Capsule Endoscopy- Future of Endoscopic Procedures

 What are the major shifts happening in the endoscopic procedures?

Endoscopy is a procedure in which a long flexible tube equipped with a camera is used to enter the human body to investigate unusual symptoms experienced in the esophagus, stomach, small portions of the small intestine, and the colon. This procedure can be very invasive, as it involves the insertion of an endoscope through a patient’s mouth or anus. Endoscopy equipment includes endoscopes, visualization systems, and other instruments that support endoscopic surgical procedures, and the accessories are used to ease the handling of instruments during surgeries.

Many existing methods of endoscopy can be very uncomfortable and potentially even painful for a patient. Using a conventional endoscope is also limited in its usable range, unable to access a majority of the small bowel. Recent advancements in LEDs (light-emitting diodes), optical design, and MEMS (microelectromechanical systems) technologies have provided the ability to create a wireless endoscope. Since its inception, the capsule endoscope has seen advancements in existing technology as well as the introduction of new components.

Capsule Endoscopy

Capsule endoscopy has played an important role in evaluating small intestinal lesions. Capsule endoscopy is recommended as the first-line test for obscure gastrointestinal bleeding. It is effectively used as a diagnostic tool for small bowel diseases such as Crohn’s disease, small bowel tumor, celiac disease, unexplained abdominal pain, and diarrhea.

Compared to conventional endoscopy, capsule endoscopy is a less invasive examination method that does not require sedation during the examination process and reduces the patient’s discomfort. In addition, it enables easy access to structures such as the small intestine that were previously difficult to access.

This technology is gaining momentum and has become the preferred choice for patients as it is a painless procedure for taking images of the esophagus, stomach, and small intestine. Although the actual procedure takes several hours, once the capsule is swallowed, it is possible to carry on normal day-to-day activities. The demand for capsule endoscopes is likely to continue in the coming years due to technological advances and an influx of new players in the market.

Recently, several new types of capsule endoscope have been developed, such as Olympus CE for the small bowel, PillCam ESO for investigation of esophageal diseases, and PillCam COLON for detection of colonic neoplasias.

Leading Manufacturers of Capsule Endoscopy

  TABLE 1                list of capsule endoscope manufacturers

Manufacturer	Capsule	Purpose
Medtronic (Ireland)	PillCam ESO 3	Esophageal Imaging
Medtronic (Ireland)	PillCam SB 3	Small Bowel (SB) Imaging
Medtronic (Ireland)	PillCam COLON	Colon Imaging
Medtronic (Ireland)	Agile Patency Capsule	Patency
CapsoVision (US)	CapsoCam Plus	SB Imaging
IntroMedic (South Korea)	MiroCam v2	SB Imaging
Medimetrics (a Philips Company, Netherlands)	IntelliCap	Sensory/Drug Delivery
Olympus (Japan)	EndoCapsul	SB Imaging
Quotient Clinical (England)	Enterion Capsule	Sensory/Drug Delivery
Chongqing Jinshan Science & Technology (China)	OMOM Smart Capsule	SB Imaging
RF System Lab (Japan)	Sayaka	SB Imaging
Check-Cap (Israel)	Check-Cap	SB Imaging

Sources: Company Website, Press Release, Investor Presentations, Expert Interviews, and other Secondary Sources.

The Pros of Capsule Endoscop

·         It can take pictures of the whole process down the gastrointestinal tract, including parts missed by other Endoscopy methods.

·         It’s painless and practically symptom-less. The capsule itself is the same size as a normal pill and after following the tract will pass in feces as normal.

·         It only take about 6-8 hours to get the data needed for a diagnosis and the camera can be tracked in real time allowing the team to know exactly where it is.

·         The images produced are high resolution

·         It takes two images every second

·         It is cost effective e.g., it costs around $500 compared to other endoscopy methods which cost $800 to $4000 and more

·         Provides ways of early diagnosis of diseases and conditions e.g., Crohn’s Disease.

·         It is less worrying and evasive than other methods, making it more comfortable for the patient.

