The Interventional Endoscopist

Episode 43: The one where I discuss all things Fractyl with Dr. Harith Rajagopalan

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.

Episode 42: The one where I discuss Endobariatrics and Endometabolic Endoscopy

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 [https://TheIE.podbean.com/e/episode-42-the-one-where-i-discuss-endobariatrics-and-endometabolic-endoscopy/?token=fe1c807a5c397ab0d6ac5335d6a7067f]

Episode 41: The one where I explore EndoDrill with Dr. Charles Walther

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/ [https://bibbinstruments.com/en/]

Episode 40: The one where I explore building a path to Advanced Endoscopy with Dan Marino, MD

In this episode of The Interventional Endoscopist, host Mankanwal Sachdev sits down with Dr. Dan Marino [https://x.com/Dmarino117], a GI fellow at NYU and future advanced endoscopy fellow, to unpack the real-world pathway to a fourth-year advanced endoscopy fellowship. Dan shares his journey from New Jersey soccer goalie to medical student, resident, fellow and ultimately interventional endoscopy fellow. He discussed how early mentorship, showing up in the endoscopy suite, and consistently doing excellent work shaped his trajectory. Together, they walk through how to think about competitiveness, building a portfolio (clinical performance, procedural exposure, research, and leadership), and how to strategically approach the ASGE Advanced Endoscopy Match [https://www.asge.org/home/education-meetings/training-trainees/advanced-endoscopy-fellowship-(aef)]—from choosing programs and asking for letters to understanding program culture, case volumes, and general GI expectations. They also dive into wellness, boundaries, and the “human side” of a very long training road, including protecting physical health, finding community, and keeping hobbies alive. Dan closes with concrete advice for residents and fellows: be present, do excellent work, say yes early in your career, and leverage mentors who genuinely want to see you succeed. This is a practical, candid roadmap for anyone seriously considering a career in advanced endoscopy.   https://www.asge.org/home/education-meetings/training-trainees/advanced-endoscopy-fellowship-(aef)

Episode 39: The one where I interview Matt Schwartz, CEO of Virgo

In this episode of The Interventional Endoscopist, I sit down with Matt Schwartz, Co-Founder and CEO of Virgo Surgical Video Solutions, a company that transforms procedural video into structured, searchable, AI-ready data. Matt shares the early spark that led him to leave Intuitive Surgical to start Virgo, the challenges of installing early systems in GI units, and how automated, zero-click video capture evolved into a massive national dataset powering the next generation of AI in endoscopy. We dive into: * Why video is one of the most overlooked datasets in medicine * The medicolegal reality (and why video can actually protect physicians) * Foundation models for endoscopy and site-level customization * The future of training, credentialing, and outcome prediction from routine colonoscopy and EGD video * Leadership lessons from building a healthcare startup If you're interested in digital endoscopy, AI, clinical training, or med-tech innovation, this episode offers a look into the future of how GI will be practiced.   Helpful links referenced in the podcast * https://virgosvs.com [https://virgosvs.com/] * https://endoml.ai [https://endoml.ai/] * EndoDINO foundation model manuscript [https://arxiv.org/pdf/2501.05488]