Putting AI in GI with Giovanni Di Napoli

May 19, 2021

Giovanni Di Napoli, president of Medtronic’s gastrointestinal business, walks us through his path from the basketball court to the medtech industry. In this discussion he shares the company’s vision for delivering less invasive diagnostic and treatment tools to make diagnosis and treatment much easier for patients.

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Tom Salemi (00:00):

Hey everyone, this is Tom Salemi of DeviceTalks. Welcome to our newest member of the DeviceTalks podcast family, it's called MedtronicTalks. Our constant search to find new ways to bring you insights in the med tech industry led us to the fine, fine folks at Medtronic. They've agreed to make their senior leaders available to us, and to you. In each episode, we'll discuss the opportunities and challenges facing one of med tech's clear leaders, so you'll have an inside view on what makes Medtronic go. We'll ask the questions, Medtronic will provide the answers and our great network of sponsors makes it all possible. So sit back, hop on a treadmill, take the dog for a walk, whatever you do when you listen to a great podcast, and let's listen to how Medtronic is getting the job done, let's go.

Tom Salemi (00:45):

Hey everyone. This is Tom Salemi, welcome back to the MedtronicTalks podcast. Today, we're going to speak with Giovanni Di Napoli. He is the President of the Gastrointestinal business. Interesting origin story from Giovanni, and of course the Gastrointestinal business is building out a really exciting pipeline. So anxious to have you hear this interview, but first let's hear from John Kawola, he is the CEO of Boston Micro Fabrication. John, tell us what BMF does.

John Kawola (01:13):

BMF is an additive manufacturing company. It was started in 2017 and we started this company to address a problem, and an opportunity that we see out there in the market for companies that typically make parts that require very high tolerance. And when I talk about high tolerance, I mean, plus or minus tens of microns. These can be larger parts, but they tend to be smaller parts in general, parts that are sort of on the millimeter scale. This is in medical device, this is an electronics, this is in photonics and optics, and 3D printing has been around for 30 years, but there hasn't really been a technology to date that can effectively prototype at that scale. More interestingly, companies are looking to think beyond prototyping and look at additive manufacturing as an alternative to what they're using today for manufacturing. So that's really what we're all about, and we're out there, we commercialize the technology, started selling to getting systems in the field, making parts for customers in early 2020.

Tom Salemi (02:14):

We'll hear more from John Kawola in just a few minutes. Now let's get into our interview with Giovanni Di Napoli, the president of Gastrointestinal at Medtronic. Well, Giovanni Di Napoli, welcome to the podcast.

Giovanni Di Napoli (02:27):

Thank you very much, Tom. I'm very happy to be here with you, and thanks for the invite.

Tom Salemi (02:31):

My pleasure, exciting times for the gastrointestinal business. And I want to talk about GI Genius™ in a little while, but first I'd love to understand what's your path into med tech. You started out, I think with J&J. How did that first job come to be?

Giovanni Di Napoli (02:48):

Yeah, actually it was a very unique coincidence because I was not planning to join med tech. I was happy in coaching basketball in Italy at that time.

Tom Salemi (02:59):

Oh, really?

Giovanni Di Napoli (03:00):

Yeah. I was assistant coach in first league, in Livorno, which is a city close by Florence, in first league, and I had a fantastic year, had a blast, because we also won the championship and we got to be the number one team in Italy, and it was an experience. But the same year, I also finished my economics degree and by just looking for some opportunities with my study, I came into these Ethicon Endo-surgery job based in Rome. They were looking for a sales rep, I said, "You know what, let me give a try, and see if my CV with my study would make any sense for them." And just few days after, I got the call for an interview, and I just wanted to challenge myself. I went down, in Rome I met the county manager of Ethicon Endo-surgery, and I loved the energy and what they were planning to do. They had a unique project called, I think it was Baselink, which is actually something very, for that time, very innovative. That was in consignment. That was 2001. So you can imagine was early days on the internet.

