The Interventional Endoscopist

Can complex interventional endoscopy thrive in an Ambulatory Surgical Center (ASC)? In this episode of The Interventional Endoscopist, host Dr. Mankanwal Sachdev sits down with pioneer Dr. Isaac Raijman (Associate Professor at Baylor College of Medicine) to explore the evolving landscape of outpatient therapeutic GI. Dr. Raijman shares his journey from fiber-optic endoscopes to modern digital cholangioscopy, breaking down the financial, clinical, and operational realities of transitioning EUS, ERCP, and endobariatrics out of the hospital setting. In this episode, we discuss: The Business & Economics: Navigating Medicare facility fees, disposable costs, and margins for EUS and ERCP in the ASC. Patient Selection & Safety Guardrails: Strict ASA criteria, BMI limits, equipment requirements, and complications management outside the hospital. Cholangioscopy & Stone Management: Practical takeaways from Dr. Raijman's DDW study on single-operator cholangioscopy and EHL in outpatient settings. The Future of Outpatient Intervention: What the shift toward outpatient care means for current fellows, interventional job markets, and the next frontier of interventional EUS. Whether you are a fellow preparing for practice or an attending looking to expand your ASC's therapeutic offerings, this conversation offers an essential blueprint for modern interventional GI.

In this episode of The Interventional Endoscopist, host Dr. Vinkaval Satdev sits down with Dr. Davinderbir Singh Pannu, a recognized leader in advanced therapeutic endoscopy at McLeod Health. For years, Endoscopic Submucosal Dissection (ESD) has been the gold standard for en bloc resection of complex mucosal lesions, but steep learning curves and equipment limitations have kept it centralized in major academic hubs. Dr. Pannu shares his journey of building a high-volume third-space endoscopy program (performing 80–100 cases a year) in a regional health system, saving patients from traveling hours for advanced care. Dive deep into the physics, economics, and clinical application of next-generation electrosurgical platforms. Dr. Satdev and Dr. Pannu break down the transition from traditional monopolar energy to multimodal bipolar microwave platforms—specifically focusing on the Creo Medical Chroma system with the Speedboat device. Key Takeaways: The Physics of Safety: How bipolar microwave energy limits collateral tissue damage and minimizes delayed perforations compared to traditional monopolar units. Tactile & Operational Shifts: Mastering pure cut currents, managing tissue resistance variations, and optimizing scope control. The Business Case for Advanced Tech: Navigating Value Analysis Committees (VAC), tracking downstream revenue, and proving ROI to hospital administrators. Clinical Humility & Career Growth: Dr. Pannu’s approach to mastering one major new technical skill every single year. Note: This podcast is completely independent and is not sponsored by any device company.

Resetting the Metabolic Setpoint: Duodenal Mucosal Resurfacing (DMR) and the Future of Obesity Care with Dr. Harith Rajagopalan Is the duodenum the "early warning beacon" for metabolic disease? In this episode, we sit down with Dr. Harith Rajagopalan, MD, PhD, Co-Founder and CEO of Fractyl Health, to discuss the revolutionary shift from treating downstream symptoms of diabetes and obesity to addressing the upstream root cause in the gut. We dive deep into the science and technique of Duodenal Mucosal Resurfacing (DMR)—an automated, 45-minute endoscopic outpatient procedure designed to reset the metabolic setpoint. Dr. Rajagopalan explains how high-fat, high-sugar diets pathologically alter the duodenal mucosa and how "resurfacing" this tissue can provide a durable off-ramp for patients on GLP-1 therapies. Key highlights include: The "Reset" Mechanism: How the duodenum acts as the body's nutrient-sensing center and why it becomes dysfunctional. Technical Deep Dive: A look at the automated circumferential saline injection and thermal ablation process (and the future of through-the-scope devices). The "Remain" Trial Data: Breakthrough insights into post-GLP-1 weight maintenance and craving reduction. The Rejuva Platform: A look at the first-in-class EUS-guided gene therapy targeting the pancreas. Whether you are a fellow learning the ropes or an attending looking for the next frontier in interventional GI, this episode explores a future where endoscopists own the management of metabolic disease.

In this episode, I explore the rapidly evolving world of Endobariatrics. As a bridge between lifestyle intervention and invasive surgery, these endoscopic procedures are fundamentally changing how I look at metabolic health and weight loss. In this episode, I discuss: Why I see endobariatrics as the "middle ground" for weight loss. My breakdown of Endometabolic Endoscopy and its impact on Type 2 Diabetes. Identifying the ideal candidate for these "incision-less" interventions. My thoughts on the future of gut-brain signaling and metabolic care. Whether you are a healthcare professional or someone curious about modern weight-loss tech, join me for a comprehensive look at the tools shaping the next decade of medicine. Listen here: https://bit.ly/TheIE-Ep42

EUS gives us phenomenal imaging — but tissue acquisition has historically been the weak link. In this episode of The Interventional Endoscopist, host Mankanwal Sachdev speaks with Dr. Charles Walther, a Swedish interventional cytopathologist and tumor genetics expert who has sampled 15,000+ patients and helped develop a new approach to obtaining high-quality specimens: EndoDrill. Walther shares the “lightbulb moment” that shaped the device: instead of advancing a needle by punching forward (“stabbing”), use high-RPM rotation to advance with low forward force — aiming for one pass and a more cohesive sample. They discuss how EndoDrill works in practical terms (setup, foot pedal activation, specimen expulsion), contamination concerns, compatibility across major scope platforms, and why tissue quality is becoming even more important in an era of precision medicine, molecular profiling, and organoids. They also cover early human experience, the learning curve, optimization for different tumor biologies, and the key cost/value debate: when does a premium tool make sense—especially for cases like nodules, GISTs, and lymphoma where yield can be inconsistent? Plus: Rapid-fire questions, technique pearls, and a reminder to seek help if you’re struggling with mental health.     Links: https://bibbinstruments.com/en/