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Thwaites PA, Yao CK, Halmos EP, Muir JG, Burgell RE, Berean KJ, Kalantar‐zadeh K, Gibson PR. Review article: Current status and future directions of ingestible electronic devices in gastroenterology. Aliment Pharmacol Ther 2024; 59:459-474. [PMID: 38168738 PMCID: PMC10952964 DOI: 10.1111/apt.17844] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/15/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Advances in microelectronics have greatly expanded the capabilities and clinical potential of ingestible electronic devices. AIM To provide an overview of the structure and potential impact of ingestible devices in development that are relevant to the gastrointestinal tract. METHODS We performed a detailed literature search to inform this narrative review. RESULTS Technical success of ingestible electronic devices relies on the ability to miniaturise the microelectronic circuits, sensors and components for interventional functions while being sufficiently powered to fulfil the intended function. These devices offer the advantages of being convenient and minimally invasive, with real-time assessment often possible and with minimal interference to normal physiology. Safety has not been a limitation, but defining and controlling device location in the gastrointestinal tract remains challenging. The success of capsule endoscopy has buoyed enthusiasm for the concepts, but few ingestible devices have reached clinical practice to date, partly due to the novelty of the information they provide and also due to the challenges of adding this novel technology to established clinical paradigms. Nonetheless, with ongoing technological advancement and as understanding of their potential impact emerges, acceptance of such technology will grow. These devices have the capacity to provide unique insight into gastrointestinal physiology and pathophysiology. Interventional functions, such as sampling of tissue or luminal contents and delivery of therapies, may further enhance their ability to sharpen gastroenterological diagnoses, monitoring and treatment. CONCLUSIONS The development of miniaturised ingestible microelectronic-based devices offers exciting prospects for enhancing gastroenterological research and the delivery of personalised, point-of-care medicine.
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Affiliation(s)
- Phoebe A. Thwaites
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Chu K. Yao
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Emma P. Halmos
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Jane G. Muir
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Rebecca E. Burgell
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Kyle J. Berean
- Atmo BiosciencesMelbourneVictoriaAustralia
- School of Engineering, RMIT UniversityMelbourneVictoriaAustralia
| | - Kourosh Kalantar‐zadeh
- Faculty of Engineering, School of Chemical and Biomolecular EngineeringThe University of SydneyCamperdownNew South WalesAustralia
| | - Peter R. Gibson
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
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Sun H, Liu J, Wang Q. Magnetic Actuation Systems and Magnetic Robots for Gastrointestinal Examination and Treatment. CHINESE JOURNAL OF ELECTRICAL ENGINEERING 2023; 9:3-28. [DOI: 10.23919/cjee.2023.000009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Affiliation(s)
- Hongbo Sun
- Institute of Electrical Engineering, Chinese Academy of Sciences,Beijing,China,100190
| | - Jianhua Liu
- Institute of Electrical Engineering, Chinese Academy of Sciences,Beijing,China,100190
| | - Qiuliang Wang
- Institute of Electrical Engineering, Chinese Academy of Sciences,Beijing,China,100190
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3
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Shi H, Pang S, Ming F, Yangdai T, Tian S, Lin R. A novel intelligent chromo capsule endoscope for the diagnosis of neoplastic lesions in the gastrointestinal tract. Gastroenterol Rep (Oxf) 2023; 11:goad021. [PMID: 37091502 PMCID: PMC10118998 DOI: 10.1093/gastro/goad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/25/2023] Open
Abstract
Background Chromoendoscopy has not been fully integrated into capsule endoscopy. This study aimded to develop and validate a novel intelligent chromo capsule endoscope (ICCE). Methods The ICCE has two modes: a white-light imaging (WLI) mode and an intelligent chromo imaging (ICI) mode. The performance of the ICCE in observing colors, animal tissues, and early gastrointestinal (GI) neoplastic lesions in humans was evaluated. Images captured by the ICCE were analysed using variance of Laplacian (VoL) values or image contrast evaluation. Results For color observation, conventional narrow-band imaging endoscopes and the ICI mode of the ICCE have similar spectral distributions. Compared with the WLI mode, the ICI mode had significantly higher VoL values for animal tissues (2.154 ± 1.044 vs 3.800 ± 1.491, P = 0.003), gastric precancerous lesions and early gastric cancers (2.242 ± 0.162 vs 6.642 ± 0.919, P < 0.001), and colon tumors (3.896 ± 1.430 vs 11.882 ± 7.663, P < 0.001), and significantly higher contrast for differentiating tumor and non-tumor areas (0.069 ± 0.046 vs 0.144 ± 0.076, P = 0.005). More importantly, the sensitivity, specificity, and accuracy of the ICI mode for early GI tumors were 95.83%, 91.67%, and 94.64%, respectively, which were significantly higher than the values of the WLI mode (78.33% [P < 0.001], 77.08% [P = 0.01], and 77.98% [P < 0.001], respectively). Conclusions We successfully integrated ICI into the capsule endoscope. The ICCE is an innovative and useful tool for differential diagnosis based on contrast-enhanced images and thus has great potential as a superior diagnostic tool for early GI tumor detection.