Giovanni Di Napoli (04:16):

Yeah. So I went through the interview and a couple of days after they called me back because they wanted me to join, and it was a very tough decision to leave what I did for 20 years, which was play basketball and coaching basketball. And I just made a decision, and I don't regret it. I think I'm very, very happy, and still watching basketball. I have a lot of friends, but enjoying this work, enjoying med tech.

Tom Salemi (04:44):

What was the deciding factor to make that change? That is a big change. I mean, I guess you could look at basketball as being a career that you perhaps expected wouldn't always be part of your life, or the main part of your life, or was this really a for you a big decision to say no more to that and to focus on something else?

Giovanni Di Napoli (05:03):

I think the first time I met in J&J inspired me. The value and the credo of J&J also inspired me. My dad also used to be a nurse, and so there is some background once in my family helping patients. So I just loved the culture, this leader, and I also felt like this might be a very good opportunity for me, and also wanted to challenge myself even more. So it was not easy at all. I really had a couple of rough weeks, when I was back and forth, should I stay in basketball? Because I was still in a good position to succeed, I was young, and I was able to potentially also move up in other teams in Italy. But I think I was driven by my heart, by my passion that I found in J&J at that time.

Tom Salemi (05:54):

That's great. I think we've all... That's one of the things I enjoy about these podcasts is talking to everyone about those moments, because I think we've all had them. Your moment I thought was going to come a little later, when you joined Barrx from J&J leaving, a big company for a small company, how did you come to work at that very cool startup in the gastrointestinal space?

Giovanni Di Napoli (06:14):

Yeah, so it was maybe seven years into J&J, and I was managing the business in Italy. I moved from a surgical division to endovascular, to cardiovascular head leadership position in Italy. And I wanted to get out of the country. I want you to be able to also experience Europe, and more challenges across the European market, and J&J at that time, they had not that many position open. So what I did, I said, "You know what, I'm going to study." I used this time to study, and I took the opportunity to go through an MBA at the Bocconi University in Milano. So I went out for a loan with a bank, got the money, and financed myself through the MBA, and was two years, very intense. We also got the first baby with my wife during this MBA.

Giovanni Di Napoli (07:07):

And then at the end of the MBA, there was a head hunter that was fishing for med tech experience, and I was the only one in the class, because you can imagine were engineers and the consumer people, I was the only one from med tech and the so I was very, very happy to be able to talk to this head hunter. And he had two options, so Boston Scientific with Watchman. And the second one was actually Barrx, which was a small company, no revenue. I got to know, again, another strong leader. I interviewed with him and I saw some very strong clinical paper on the device, and with my wife, we were able to get to a decision that was a risky one at that point in time, but again, with this decision, I'm able to now talk to you and sitting in this position, everything started from there.

Tom Salemi (07:59):

That's amazing. Did that bring you to California? Did you work at Barrx HQ or did you work for them in Europe?

Giovanni Di Napoli (08:07):

I'm now sitting where the CEO of Barrx was sitting in the same office, which is actually pretty-

Tom Salemi (08:10):

Oh really?

Giovanni Di Napoli (08:12):

Yeah. But I was, yeah, I was in Europe, was able to manage the European business. So we started from scratch. I was based in Rome, but managing European business, so I think for the first three years I took like 200 flights every year. Yeah. It was like crazy traveling, opening new accounts, and expanding the technology across the European markets. And then Covidien came with the acquisition of Barrx, and Given Imaging came with acquisition of PillCam™, and I was able to stay because Covidien didn't have experience in GI, and at that point I really was able to build a lot of relationship across the European markets. And I managed the acquisition of even integration. And then what happened was, the dream of being in the US was still always in my mind, and a new position became available in the US as vice president of sales, it was 2014.

Giovanni Di Napoli (09:08):

And what happened, at the time I sent a text to the general manager of the business, Vafa Jamali, and I said, "Have you thought about me about this job?" And I didn't get any answer for a week, which was very frustrating. So I said, "Okay, maybe it's not for me. I come from Europe, I don't know the US market. So maybe it's not the job for me." But a week after I sat down in front of my laptop, and sent him an email explaining why I was the right person for this job, and sent the email, that was Saturday night, Italian time, and so it was early in morning here in California, and he answered very quickly, "Nice!"

