Article, Research and Innovation

How One Doctor’s ‘Crazy Idea’ Made an Invasive Test Much Easier

September 24, 2019

With support from the Center for Innovation, Dr. Joel Friedlander pioneered a new way to do nasal endoscopy tests on kids that eliminates the need for sedation. Now he's sharing his invention with pediatric providers across the country to help thousands of children avoid anesthesia.

Dr. Joel Friedlander comes from a family of tinkerers. He vividly remembers spending many days of his youth building model cars with his father and grandfather. As a teenager, he built a radio station, although the frequency traveled only about three blocks, he admits with a laugh.

“I love to play around with things,” Dr. Friedlander says. “My wife jokes that when I go to sleep, my brain doesn’t turn off.”

As a pediatric gastroenterologist with an inventor’s mind, it’s not surprising that Dr. Friedlander would look for new, better ways to care for his young patients at Children’s Hospital Colorado.

“Innovation is important because medicine is not just about working within the parameters of what we know. It’s also about thinking outside the box,” he says.

Asking ‘Why Not?’

Many of Dr. Friedlander’s patients have a condition called eosinophilic esophagitis (EoE), which is chronic inflammation of the esophagus triggered by food allergies. Patients with EoE experience a range of symptoms including failure to thrive, abdominal and chest pain, and feeding or swallowing issues.

Currently, there is no cure for EoE, and patients require lifelong monitoring. Diagnosis and subsequent monitoring of EoE require an endoscopy of the upper gastrointestinal tract. Performed under heavy sedation or anesthesia, the procedure entails inserting a tiny camera and biopsy tool down a patient’s throat. Although necessary for EoE patients, the procedure is costly, must be done frequently and, due to sedation, it comes with additional risks and time spent at the hospital.

Adults with EoE are able to receive a nasal endoscopy, in which the scope is inserted through the nose instead of the throat, so it can be performed without sedation. Unfortunately, nasal endoscopy imaging tools were always too big for pediatric use — that is, until Dr. Friedlander’s self-described “crazy idea.”

Building a Better Endoscopy for Kids

“I’m in the operating room with ENTs and pulmonologists every week,” Dr. Friedlander says. “We noticed that we all have different pediatric scopes that are used for different things. Our team realized that we could take an ENT technique and use a pulmonary scope to fulfill our EoE patients’ endoscopy needs. The idea just grew from working together.”

This new approach, officially called transnasal esophagoscopy/endoscopy with biopsies, was pioneered by Dr. Friedlander, along with his colleagues Dr. Robin Deterding, Dr. Emily DeBoer and Dr. Jeremy Prager. With the new technique, patients receive a numbing nose spray in the clinic. Then they slip on a pair of virtual reality goggles to distract them while a caregiver gently glides a tiny camera and biopsy tool within a flexible scope through the nose, into their esophagus. The pioneering procedure has been validated through patient trials at Children’s Colorado.

The procedure takes about eight minutes, dramatically cutting costs. And with no anesthesia, it reduces what was a full day at the hospital down to a one-hour appointment, so children can often return to school the same day. These improvements have made a tremendous difference for patients like Haylie, who requires frequent endoscopes but is allergic to anesthesia.

“It has worked out amazingly,” says Michelle Nielsen, Haylie’s mom. “It obviously saves us from the worry of going under. It’s so fast.”

So far, doctors from more than a dozen other hospitals around the country have traveled to Children’s Colorado to learn the new endoscopy technique and bring it back to their patients.

How does the transnasal endoscopy improve care for kids?

1 hour

average time from admission to discharge compared to 4 hours for a sedated endoscopy


the cost of sedated endoscopy

2 hours

without eating instead of 10 hours of food restrictions with general anesthesia

Making the Impossible, Possible

While the new technique was successful, it was initially “piecemealed together” with existing tools. Further improvements meant creating an entirely new device — one that could be brought to market to improve care for children around the world.

Fortunately, Dr. Friedlander and his colleagues had access to the Center for Innovation and campus partners at CU Innovations. With their support and mentoring, Triple Endoscopy, Inc., was founded in 2017 to manufacture and market the new device and procedure.

Triple Endoscopy plans to commercially launch its first medical device, described as a turn-key system that includes an improved pediatric endoscope, a transnasal endoscope distraction system and all the necessary software, by the end of 2020.

“It’s incredible to be a part of this with my team and all that we have learned through the Center for Innovation,” Friedlander says. “We’re making the impossible, possible.”