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Affiliation(s)
| | | | - Fanhua Ming
- Ankon Technologies Co., Ltd, Wuhan, Hubei, P. R. China
| | | | - Shuxin Tian
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
- Department of Gastroenterology, The First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang, P. R. China
| | - Rong Lin
- Corresponding author. Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, P. R. China. Tel: +86-27-85726085;
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He C, Wang Q, Jiang X, Jiang B, Qian YY, Pan J, Liao Z. Magnetic capsule endoscopy: concept and application of artificial intelligence. ARTIFICIAL INTELLIGENCE IN CAPSULE ENDOSCOPY 2023:217-241. [DOI: 10.1016/b978-0-323-99647-1.00009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Sun H, Liu J, Wang Q, Lai C, Chi W, Niu C, Wang L, Teng Z, Shi Y, Tian P. In vivo animal study of the magnetic navigation system for capsule endoscope manipulation within the esophagus, stomach, and colorectum. Med Phys 2022; 49:6813-6823. [PMID: 36087029 DOI: 10.1002/mp.15976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/PURPOSES Magnetic navigation capsule endoscopy (MNCE) is considered to be an important means to realize the controllable and precise examination of capsule endoscopy (CE) in the unstructured gastrointestinal (GI) tract. For the current magnetic navigation system (MNS), due to the limitation of workspace, driving force, and control method of the CE, only clinical application in the stomach has been realized, whereas the examination of other parts of the GI tract is still in the experimental stage. More preclinical studies are needed to achieve the multisite examination of the GI tract. METHODS Based on the MNS (Supiee) developed in the laboratory, an X-ray imaging system with magnetic shielding and a commercial CE are integrated to form the MNCE system. Then, in vivo GI tract experiments with a porcine model are performed to verify the clinical feasibility and safety of this system. Moreover, the effects of different control modes on the efficiency and effect of GI tract examination are studied. RESULTS Animal experiments demonstrate that with the MNCE system, it is convenient to achieve steering control in any direction and multiple reciprocating movements of CE in the GI tract. Benefiting from the flexibility of the three basic control modes, the achieved swing movement pattern of CE can effectively reduce the inspection time. It is demonstrated that the esophageal examination time can be reduced from 13.2 to 9.2 min with a maximum movement speed of 5 mm/s. CONCLUSION In this paper, the feasibility, safety, and efficacy of the MNCE system for a one-stop examination of the in vivo GI tract (esophagus, stomach, and colorectum) is first demonstrated. In addition, complex movement patterns of CE such as the swinging are proved to effectively improve examination efficiency and disease detection rates. This study is crucial for the clinical application of the MNCE system.