Tom Salemi (10:01):

Now let's take a quick break from this interview with Gio Di Napoli to hear a little more from our sponsor Boston Micro Fabrication, John Kowala is the CEO. John, what makes BMS approach unique?

John Kawola (10:12):

So 3D printing has been around for 30 years, and there's a number of different sort of core technologies that have been developed from extrusion, to photopolymers, to metals, powders. We're different, really, than anything that exists on the market today, we've taken a general concept, that's used with some other manufacturers, and we're using a photopolymer process, but we've added a number of different components and features. One is a high precision lens, two is a very highly controlled XYZ movements, because people care about resolution, but they also care very much about accuracy and precision. And that's what really makes us different from what's available on the market today.

Tom Salemi (10:50):

That's great. And final question, John, where does this all fit into gastrointestinal and medical devices?

John Kawola (10:57):

Because we're addressing needs in the marketplace for high precision accuracy. Again, that falls into a bunch of different vertical markets, but medical device is very much an area that is looking to miniaturize, whether that's drug delivery devices, whether that's monitoring devices, these are all areas that medical device manufacturers have been chasing for years to be able to get things smaller, to be able to miniaturize things like sensors and diagnostic devices are all getting smaller, lenses are getting smaller, but what is challenging is often the packaging and the plastic components on the polymers that sort of house those components.

John Kawola (11:37):

So what we're finding is a real need for addressing that drive to miniaturization. A very good example is endoscope heads, so that is sort of the tip of an endoscope. Typically it's a very complex small part, with holes and features on both sides of the part, challenging to mold, expensive to mold, endoscope heads are a very good example of something that's also a consumable item, typically use it once for a procedure. So that's very well within the reach of what's capable of that additive manufacturing. So we have a number of different companies looking at this and saying, one it's ideal to prototype, but two, to really looking for this as an alternative to current manufacturing methods, which is primarily injection molding, again is expensive, and time consuming, and 3D printing could potentially be a nice alternative.

Tom Salemi (12:29):

All right, thanks again to John Kowala and BMF for sponsoring this podcast. Again, go to bmf3d.com for more information.

Giovanni Di Napoli (12:41):

I sat down in front of my laptop and sent him an email explaining why I was the right person for this job, and sent the email, it was Saturday night, Italian time, and so it was early in the morning here in California, and he answered very quickly, "Nice!" So, which made me feeling okay, the job is still open, and I can try to get it. And a few weeks after I flew to Boston and met a few executives, and went through the interview process, and then in October, I signed a contract and moved to the US in January.

Tom Salemi (13:15):

Fantastic. I love those details, those moments when you decide to act and it pays off, and if you hadn't sent that email, who knows. So you've been in the gastrointestinal space for a long time. Talk to me about, about what you like about this market. I think it's one that has an amazing amount of innovation going on with things like GI Genius™ that we'll talk about, but we talked about the swallowable cameras, you've got that as well. There is a lot of innovation in the space, I don't know if though, if it gets the attention that others do, like cardiac. People don't recognize all that's going on in this space. What do you like about gastrointestinal?

Giovanni Di Napoli (13:55):

I love this space because it's the most minimally invasive procedure in my opinion, available in med tech, right? So you can do many, many different things just going through the endoscope. In most of the cases also you don't require sedation in some procedures, so I knew that this space would have been growing over the last 10, 15 years. So technology evolved, and also skills of the endoscopist evolved. And the idea for me was to understand how these technologies and this part of med tech was going to be, and that's the reason why the last four years, I spent a lot of time understanding also the strategy, and where actually this GI business could be, especially in Medtronic.

Giovanni Di Napoli (14:48):

To me, the big take is that we want you to build a care continuum, right? So if you think about our business in Medtronic, we used to be PillCam™ and Barrx, so that was basically the acquisition of Covidien. It was PillCam™ and Barrx, and then Medtronic came, and we were still seeing as, okay, Medtronic is not investing in GI, so this is the result of the acquisition of Covidien, and so now what?

