I think there are already a couple of questions here in the chat for you. So the first question is, how do you see the clinical utility of MCCE use in the future? If an abnormality is identified on MCCE, should it trigger a focused endoscopy to verify the findings, provide a comprehensive evaluation and take biopsies if needed, especially if the reader is not a gastroenterologist? That's a great question, and I think that you really hit the nail on the head there in that I see the potential of MCCE to be almost utilized as an initial kind of, if we suspect choledocalothiasis, let's get an abdominal ultrasound, and if that triggers a cascade of events that requires an intervention, then we can go that route. So when this tool or this platform was originally developed, it was developed to screen patients for gastric cancer specifically. And in countries like China, for example, it's almost like getting a screening mammogram where the procedure is done by a technician and then is sent to a specialist, a gastroenterologist for reading. And then once the study is read, it can then trigger an actual traditional diagnostic endoscopy based on abnormalities that are detected. So even though gastric cancer itself in this particular example may not be as prevalent of a disorder as it is in those countries, I still think the principle is useful in that if you have patients who either may not be able to undergo traditional endoscopy but still need a diagnostic evaluation, this could be a niche tool for those patients to then potentially get a diagnostic traditional endoscopy if indicated. Excellent. Thank you so much. And then the subsequent question is, when you're using AI-assisted CAPSU, do you only read the frames picked up as abnormal by the AI or would you do a quick read through the rest of the study just to make sure nothing else was missed? Also great question. In my opinion, I think it is useful to do it both ways, especially if you are an early adopter or are getting your feet wet and getting used to the AI-assisted technology. In the beginning, this is going to add actually more study time to get used to the comparison and contrast of AI-assisted mode versus traditional mode. But I think that once you get the hang of using the AI-assist, you can rely on it a little bit more. But the idea here is to use AI as an adjunct and not necessarily go to it straight out and use that and only do the AI-assisted mode and not even look at any of the other images. I think a blend of the two is the best way to go and relying more on traditional methodology as you gain more experience using AI-assisted features. Excellent point. Neil, the OMAM technology appears disruptive to the current model. What's the current status in the United States of that? Would you just comment on that and how disruptive is it and how are the American companies, Medtronic, going to respond to that? I think that the companies that are integrating AI into their platforms like OMAM and ANX, I think they are being highly disruptive to the capital market. And I think that the larger companies like Medtronic, I think they are now trying to incorporate these features, but it's kind of a double-edged sword because the product iteration of the larger companies is slower, but they already have existing market share so that they can be the Goliaths in the room. Whereas some of these smaller, more nimble companies like OMAM, the OMAM company and ANX, they may be more nimble, but adoption is now trying to gain market share and adoption is going to be the key factor going forward. So I think these technologies are very disruptive, but at the end of the day, it requires, I think, gastroenterologists trying something new and then institutions buying into that and then that gaining traction. So it's going to be interesting to see how it all plays out over the next 5 to 10 years. And the ANX ProScan is FDA approved? Yes. All right. So another question. So for MCCE, how long would this procedure typically take? Is the patient awake? If so, is it uncomfortable? How still does the patient have to remain during the procedure? With this particular procedure, it takes about 20 minutes or so is my understanding. I can double check that. But the patient is awake and ingests the capsule and then lays in the left lateral position, similar to a colonoscopy or a traditional endoscopy. And the patient just lays on the table and remains still. And then the magnet does the maneuvering and it's not meant to be painful or uncomfortable at all. Thank you. Any other questions? I have one. It's a little bit wonky and may appear a little bit off a little bit. But Neil, you're an MBA, is that right? Yes. Yeah, good. So that's the one for you. So it may be a little nerdy and wonky. But the capsule endoscopy is my understanding. And I'm not sure whether I have this right, but I believe it's considered a designated health service now, which puts it in a unique category for those people who don't know. When you have a patient under the Stark laws in the United States, when you see a patient in the office and you do an upper endoscopy on them, you can go build that and collect that. But if it's considered a designated health service, it's in a different category. You send someone for a capsule. And if you read it yourself, that's considered a self-referral like it would be to a lab or something else. Is that an issue in this? You mentioned some of the issue with reimbursement, et cetera. So it may be a little off topic, but I don't know whether other people think this is an issue for our specialty here. No, definitely. I think it's a really great question and very relevant to the discussion because as we were discussing, reimbursement and the financial piece really drives adoption in a lot of cases, especially in the early goings of new technologies like this. I haven't seen too many issues with self-referral or that sort of implication in capsule endoscopy. It may be different if, for example, if you do a upper endoscopy and a colonoscopy and then refer a patient for a capsule endoscopy, which you then perform in your group's ASC, for example, that's where I can see it getting a little bit hairy. But overall, I haven't seen any case law that has really called that into question very much. Sometimes, in your example, if basically two people are reading a capsule endoscopy, so if I do it myself, but then send it out to a reader, that could also trigger an audit from a billing standpoint. But overall, I haven't seen too many issues with that. I think one thing that... Sorry, go ahead. No, no, no, no, you're rolling along fine. Please, perfect. Yeah, so one thing that I also wanted to highlight for the audience is that oftentimes capsule endoscopy is looked at as a procedure in and of itself. So, for example, if I want to do a capsule endoscopy on my patient and I want to purchase this system, a lot of times your executives and your administrators, they're going to go to Google or whatever spreadsheet they use or pull up their CMS reimbursement fee schedule and look at the reimbursement of a capsule endoscopy itself. And they may say, okay, well, our facility payment is, let's say, $900 for this procedure, so then what's our payback and all those kinds of things. But I think it's also really important as gastroenterologists to highlight for our administrative partners this concept of what is called contribution margin. And what that means is not only are we going to capture the revenue from this capsule endoscopy, but look at all of the other services and all of the other work that has gone into getting to this point. So every patient who is getting a capsule endoscopy will get an upper endoscopy, will get a colonoscopy, will get some kind of small bowel imaging, will probably have multiple clinic visits, they'll get lab work, etc., etc., etc. So the idea here is not to just run up a tab, but the idea here is to use that information, package that, and communicate that in a way that our administrative partners can understand in their language to say, you know what, we're actually not just getting that $900 for this capsule endoscopy, we're getting all of that too. So if that adds up to, let's say, $5,000 or $10,000, then as the GIs in the room, we can then stack the deck in our favor and say, this is not only an essential clinical service, but this is really favorable on your balance sheet.

Magnetically Controlled Capsule Endoscopy

AI-assisted diagnostics

gastric cancer screening

disruptive medical technology

healthcare reimbursement