Pavmed Inc., a commercial-stage medical technology company, announced it has signed a non-binding letter of intent (LOI) to license a novel endoscopic esophageal imaging technology developed at Duke University. The agreement, executed through a newly formed subsidiary, grants Pavmed exclusive worldwide rights to the intellectual property underpinning the platform, which is designed to transform the detection and treatment of esophageal precancer (dysplasia).
The technology combines angle-resolved low coherence interferometry (a/LCI) with optical coherence tomography (OCT) into a single multimodality probe, offering a powerful tool for real-time, in vivo evaluation of precancerous changes in the esophagus during routine upper endoscopy.
Tackling a high-burden disease
Esophageal cancer remains among the deadliest malignancies, with poor survival rates largely due to late-stage diagnosis. The progression from Barrett’s esophagus to high-grade dysplasia and ultimately adenocarcinoma is well characterized, but current surveillance methods—particularly random forceps biopsies—are time-consuming, resource-intensive, and prone to sampling error.
Pavmed believes the Duke-developed technology could provide a safer, faster, and more effective alternative to traditional biopsies, enabling gastroenterologists to detect and treat dysplasia earlier, when interventions are most effective.
A foundation in pioneering optical science
The core a/LCI platform was developed by Dr. Nicholas Shaheen, a recognized leader in esophageal disease, and Dr. Adam Wax, an expert in biomedical optics.
a/LCI measures nuclear morphology, a key indicator of dysplasia, with high sensitivity.
OCT provides cross-sectional images of tissue microstructure, allowing for precise anatomical localization.
Integrated together, the system delivers both molecular and structural insights in real time.
Dr. Shaheen has described the technology as capable of “fundamentally transforming” esophageal precancer detection, citing its potential to improve patient outcomes, enhance procedural efficiency, and optimize healthcare resource utilization.
Clinical validation to date
Early clinical studies demonstrated the standalone power of a/LCI:
100% sensitivity for detecting precancerous changes.
88% overall accuracy, significantly reducing false negatives.
More recently, a pilot study using the integrated a/LCI+OCT probe showed comparable sensitivity with improved specificity, further validating the promise of this combined imaging approach. These results suggest the system could minimize unnecessary biopsies while improving diagnostic confidence, a key advantage for gastroenterologists and patients alike.
Strategic fit with Pavmed’s esophageal portfolio
For Pavmed, the deal builds on its growing franchise in esophageal disease, particularly through Lucid Diagnostics, its majority-owned subsidiary focused on noninvasive early detection of esophageal precancer and cancer. Lucid’s EsoGuard DNA test is already marketed for identifying high-risk Barrett’s esophagus patients before they progress to advanced disease.
By adding the Duke-developed endoscopic imaging technology, Pavmed creates a complementary suite of toolsspanning:
Screening and early detection (EsoGuard)
Real-time diagnosis and staging (a/LCI+OCT)
Treatment and surveillance (potential integration with endoscopic ablation therapies)
This integrated approach could streamline the entire patient care pathway, from identifying at-risk individuals to confirming disease and guiding intervention.
Leadership perspective
Pavmed chair and CEO Dr. Lishan Aklog emphasized both the clinical and commercial potential of the partnership:
“Widespread EsoGuard adoption is expected to significantly increase the number of patients diagnosed with esophageal precancer. The exceptional performance of this technology to date promises to make the evaluation and treatment of these patients more streamlined, timely, and effective in preventing progression to cancer. Its significant clinical and commercial potential should attract strong interest from strategics active in the endoscopic ablation space.”
Aklog also highlighted how the deal aligns with Pavmed’s subsidiary-driven model, where independently financeable units share a centralized infrastructure. This structure has already proven successful with Lucid and provides a framework for scaling new ventures efficiently.
A compelling academic–industry partnership
The agreement reflects a broader trend of academic commercialization in MedTech, where university-developed innovations are increasingly licensed to industry partners with the resources to bring them to market. For Duke, the deal validates years of translational research in biomedical optics. For Pavmed, it provides a pipeline of proprietary innovation in one of the most critical areas of gastroenterology.
Competitive landscape: Pavmed targets esophageal imaging with Duke-licensed platform
The licensing of Duke University’s a/LCI+OCT endoscopic imaging technology places Pavmed into a highly competitive but rapidly evolving market: esophageal disease detection and treatment. While endoscopy remains the standard of care for surveillance and diagnosis, limitations in sensitivity, specificity, and workflow efficiency have left room for disruptive solutions. With this move, Pavmed positions itself against established MedTech players like Olympus, Fujifilm, and Medtronic, while also complementing its own Lucid Diagnostics platform.