·         Unlike traditional endoscopies there is no risk of damage to the tract and less risks of infections

Emerging trends in endoscopy

1.    Growing focus of hospitals to invest in technologically advanced endoscopy instruments and expand endoscopy units

n With the rising preference for minimally invasive procedures by patients and doctors, the number of hospitals providing endoscopy procedures has increased. Hospitals that already possess endoscopy equipment are also investing in new technologies and expanding their endoscopy units. This scenario is observed in all regions across the world.

n The following table showcases a few examples of investments by hospitals/government bodies in the endoscopy equipment market.

 

  TABLE 2                Examples of Investments by hospitals in endoscopy instruments

Month and Year	Investors	Description	Value
July 2022	Australian Capital Territory (ACT) Government	Government tends to invest in Canberra hospital to boost endoscopy services and to deliver an additional 900 endoscopies each year for the next two years	USD 5.7 million
May 2021	The United Lincolnshire Hospitals NHS Trust, UK	Invested to improve patient access to diagnostic imaging procedures, such as endoscopy	GBP 1.4 million
July 2020	Scottish Government, UK	Funded Raigmore Hospital Inverness, UK, to allow NHS Highland to place a temporary unit dedicated solely to endoscopy services and pay for additional staff to carry out the work	GBP 1.35 million
July 2020	Yarden Oakland Hospital S.A.	Invested to provide emergency services, bedding units, diagnostic imaging, tomography, magnetic resonance imaging, x-ray, ultrasound, densitometry, endoscopy rooms, adult and neonatal intensive care units, nursery area, operating rooms, and patient cafeteria and kitchen areas	USD 10 million
November 2019	Alexandra Hospital in Redditch, England	Invested in high-definition cameras and top-of-the-range optical technology for patients undergoing endoscopy procedures for gastrointestinal, respiratory, or urology-related conditions	GBP 4.2 million

Sources: Company Website, Press Release, Investor Presentations, Expert Interviews, and other Secondary Sources.

 

 

Investments by hospitals, especially from developed countries, to purchase technologically advanced endoscopy instruments and expand new endoscopy units, coupled with the establishment of new hospitals, are expected to boost the demand for endoscopy equipment in the next few years.

2.    Developing maneuverable systems

One important disadvantage of modern capsule endoscopy is its lack of maneuverability. Thus, clinically available systems depend on transportation by spontaneous gastrointestinal motility. Even in subjects with normal motility, transit time for different intestinal segments may vary considerably, and relevant segments may be passed too quickly. This probably explains why approximately 10% of all pathologies are overlooked during small bowel investigations.

Moreover, without maneuverable capsule endoscopes, the large inner surface of the stomach cannot be investigated properly. The most advanced approaches, which try to develop maneuverable systems for targeted inspection of the GI tract, use magnetic fields for steering of a videocapsule with magnetic inclusions. With such systems, preliminary clinical studies have already been performed.

Several magnetically controlled capsule endoscopes (MCCE) have been developed for the evaluation of gastric lesions, including NaviCam (ANKON), MiroCam-Navi (Intromedic), Endocapsule MGCE (Olympus and Siemens), SMCE (JIFU), and FAMCE (Jinshan).

3.    Adoption of artificial intelligence

Artificial intelligence (AI) is rapidly developing in various medical fields, and there is an increase in research performed in the field of gastrointestinal (GI) endoscopy. In particular, the advent of the convolutional neural network, which is a class of deep learning methods, has the potential to revolutionize the field of GI endoscopy, including capsule endoscopy (CE).

In the field of CE, automated detection of bleeding sites, ulcers, tumors, and various small bowel diseases is being investigated. AI in colonoscopy has advanced, with several patient-based prospective studies being conducted on the automated detection and classification of colon polyps.

How does the future look like?

The use of MEMS technologies such as the CMOS image sensor and other small technologies like the wireless radio-frequency transmitter has, in many ways, made the device more versatile than its conventional counterpart.

As technology has progressed, so have the capabilities of the capsule endoscope. Its novel, noninvasive, and safe approach towards endoscopy has made it popular amongst gastroenterologists. From the inception of the PillCam SB to the release of the current PillCam COLON 2, the capsule endoscope has seen improvements in resolution, view angle, frame rate, and power consumption. Future capabilities such as automated locomotion and targeted drug delivery could even further broaden the application of this device. Although it is not yet the ideal analytical device, continuous improvement and innovation upon the capsule endoscope will help it eventually become the first choice for all diagnostic procedures of the GI tract.

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