Masterclass: Advanced GI Endoscopic Imaging (Live/Virtual) | December 2025-Wang

Wang - Hurdles in Imaging Technology

Pdf Summary

This presentation by Dr. Kenneth K. Wang addresses the significant challenges and complexities involved in the development, regulatory approval, and reimbursement of gastrointestinal (GI) imaging technologies, particularly innovations that could revolutionize colonoscopy.

Key points include:

1. <strong>Development Challenges:</strong> Creating advanced devices, like AI-powered colonoscopists that can detect and treat polyps, requires overcoming training inefficiencies, enhancing adenoma detection rates (ADR), and minimizing complications.

2. <strong>Regulatory Pathways:</strong> The approval process depends heavily on the device’s risk profile and claims:
   - The 510(k) pathway is the simplest, requiring demonstration of substantial equivalence to existing devices, with relatively low costs ($50,000-$500,000) and short timelines.
   - The De Novo pathway suits novel but low-risk devices, involving moderate costs ($500,000-$5 million) and varied approval times.
   - Premarket Approval Applications (PMA) for high-risk devices, such as those making life-threatening diagnoses, demand extensive clinical trials, manufacturing audits, and FDA reviews, with costs reaching tens of millions and approval timeframes spanning years.

3. <strong>Financial Burden:</strong> Average costs for FDA approvals are extremely high—approximately $31 million for low/moderate risk and $94 million for high-risk devices, including clinical trials and compliance.

4. <strong>Reimbursement Challenges:</strong> Securing procedural coding (CPT, HCPCS, APC) and reimbursement is complex. New devices often initially lack established billing codes and require rigorous clinical evidence and specialty society endorsement for valuation through the RUC process. Budget neutrality policies by CMS may limit increases in reimbursement.

5. <strong>Post-Marketing and Legal:</strong> After approval, manufacturers must conduct ongoing outcome monitoring and address medico-legal responsibilities, especially for AI-driven technologies.

6. <strong>Commercialization and Investment:</strong> Early-stage research, patenting, comprehensive testing, and attracting investors are critical for device development success.

In summary, the innovation of GI imaging devices demands a multi-faceted approach balancing rigorous scientific validation, costly regulatory pathways, and strategic reimbursement planning. The complexity and expense escalate with the novelty and risk level of the device’s claims.

Keywords

Gastrointestinal imaging

Colonoscopy innovation

AI-powered colonoscopists

Adenoma detection rate

FDA regulatory pathways

510(k) approval

De Novo pathway

Premarket Approval (PMA)

Medical device reimbursement

Post-marketing surveillance