Current standards: biopsy-driven endoscopy
The gold standard for evaluating Barrett’s esophagus and suspected precancer remains upper endoscopy with random forceps biopsies. However, this approach suffers from well-documented drawbacks:
Sampling error: Dysplasia is often patchy, meaning biopsies can miss areas of disease.
Time-intensive procedures: Multiple biopsies extend procedure time, adding to resource burden.
Patient discomfort and risks: Biopsies increase bleeding risk and procedural complexity.
Cost implications: Repeated surveillance endoscopies and biopsies drive significant healthcare costs.
These limitations have spurred the search for advanced imaging technologies capable of detecting precancerous changes in real time without heavy reliance on random tissue sampling.
Major players in endoscopic imaging
The esophageal imaging space is currently shaped by leading MedTech companies offering enhanced visualization tools:
Olympus: Dominates the global endoscopy market with advanced systems such as Narrow Band Imaging (NBI), which improves visualization of mucosal and vascular patterns.
Fujifilm: Offers Linked Color Imaging (LCI) and Blue Light Imaging (BLI), both designed to enhance contrast and assist physicians in spotting dysplasia.
Medtronic: Acquired Covidien’s GI portfolio and has focused on integrating AI-assisted endoscopy, where machine learning algorithms analyze real-time images to flag abnormalities.
While these technologies improve visualization, they do not directly measure cellular or structural changes the way Duke’s a/LCI+OCT probe does. This distinction may allow Pavmed to position itself as providing functional, rather than purely visual, diagnostic insights.
Pavmed’s differentiator: real-time cellular assessment
Unlike narrow-band or color-enhanced imaging systems, Pavmed’s platform delivers quantitative assessment of nuclear morphology and tissue microstructure. This represents a shift from visual interpretation toward objective, data-driven diagnosis.
Key advantages include:
High sensitivity and specificity demonstrated in clinical studies.
Reduced need for biopsies, potentially lowering procedural time and cost.
Integration with treatment workflows, allowing endoscopists to identify dysplasia and proceed directly to ablation if indicated.
If successfully commercialized, this could streamline care pathways and appeal to physicians who want greater diagnostic confidence without increasing complexity.
Strategic fit with Lucid Diagnostics
Pavmed’s strategy appears designed to create a vertically integrated esophageal care ecosystem:
Lucid’s EsoGuard DNA test identifies at-risk patients noninvasively, enabling earlier diagnosis of Barrett’s esophagus.
The Duke imaging technology could then confirm and stage dysplasia during endoscopy with high accuracy, reducing reliance on biopsies.
Endoscopic ablation therapies (from third-party companies like Medtronic and Boston Scientific) could follow immediately, guided by the real-time imaging data.
This “screen-to-diagnosis-to-treatment” continuum strengthens Pavmed’s ability to address esophageal precancer comprehensively while offering hospitals a more efficient care model.
Commercial opportunity and challenges
The U.S. sees an estimated 3 million patients with Barrett’s esophagus, many of whom require regular surveillance. With 60,000 new esophageal cancer cases annually, the potential addressable market for improved detection tools is significant.
However, Pavmed must navigate several challenges:
Regulatory clearance: While the LOI grants rights, successful commercialization will require FDA approval, which depends on rigorous clinical validation.
Clinical adoption: Physicians familiar with Olympus or Fujifilm systems may need convincing to adopt a new platform, particularly if integration into existing endoscopy towers is complex.
Reimbursement pathways: Pavmed will need to establish coverage for the imaging procedure, potentially linking it to cost savings from reduced biopsies.
Competitive response: Major players could accelerate their own AI or multimodal imaging programs to counter Pavmed’s entry.
Strategic outlook
Despite these challenges, Pavmed’s move is strategically differentiated. By securing worldwide exclusivity on Duke’s technology, the company now holds intellectual property with the potential to set new performance benchmarks in esophageal imaging.
If integrated successfully with Lucid’s EsoGuard platform, Pavmed could create the first end-to-end esophageal precancer solution that addresses:
Who should be screened (EsoGuard).
How precancer is confirmed (a/LCI+OCT).
How treatment is guided (partnerships in ablation).
This synergy could make Pavmed not just another competitor in endoscopy, but a category creator in esophageal disease management, capable of reshaping standards of care and attracting partnerships with larger strategics in the endoscopic ablation space.
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