Ponsky and Gauderer invent the PEG tube

Flexible fiber optic gastrointestinal endoscopy began around 1958 when Hersowitz at the University of Michigan developed a method using glass fibers to transmit images.

In the 1960s, flexible endoscopy was used only for visualization of the GI tract without therapeutic interventions.

In the early 1970s, Shina, a surgeon in New York, developed the ability to remove polyps from the GI tract endoscopically.

Endoscopic polyp removal was significant because it enabled removal of polyps before they became cancer.

The chief of gastroenterology at Case Western Reserve University refused to train surgical residents in endoscopy in the early 1970s.

After completing approximately 500 endoscopy cases during training in Canton, Ohio, the speaker was again refused permission to participate in endoscopy training at Case Western Reserve because he was a surgeon.

By the end of residency, the speaker had displaced the gastroenterology service at University Hospitals through independent endoscopy practice using a personally owned endoscope.

Children with brain damage often required long-term feeding tubes.

The speaker and Michael Gauderer developed a technique to place feeding tubes endoscopically through the abdominal wall.

The PEG tube procedure was probably the beginning of minimally invasive surgery.

The speaker moved to Mount Sinai Hospital in 1979, almost 40 years before this presentation, and began performing PEG tube placement in adults.

Olympus, Ross Laboratories, and Eaton Laboratory all declined interest in commercializing the PEG tube when initially contacted.

Marlon Yonker owned a small endoscopy company called American Endoscopy and agreed to manufacture the PEG tube.

American Endoscopy was sold to Bard Endoscopy in 1986.

The PEG tube is now used and overused throughout the world.

The PEG tube was the first minimally invasive surgical procedure.

In the era of PEG development, innovators could directly contact company representatives who would work collaboratively in garages and laboratories to develop prototypes.

Modern medical device innovation faces greater challenges due to FDA regulations compared to the 1970s-1980s era.

The PEG tube has become a standard procedure.

Surgical endoscopy now includes procedures to divide muscles for achalasia, a condition where people cannot swallow.

Surgical endoscopy is used to treat Zenker's diverticulum, an outpouching of the esophagus causing swallowing difficulty.

Surgery is now performed through the endoscope.