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Affiliation(s)
- Hongbo Sun
- Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Jianhua Liu
- Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Qiuliang Wang
- Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Chunxiao Lai
- Department of Gastroenterology, Baiyun Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenqiang Chi
- Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, China
| | - Chaoqun Niu
- College of Information and Communication Engineering, Faculty of Information Technology, Beijing University of Technology, Beijing, China
| | - Lei Wang
- Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Zhifan Teng
- College of Electrical and Information Engineering, Hunan University, Changsha, China
| | - Yang Shi
- School of Mechanical and Electrical Engineering, Xi'an Technological University, Xi'an, China
| | - Peilong Tian
- School of Mechanical and Electrical Engineering, Xi'an Technological University, Xi'an, China
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Abstract
In conventional classification, soft robots feature mechanical compliance as the main distinguishing factor from traditional robots made of rigid materials. Recent advances in functional soft materials have facilitated the emergence of a new class of soft robots capable of tether-free actuation in response to external stimuli such as heat, light, solvent, or electric or magnetic field. Among the various types of stimuli-responsive materials, magnetic soft materials have shown remarkable progress in their design and fabrication, leading to the development of magnetic soft robots with unique advantages and potential for many important applications. However, the field of magnetic soft robots is still in its infancy and requires further advancements in terms of design principles, fabrication methods, control mechanisms, and sensing modalities. Successful future development of magnetic soft robots would require a comprehensive understanding of the fundamental principle of magnetic actuation, as well as the physical properties and behavior of magnetic soft materials. In this review, we discuss recent progress in the design and fabrication, modeling and simulation, and actuation and control of magnetic soft materials and robots. We then give a set of design guidelines for optimal actuation performance of magnetic soft materials. Lastly, we summarize potential biomedical applications of magnetic soft robots and provide our perspectives on next-generation magnetic soft robots.
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Affiliation(s)
- Yoonho Kim
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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7
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Development and Application of Magnetically Controlled Capsule Endoscopy in Detecting Gastric Lesions. Gastroenterol Res Pract 2022; 2021:2716559. [PMID: 35003252 PMCID: PMC8739542 DOI: 10.1155/2021/2716559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022] Open
Abstract
In the past 20 years, 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). Although limited to observing esophageal and duodenal lesions and lacking the ability of biopsy, MCCE has the advantages of comfort, safety, no anesthesia, no risk of cross-infection, and high acceptability. Several high-quality RCTs showed that the diagnostic accuracy of MCCE is comparable to the traditional gastroscopy. Due to the nonnecessity of anesthesia, MCCE may be more suitable for the elderly with obvious comorbidities as well as children. With more evidences accumulated and more innovative technologies developed, MCCE is expected to be an important tool for screening of early gastric cancer or the diagnosis of gastric diseases.
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Hanscom M, Stead C, Feldman H, Marya NB, Cave D. Video Capsule Endoscopy and Device-Assisted Enteroscopy. Dig Dis Sci 2022; 67:1539-1552. [PMID: 34383197 PMCID: PMC8358900 DOI: 10.1007/s10620-021-07085-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/09/2022]
Abstract
Mark Hanscom Courtney Stead Harris Feldman Neil B. Marya David Cave.
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Affiliation(s)
- Mark Hanscom
- grid.168645.80000 0001 0742 0364Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA 01655 USA
| | - Courtney Stead
- grid.168645.80000 0001 0742 0364Department of Medicine, University of Massachusetts Medical School, Worcester, MA USA
| | - Harris Feldman
- grid.168645.80000 0001 0742 0364Department of Medicine, University of Massachusetts Medical School, Worcester, MA USA
| | - Neil B. Marya
- grid.168645.80000 0001 0742 0364Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA 01655 USA
| | - David Cave
- grid.168645.80000 0001 0742 0364Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA 01655 USA
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9
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Nam JH, Lee KH, Lim YJ. Examination of Entire Gastrointestinal Tract: A Perspective of Mouth to Anus (M2A) Capsule Endoscopy. Diagnostics (Basel) 2021; 11:diagnostics11081367. [PMID: 34441301 PMCID: PMC8394372 DOI: 10.3390/diagnostics11081367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022] Open
Abstract
Capsule endoscopy (CE) is the only non-invasive diagnostic tool that enables the direct visualization of the gastrointestinal (GI) tract. Even though CE was initially developed for small-bowel investigation, its clinical application is expanding, and technological advances continue. The final iteration of CE will be a mouth to anus (M2A) capsule that investigates the entire GI tract by the ingestion of a single capsule. This narrative review describes the current developmental status of CE and discusses the possibility of realizing an M2A capsule and what needs to be overcome in the future.