Giovanni Di Napoli (15:18):

And I could talk to many different endoscopists across the world, and they were not really believing in Medtronic. So they were not even thinking about Medtronic being a GI company, so that's where we had to make a turn around in terms of portfolio. So we could not be any more seen as a PillCam™ company, because PillCam™ is big, it's an important technology, but the opportunity is to go through this care continuum, once you diagnose a disease was very important, very, very real for us. And that's where we started to shop around, and also to develop internally technologies that can make difference now, because we want to be in this space, and we are actually in a good position to do that.

Tom Salemi (16:05):

Talk to me for a moment about the GI specialty, are the physicians in this specialty quick to adopt new technology, or are they tough to convince?

Giovanni Di Napoli (16:14):

I used to work in cardiology and radiology, and it's night and day. So they're much more aggressive. I do remember when I used to work for J&J, for Cordis when we launched CYPHER stent, it was a quick adoption and GI's are different - much more conservative. They need to have one more study all the time. They are slow adopters, so it's not easy, but they're very loyal, which means when they buy into technology, because there is clinical evidence, then they really dig into it. And actually, that's actually a good piece for us. That's the reason why we wanted to build a portfolio that had enough clinical evidence, and the right clinical evidence, to show patient outcome and the benefit of our devices.

Tom Salemi (17:03):

So it's an interesting point, and just looking at the way that GI technology is covered, I think there's a stronger connection with the patient, as well. I think as someone reading about this technology, you can sort of... I don't know, you seem to have a tighter connection to this technology than you might with the cardiac and stuff, which seems out of your experience a bit, but if you're a potential user of, or a patient in which an endoscope like this will be used, you can connect with it more. You can understand why a PillCam™ can be more beneficial, you can understand why a more accurate colonoscopy is going to benefit you. There just seems to be a real, tangible connection with patients and with med tech. Do you sense that as well, or am I reaching?

Giovanni Di Napoli (17:44):

I do. Because most of these disease that we manage, we diagnose, we treat, are very common, right? So they live with you, right? Reflux, colonoscopy, CRC, liver. So all of these potential issues that we face in our daily life, right? So that's the reason why the goal was also for us to get to the point where we can simplify diagnosis, get diagnosis earlier, and treat these diseases earlier to prevent progression, progression to cancer, progression to even more tougher diseases.

Tom Salemi (18:17):

That's great. Well, let's first focus on the new GI operating unit. What does that look like? And has your philosophy, your approach, changed to growing this business now that you're sort of the head of this new group?

Giovanni Di Napoli (18:34):

Somehow no, the reason why is because we used to be in a nice space, even before this new operating model, which means we try to be always nimble, agile, even in the old Medtronic. I give you an example, I was already managing the US business directly, and I was the exception across Medtronic. That was because of the early days with Covidien and post-acquisition, we were able to maintain the ownership of the business in the US, so this hasn't changed. We were also able to globalize the company even more than what we were supposed to, because relationship wise, we were able to build a strong relationships with many key opinion leaders across the globe, from the US. I come from Europe, I know the European market upside down, I spent five years managing sales in the US, and so I know very well, key opinion leaders in the US. All of these key opinion leaders, every relationship with Chinese key opinion leaders, Japanese key opinion leaders, south America.

Giovanni Di Napoli (19:37):

So it's a small community that we were able to build and bring forward all together. Now, what has changed, for sure, is the pace. I can't thank Geoff enough for this change, because I can see there is a huge upside for us now to move even faster. That's actually really changed a lot, owning the business now in the region gives us also accountability, decision-making, and also understanding better where to invest, how to invest, and how to improve our ROI in many of these projects we have going on. Including also BD, including also technologies, which are coming to market now.

Tom Salemi (20:18):

Will you be investing more in new technologies or earlier stage companies that are developing new technologies with this sort of newfound freedom, or at least reinforced freedom?

