The digestive system disorders are categorized as:

(Source: MeSH)

Volumes, Prevalence and Incidence

Source: Kalorama Information; WHO; US Census Bureau; Centers for Disease Control and Prevention

NOTE: All values for USA and Europe are in 000's. Data includes both in-patient and out-patient surgical procedures in all populations

Reimbursements

Upper GI/ Colonoscopy

CPT Code Procedure 2008 National Average Medicare Payment Facility
43250 Upper GI endoscopy including esophagus, stomach and either duodenum and/or jejunum as appropriate; with removal of tumors, polyps, or other lesions by hot biopsy forceps or bipolar cautery $172.91
43251 Upper GI endoscopy including esophagus, stomach and either duodenum and/or jejunum as appropriate; with removal of tumors, polyps, or other lesions by snare technique $199.58
43255 Upper GI endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; diagnostic, with control of bleeding any method $258.99
43256 Upper GI endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with transendoscopic stent placement (includes predilation) $233.09
43258 Upper GI endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with ablation of tumors, polyps, or other lesions not amendable by hot biopsy forceps, bipolar cautery or snare technique $244.14
45383 Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesions(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique $307.36
45384 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery $248.33
45385 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique $281.84
91110 Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), esophagus through ileum, with physician interpretation and report (Visualization of the colon is not reported separately) $944.18


Bariatric Surgery


APC APC Description (Hospital Outpatient Dept) Medicare Payment
130 Level I Laparoscopy (CPT 43659) $2,190.81
135 Level III Skin Repair (CPT 43887) $288.30
137 Level V Skin Repair (CPT 43886, 43888) $1,287.06
141 Level I Upper GI Procedure (CPT 43999) $541.59


CPT Code Procedure 2008 National Average Medicare Payment Facility
43886 Gastric reconstructive procedure, open; revision of subcutaneous port component only $836.59
43888 Removal and replacement of subcutaneous port component only $836.59
43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (Roux limb 150 cm or less) $1,507.10
43645 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption $1,615.27
43659 Unlisted laparoscopy procedure, stomach (Removal and replacement of both adjustable gastric band and subcutaneous port component) Carrier Priced
43770 Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components)(use modifier - 52 for individual component placement) $970.08
43771 Laparoscopy, surgical, gastric restrictive procedure; Revision of adjustable gastric band component only $1,107.95
43772 Laparoscopy, surgical, gastric restrictive procedure; Removal of adjustable gastric band component only $833.72
43773 Laparoscopy, surgical, gastric restrictive procedure; Removal and placement of adjustable gastric band component only $1,107.95
43774 Laparoscopy, surgical, gastric restrictive procedure: Removal of adjustable gastric band and subcutaneous port components $838.29
43842 Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical banded gastroplasty $1,071.01
43843 Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical banded gastroplasty $1,097.67
43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy (50 to 100 cm common channel) to limit absorption (billopancreatic diversion with duodenal switch) $1,716.20
43846 Gastric restrictive procedure, with gastric bypass, for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy $1,416.07
43847 Gastric restrictive procedure, with small intestine reconstruction to limit absorption $1,553.19
43848 Revision of gastric restrictive procedure for morbid obesity (separate procedure), other than adjustable gastric band $1,680.40
43886 Gastric reconstructive procedure, open; revision of subcutaneous port component only $287.18
43887 Removal of subcutaneous port component only $272.32
43888 Removal and replacement of subcutaneous port component only $387.34
43999 Unlisted procedure, stomach Carrier Priced
S2083 Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Carrier Priced


Technology Advancements

Areas Companies Involved
Enhanced Imaging Modalities Olympus Medical System Corp.
Pentax Crop. (Hoya Corporation)
Fujinon
Mauna Kea Technologies
KARL STORZ
SpectraScience Inc.
Robotic-Assisted Endomicroscope EndoControl Inc.
Wireless Biosensors and Polymers for GI bleeding (Hemostasis) Pluromed Inc.
Electronic Nose "Smells" Disease Cyrano Science Inc.


Enhanced Imaging Modalities: High-definition and virtual chromoendoscopy; (a) White-light imaging during endoscopy; a lesion beside a diverticular is hardly visible (arrow). (b) Closer inspection and image enhancement reveals tubular surface structures (arrows); (c) Virtual chromoendoscopy leads to pseudocolorization and improved visualization of the flat adenoma (arrows); (d) Chromoendoscopy using methylene blue unmasks the full extent of the lesion (arrows).