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Affiliation(s)
- Ji Hyung Nam
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea;
| | - Kwang Hoon Lee
- Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea;
| | - Yun Jeong Lim
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea;
- Correspondence: ; Tel.: +82-31-961-7133
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10
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Novel Clinical Applications and Technical Developments in Video Capsule Endoscopy. Gastrointest Endosc Clin N Am 2021; 31:399-412. [PMID: 33743934 DOI: 10.1016/j.giec.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Video capsule endoscopy is entering its third decade. After slow acceptance, it has become the gold standard in diagnosing small intestinal disorders. This article summarizes new practical applications for capsule endoscopy outside the small intestine. From 2 randomized controlled trials, it is becoming clear that it has a role in the management of patients with hematemesis and nonhematemesis bleeding. Under active investigation are novel applications of capsule technology, including the potential ability to sample luminal contents or tissue, self-propelled capsules, incorporation of other imaging techniques beyond white light, such as ultrasound and fluorescents, and the possibility of drug delivery.
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11
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Detachable string magnetically controlled capsule endoscopy for complete observation of the upper gastrointestinal tract. Eur J Gastroenterol Hepatol 2021; 33:508-513. [PMID: 32956183 DOI: 10.1097/meg.0000000000001939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Wireless magnetically controlled capsule endoscopy (WMCCE) was feasible, well tolerated, highly acceptable, and had high consistency in diagnosis of gastric diseases with esophagogastroduodenoscopy (EGD). But WMCCE is not suitable for inspection of the esophagus. We developed detachable string magnetically controlled capsule endoscopy (DS-MCCE) to observe gastroesophageal diseases. METHODS A total of 60 volunteers were enrolled. Thirty participants underwent DS-MCCE, and the other 30 underwent WMCCE. The primary outcome measures included swallowing time, esophageal transit time, the whole examination time, grade of air-bubble interference on esophageal, gastric preparation, visualization of Z-line and gastric mucosa, and discomfort scores. RESULTS The esophageal time (222.53 ± 107.53 s vs. 49.50 ± 34.90 s, P < 0.001) and the whole examination time (26.53 ± 6.33 min vs. 15.97±4.90 min, P < 0.001) in DS-MCCE group were longer than in WMCCE group. DS-MCCE had a significantly better visualization of Z-line visualization. Visualization of the gastric mucosa was assessed as good in 24 (80%) participants for DS-MCCE and 26 (86.6%) for WMCCE, moderate in 6 (20%) with DS-MCCE as compared with 4 (13.3%) with WMCCE. The visualization of gastric cardia for DS-MCCE was better than for WMCCE (100 vs 80%, P = 0.024). The visualization of gastric angle, antrum, and pylorus in DS-MCCE group was not as good as in WMCCE group (80 vs. 100%, 80 vs. 100%, 83.3 vs. 100%, P = 0.024). CONCLUSIONS DS-MCCE is feasible and well tolerated in the diagnosis of gastroesophageal diseases. For people who cannot stand conventional EGD or with contraindication of EGD, DS-MCCE may be an excellent alternative screening modality.
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12
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Abstract
The incidence of esophageal cancer (EC) is on the rise. With the distinct subtypes of adenocarcinoma and squamous cell carcinoma comes specific risk factors, and as a result, people of certain regions of the world can be more prone to a subtype. For example, squamous cell carcinoma of the esophagus has the highest incidence in eastern Africa and eastern Asia, with smoking being a major risk factor, whereas adenocarcinoma is more prevalent in North America and western Europe, with gastroesophageal reflux disease being a leading risk factor. With that being said, adenocarcinoma and squamous cell carcinoma have similar and unfortunately poor survival rates, partly because EC is prone to early metastasis given that the esophagus does not have a serosa, as well as the superficial nature of its lymphatics compared with the rest of the gastrointestinal tract. This makes early detection of the utmost importance, and certain patients have been shown to have the benefit of screening/surveillance endoscopies, including those with Barrett's esophagus, lye-induced/caustic strictures, tylosis, and Peutz-Jeghers syndrome. Until treatments significantly improve, identifying EC at the earliest stage will have the best success for patient outcomes, and further elucidation of its pathogenesis and risk factors may lead to identifying other high-risk groups that should be screened.
