SAGES Stories Episode 11 – Jeff Ponsky, MD

Ponsky had a 2.027 GPA graduating from Cleveland Heights High School and his college counselor recommended trade school instead of college.

Ponsky's transformation in college came from memorizing everything and studying constantly, discovering he had an exceptional memory that allowed him to 'eat the book and spit it out.'

Walter Pore taught pinch grafting technique at Metro Hospital, where students would inject local anesthesia, harvest small 'postage stamp' skin grafts from the thigh, and apply them to debrided bedsores. Pore emphasized giving patients zinc supplementation.

Gastroenterologists at University Hospitals refused to train surgeons in endoscopy, telling Ponsky 'we're not training any surgeons.'

Ponsky trained in endoscopy with Jim King in Canton, Ohio, performing approximately 500 cases over 5-6 months during an extended elective.

Early endoscopes were cleaned with green soap and stored in the back of cars, without high-level disinfection protocols. Operators did not wear gloves during procedures.

When SAGES started, it had approximately 300 members. When Ponsky became president in 1990, the society was giving courses on surgical endoscopy and its relationship to surgical problem-solving.

Jacques Perissat showed the video of laparoscopic cholecystectomy in the exhibit hall at the SAGES meeting in Louisville, Kentucky, marking a pivotal moment when Ponsky was SAGES president.

When laparoscopic cholecystectomy was introduced, instruments could not be purchased and surgeons had to use gynecologic instruments initially.

Ponsky took one of the first laparoscopic cholecystectomy courses taught by Nat Soper, George Bercy, John Hunter, and John Sackier in Salt Lake City.

Ponsky's first two laparoscopic cholecystectomies at Mount Sinai were proctored by David Dupper, who had performed only 8 cases himself at that time. The first patient was a member of the hospital's board of trustees.

Ponsky became director of surgical endoscopy at University Hospitals at age 29 as a new attending.

The PEG (percutaneous endoscopic gastrostomy) was developed in May 1979 by Ponsky and pediatric gastroenterologist Mike Gower, with the first five cases performed on babies with birth asphyxia and psychomotor retardation.

The PEG procedure was developed without IRB approval, only discussing the approach with patients' families.

Ponsky became chief of surgery at Mount Sinai Hospital at age 32 in 1979.

Mount Sinai Hospital had an animal laboratory that was larger than Cleveland Clinic's laboratory, providing Ponsky freedom to conduct courses and train fellows.

The distal splenorenal shunt, once considered a great operation based on physiology to reduce variceal pressure without decreasing portal flow, became obsolete when endoscopic variceal banding was introduced.

Ponsky performed 180 vertical banded gastroplasties in one year in the mid-1980s, an operation that later required reversal in many patients.

Ponsky performed 1,600 colonoscopies in a single year during his practice.

ERCP was developed primarily in Japan by Itaru Oi and colleagues, with contributions from German physicians and Peter Cotton's group in London.

Ponsky learned ERCP primarily through watching videos and self-teaching, then traded training with George Brodmerkel in Pittsburgh—teaching him laparoscopy under local anesthesia in exchange for learning sphincterotomy.

Early SAGES meetings focused on surgical problem-solving with endoscopy, addressing topics like managing bowel obstruction, evaluating suture lines, and treating intestinal volvulus endoscopically—distinct from ASGE's focus.

Ponsky advocated to the Residency Review Committee (when Joe Fisher was head) for a minimum endoscopy requirement in general surgery training. The initial requirement of 50 cases was controversial but established endoscopy as a required component of general surgery.