Giovanni Di Napoli (20:31):

The space we are now in GI, the portfolio we built in the last three years is very solid, it's very innovative. I'm saying this not because of my position, I know I'm biased, but if you talk to GI's across the globe, now they see Medtronic being the most innovative company in GI. If you look at our portfolio versus other companies, clearly we have made huge progress in terms of helping our customers to improve performance and patients' outcome, in many different areas. I mean, the latest one is AI with GI Genius™. You just mentioned this a couple of times, so we knew this two years ago when we wanted to get into AI, not only with GI Genius™, but also with other technologies across the portfolio. So I would say right now, our focus is execution, so we have a very robust portfolio.

Giovanni Di Napoli (21:23):

We can drive business faster and faster than before. Clearly also we want to complete our portfolio with additional technologies, which are very important and complementary to what we do. It's a mix of BD, but also internal development. We have the opportunity also, and the honor to have engineers in Silicon Valley, in Israel, and also in Ireland. So three major hubs of innovation globally, and we're using them in a way that it makes sense. They work together, we have big projects, and we don't go beyond what we can, so we pick and choose the one that can make a big difference in the market and also in the patient's outcome.

Tom Salemi (22:07):

Well, let's talk a bit about GI Genius™, like you said, I've mentioned it a few times already. Tell us what it's able to do and what does a rollout look like? Because this, I mean, this is the kind of thing where a patient reads the article in Wired and says to themselves, "When I have this procedure done, I would very much like them to use this because it just seems like it will be much more accurate." Is there an effort there to really, to reach out to those types of patients in marketing this sort of system?

Giovanni Di Napoli (22:34):

So what we want to do now and what we're doing now, since the approval from last week, is to really go into our market with our customers, let them know what this technology can do, why it is really strong, and really the best. I told my team a couple of times to remember three things. First, AI technology approved in the US, best because we have a randomized control trial that proved this technology to be working very, very well. And must - must because it's a must have in our portfolio to fight CRC.

Giovanni Di Napoli (23:06):

We have a series of technologies also to treat colon cancer and GI Genius™ is going to have to identify these lesions earlier. So first, best, and must. The strategy is to go top down for sure, with our GI customers, but also help patients understanding why AI can also benefit this procedure. So we're not going to go aggressively on patients, but they will know, because this is now common in med tech, and I think the more they will see AI, I see a future where colonoscopy needs to be performed with AI-assisted technologies. That's maybe a place where in two or three years, we should be able to be.

Tom Salemi (23:52):

And what about the smart pill technology? Is that something that's going to displace colonoscopy? Or is it more of an additive, or is it to complement it?

Giovanni Di Napoli (24:02):

My vision is that in the next 10 years, colonoscopy is going to become only therapeutic. So you basically go for a colonoscopy when there is something to be removed. There will be a variety of different tests. You have a FIT test, you have DNA test, you're going to have also liquid biopsy, and also you will have pill camera. It depends on the type of patients and background, and also family history. Some of these options that would be maybe better fit for some of these patients, but the colonoscopy procedure is invasive for a screening test. So clearly GI's know that this is going to change in the next 10 years. I remember a couple of years ago, a GI saying in a conference that if you don't get into therapeutic as an endoscopist, you will lose your job because colonoscopy is going to move into therapy more than screening.

Tom Salemi (24:56):

And how about some of the other screening that's going on using fecal tests and such? Is there an opportunity for Medtronic to work there or is that a different business entirely?

Giovanni Di Napoli (25:07):

Well, we are focusing on PillCam™. I think what we believe, miniaturization is very important, if you think about DNA and FIT, it's going to be an answer yes or no, but you don't know where the lesion is going to be located, and how this lesion will look like. So the value of PillCam™ is that you can visualize, localize, and size the lesion. So that's where actually we believe the benefit of a camera into your colon, taking pictures and showing also these outcome to the GI before you go for a therapeutical colonoscopy is going to help also the therapy afterwards.