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Affiliation(s)
- Michael DiSiena
- From the Division of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington
| | - Alexander Perelman
- From the Division of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington
| | - John Birk
- From the Division of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington
| | - Houman Rezaizadeh
- From the Division of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington
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13
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Fan X, Qin X, Zhang Y, Li Z, Zhou T, Zhang J, You W, Li W, Pan K. Screening for gastric cancer in China: Advances, challenges and visions. Chin J Cancer Res 2021; 33:168-180. [PMID: 34158737 PMCID: PMC8181866 DOI: 10.21147/j.issn.1000-9604.2021.02.05] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Gastric cancer (GC) is one of the major cancers in China and all over the world. Most GCs are diagnosed at an advanced stage with unfavorable prognosis. Along with some other countries, China has developed the government-funded national screening programs for GC and other major cancers. GC screening has been shown to effectively decrease the incidence of and mortality from GC in countries adopting nationwide screening programs (Japan and Korea) and in studies based on selected Chinese populations. The screening of GC relies mostly on gastroendoscopy, the accuracy, reliability and safety of which have been indicated by previous studies. However, considering its invasive screening approach, requirements on skilled endoscopists and pathologists, and a high cost, developing noninvasive methods to amend endoscopic screening would be highly needed. Numerous studies have examined biomarkers for GC screening and the combination of biomarkers involving pepsinogen, gastrin, and Helicobacter pylori antibodies has been proposed for risk stratification, seeking to narrow down the high-risk populations for further endoscopy. Despite all the achievements of endoscopic screening, evidence on appropriate screening age, intervals for repeated screening, novel biomarkers promoting precision prevention, and health economics need to be accumulated to inform policymakers on endoscopic screening in China. With the guide of Health China 2030 Planning Outline, we have golden opportunities to promote prevention and control of GC. In this review, we summarize the characteristics of screening programs in China and other East Asian countries and introduce the past and current approaches and strategies for GC screening, aiming for featuring the latest advances and key challenges, and illustrating future visions of GC screening.
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Affiliation(s)
- Xiaohan Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiangxiang Qin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yang Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhexuan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Tong Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jingying Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Weicheng You
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Wenqing Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Kaifeng Pan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
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14
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Sedghi S, Kendrick K, Lee SC, Engle S, Yoshida K, Smith B. Magnetic Satiety System: The Use of Magnets to Assist in Combating Obesity. MAGNETIC SURGERY 2021:221-242. [DOI: 10.1007/978-3-030-73947-8_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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15
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Daniel P, Rana SS. Magnetically Assisted Capsule Endoscopy for Endoscopic Examination of Esophagus and Stomach—Beginning of the End of Flexible Esophagogastroscopy! JOURNAL OF DIGESTIVE ENDOSCOPY 2020. [DOI: 10.1055/s-0040-1718470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Philip Daniel
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Song J, Bai T, Zhang L, Xiang XL, Xie XP, Hou XH. Better view by detachable string magnetically controlled capsule endoscopy for esophageal observation: a retrospective comparative study. Dis Esophagus 2020; 33:doz104. [PMID: 32008045 DOI: 10.1093/dote/doz104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/19/2019] [Indexed: 12/11/2022]
Abstract
Magnetically controlled capsule endoscopy (MCE) system has been used to screen gastric lesions. However, the visualization performance of MCE in the esophagus has not been investigated systematically. String method improved the ability of capsule endoscopy (CE) for esophageal observing; however, the string attachment is complicated and cannot be detached with the CE inside the esophagus. We used a modified string, called detachable string attached to MCE. The aim of the study was to compare the observation performance of MCE with and without the detachable string. A total of 238 participants with upper gastrointestinal symptoms and a healthy check who refused esophagogastroduodenoscopy examination were retrospectively divided into the detachable string MCE group and the MCE alone group from June 2016 to May 2018. A suction cap with a thin, hollow string was attached to the MCE system in the detachable string group. Circumferential visualization of the esophagus including the upper, middle, and lower esophagus and Z-line, and esophageal focal lesion, as well as the recording time, safety and tolerability of the procedure, were assessed. The circumferential visualization of the upper, middle, and lower esophagus and Z-line was more efficient in the detachable string MCE group than in the MCE alone group (P < 0.001). In all, 31 esophageal lesions were detected in the detachable string MCE group, which was more than that in the MCE alone group (10, P < 0.001). The mean recording time was 305 seconds in the string MCE group, which was longer than that in the MCE alone group (48.5 seconds, P < 0.001). In seven participants (6.1%) in the detachable string MCE group, the capsule could not be separated from the string. Detachable string MCE showed better performance in terms of observation of the esophagus. Detachable string MCE can be used to screen for esophageal diseases as an alternative method in the future.