Tom Salemi (25:46):

Makes sense. So, looking forward, where does your growth come from? You've had your financial performance. It looks like you had some growth over this period of time. I guess my first question would be, how were you impacted during COVID? Because I imagine a lot of people put off colonoscopies during this, but then, well, let's focus on that question, and then I'll ask about growth after that.

Giovanni Di Napoli (26:10):

Yeah. So yeah, COVID hit very hard on us last year for the first three months of the lockdown, many of these elective cases were canceled, including also some of these diagnostic tests were canceled and postponed. We were able to get out of this during the summer period of last year, now we're almost back to a pre-pandemic. There is a backlog of patients, which needs to receive also these treatments or diagnoses. I don't know if you read the article, but a few weeks ago they mentioned that 87% of people who were supposed to get screening colonoscopy, they skip it last year because of COVID. So this is a big problem because some of these patients they would have found the polyp or adenoma, and now, I mean, they're late to the screening. So that's the reason why there is a lot of effort from GI to offset this backlog with additional cases per day to make sure also they can recover this issue.

Tom Salemi (27:15):

No, I hadn't read that. That's a big number. So final question, where does your growth come from? I remember talking to Barrx before it was acquired by Covidien, I talked to the CEO. I know there was a lot of growth in China for what they're working on, but where do you see your growth in gastrointestinal coming from? Is it in US, OUS, both? What does the future look like?

Giovanni Di Napoli (27:37):

I think we are making a lot of efforts to globalize the business even more. I mean, think about China, GI diseases and cancer are very common, so we are not where we have to be yet. And we are really putting a lot of efforts to expand the portfolio, as well as our cyber footprint with our commercial organization. So China we'll say is number one priority. I think Europe, and also US are going to mean a lot for us, because Europe, we were able to also use this situation with Covid to help more patients, especially in the UK, I don't know if you read, but we had a couple of articles where the NHS is using actually our PillCam™ colon technology to offset the backlog of colonoscopy. Yeah. We get into an agreement with the NHS for a couple of years, which is very important to us. So Europe is going to be in a trajectory of growth because of the investment we made in the last two years. US, clearly we have a very robust portfolio and team, GI Genius™ could be a big one for us if we execute this well. But China and Japan, these two regions are critical to us, so if we want to double the business, this region needs to perform. That's actually where we're investing more than anything else.

Tom Salemi (29:01):

That was my final question, but I just have to ask you, if you've got a sign "Dream Big" behind you, I've been staring at it during the whole interview. I hope that's your office, I hope this is a good question, but what does that message say to you?

Giovanni Di Napoli (29:13):

That says to me, and also to my team, that we can become a very relevant to Medtronic, so we want to be the fastest growing business across the 20 [operating units]. And that's our goal, by doing this, we can help millions of patients worldwide with our technologies.

Tom Salemi (29:32):

Good message. All right Giovanni, I appreciate your taking a few minutes with us on the podcast. Thanks for joining us.

Giovanni Di Napoli (29:37):

Thanks to you. It was a pleasure.

Tom Salemi (29:42):

Thanks again to Giovanni Di Napoli for joining us on MedtronicTalks. If you'd like to hear other Medtronic stories, please go to Medtronic's website. You can find MedtronicTalks up there, or you can go to the devicetalks.com website, look for podcasts, and MedtronicTalks is featured prominently, right there. We have every episode up there waiting for you to listen. Of course, you'd be better off subscribing, so go to any podcast application that you can think of Google, Apple, Amazon, we're up there, and you can subscribe and get future episodes sent directly to you.

Tom Salemi (30:12):

Thanks again to Giovanni Di Napoli for joining us on the podcast, and thanks again to our sponsor Boston Micro Fabrication. If you enjoyed this podcast, please make sure you share it on social media channels, and you can find me out there. I'm on Twitter @MedTechTom, I'm on LinkedIn, Tom Salemi. Just connect me to any posting you do, I'd love to be part of that conversation. All right, folks, that's it. Tune in next time. We'll have another great episode of the MedtronicTalks podcast waiting for you.