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Affiliation(s)
- J Song
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan 430022, China
| | - T Bai
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan 430022, China
| | - L Zhang
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan 430022, China
| | - X-L Xiang
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan 430022, China
| | - X-P Xie
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan 430022, China
| | - X-H Hou
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan 430022, China
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Will magnet-assisted capsule endoscopy become a viable screening tool for Barrett's esophagus and esophageal varices? Gastrointest Endosc 2020; 91:782-784. [PMID: 32204813 DOI: 10.1016/j.gie.2019.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 12/11/2022]
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Li X, Zhang H, Zhang M, Niu S, Zhang F. Development of a Magnetic Kissing Guidewire and Animal Experiment: a Preliminary Study. J Cardiovasc Transl Res 2020; 14:589-594. [PMID: 32152796 DOI: 10.1007/s12265-020-09980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/26/2020] [Indexed: 11/28/2022]
Abstract
Endovascular therapy has been the first option for many vascular diseases. Due to the increasing development of endovascular devices and techniques in recent decades, endovascular procedures could be applied in treating those cases with complex anatomy. Two or three vascular access routes are required to establish through-and-through access in endovascular therapy for arterial occlusive disease and complex aortic aneurysm. Guidewire snaring with a snare kit is essential but sometimes time-consuming in the establishment of through-and-through access. To simplify the procedure, we design the magnetic kissing guidewire (MKG) with a magnetic tip that attracts each other to establish a guidewire route that meets the needs of clinical practice. We conducted the in vitro test to evaluate its magnetic force and the in vivo test to assess its performance in the arteries of twelve sheep. The results revealed that this novel guidewire significantly simplified the establishment of through-and-through access.
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Affiliation(s)
- Xiangtao Li
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyi Rd, Haidian District, Beijing, 100038, China
| | - Huan Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyi Rd, Haidian District, Beijing, 100038, China
| | - Mingyi Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuai Niu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Fuxian Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyi Rd, Haidian District, Beijing, 100038, China.
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Hu B, Ye LS. Endoscopic applications of magnets for the treatment of gastrointestinal diseases. World J Gastrointest Endosc 2019; 11:548-560. [PMID: 31839874 PMCID: PMC6885730 DOI: 10.4253/wjge.v11.i12.548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/21/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023] Open
Abstract
Endoscopic treatment of gastrointestinal diseases has developed rapidly in recent years, due to its minimally invasive nature. One of the main contributing factors for this progress is the improvement of endoscopic instruments, which are essential for facilitating safe and effective endoscopic interventions. However, the slow learning curve required in the implementation of many advanced endoscopic procedures using standard devices is associated with a high risk of complications. Other routine procedures may also be complicated by unexpected difficulties. Based on the ferromagnetic properties of many objects, both internal and external magnetic devices have been developed and applied for multiple endoscopic interventions. The applications of magnets, mainly including compression, anchoring and traction, facilitate many difficult procedures and make it feasible to operate procedures that were previously impossible. Other novel endoscopic applications, such as magnetic nanoparticles, are also under development. In this article, we reviewed published studies of endoscopic applications of magnets for the treatment of gastrointestinal diseases such as precancerous lesions and cancer, obstruction, stricture, congenital and acquired malformations, motility disorders, and ingestion of foreign bodies. Since several endoscopic applications of magnets may also be relevant to surgery, we included them in this review.
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Affiliation(s)
- Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lian-Song Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Ching HL, Hale MF, Sidhu R, Beg S, Ragunath K, McAlindon ME. Magnetically assisted capsule endoscopy in suspected acute upper GI bleeding versus esophagogastroduodenoscopy in detecting focal lesions. Gastrointest Endosc 2019; 90:430-439. [PMID: 31082392 DOI: 10.1016/j.gie.2019.04.248] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Acute upper GI bleeding is common and requires investigation with EGD, but endotherapy is not always necessary. Magnetically assisted capsule endoscopy (MACE) uses a capsule steerable by an external magnet and allows examination of the upper GI tract and small bowel, but its role in acute upper GI bleeding has not been assessed. METHODS We conducted a prospective cohort study comparing the diagnostic yield of MACE and EGD in patients with suspected acute upper GI bleeding. Patient tolerance, mucosal visibility by MACE, and frequency of small-bowel bleeding were assessed. Whether or not MACE could safely predict discharge of patients was also determined. RESULTS Thirty-three patients were included for analysis (median age, 60 years; 75.8% male). MACE detected more focal lesions (peptic, vascular, and fresh/altered blood without a clear source) than EGD (40 versus 25, respectively, P = .02) but statistical significance was not reached for significant lesions (considered to be the bleeding source; 14 vs 13, respectively, P = 1). Capsule endoscopy identified an additional cause for bleeding in the small bowel in 18%. Visualization by MACE was excellent in most areas; views of the esophagus, gastroesophageal junction, fundus, and duodenal bulb were suboptimal. MACE was better tolerated than unsedated EGD and correctly identified patients who were safe for discharge. CONCLUSIONS MACE had higher diagnostic yield for focal lesions and was better tolerated than EGD. It also correctly predicted safe discharge for patients with acute upper GI bleeding. (Clinical trials registration number: NCT02690376.).
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Affiliation(s)
- Hey-Long Ching
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, Nottingham, United Kingdom
| | - Melissa F Hale
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, Nottingham, United Kingdom
| | - Reena Sidhu
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, Nottingham, United Kingdom
| | - Sabina Beg
- NIHR Nottingham Biomedical Research Center, Nottingham Digestive Diseases Center, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Krish Ragunath
- NIHR Nottingham Biomedical Research Center, Nottingham Digestive Diseases Center, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Mark E McAlindon
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, Nottingham, United Kingdom
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Liao Z, Zou W, Li ZS. Clinical application of magnetically controlled capsule gastroscopy in gastric disease diagnosis: recent advances. SCIENCE CHINA-LIFE SCIENCES 2018; 61:1304-1309. [PMID: 30367341 DOI: 10.1007/s11427-018-9353-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/23/2018] [Indexed: 12/16/2022]
Abstract
Magnetically controlled capsule gastroscopy (MCCG) is a novel system primarily used for the diagnosis of gastric disease. It consists of an endoscopic capsule with magnetic material inside, external guidance magnet equipment, data recorder and computer workstation. Several clinical trials have demonstrated that MCCG is comparable in accuracy in diagnosing gastric focal disease when compared to conventional gastroscopy. Further clinical studies are needed to test the diagnostic accuracy and improve the functioning of MCCG. This novel MCCG system could be a promising alternative for screening for gastric diseases, with the advantages of no anesthesia required, comfort and high acceptance across populations.
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Affiliation(s)
- Zhuan Liao
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, 200433, China
| | - Wenbin Zou
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, 200433, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, 200433, China.
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Park J, Cho YK, Kim JH. Current and Future Use of Esophageal Capsule Endoscopy. Clin Endosc 2018; 51:317-322. [PMID: 30078304 PMCID: PMC6078930 DOI: 10.5946/ce.2018.101] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 07/17/2018] [Indexed: 12/28/2022] Open
Abstract
Capsule endoscopy can be a diagnostic option for patients with esophageal diseases who cannot tolerate esophagogastroduodenoscopy.Functional modifications of the capsule allow for thorough examination of the esophagus. Esophageal capsule endoscopy has so farfailed to show sufficient performance to justify the replacement of traditional endoscopy for the diagnosis of esophageal diseasesbecause the esophagus has a short transit time and common pathologies appear near the esophagogastric junction. However,technological improvements are being introduced to overcome the limitations of capsule endoscopy, which is expected to become agood alternative to conventional endoscopy.
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Affiliation(s)
- Junseok Park
- Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Young Kwan Cho
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
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Gastric preparation for magnetically controlled capsule endoscopy: A prospective, randomized single-blinded controlled trial. Dig Liver Dis 2018; 50:42-47. [PMID: 29110963 DOI: 10.1016/j.dld.2017.09.129] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Magnetically controlled capsule endoscopy (MCE) is a novel technique for which there is no agreed gastric preparation. We aimed to determine an optimal standardized gastric preparation regimen. METHODS 120 patients referred for MCE were randomly assigned to gastric preparation with either water alone (A), water with simethicone (B) or water, simethicone and pronase (C). Image quality was assessed using cleanliness and visualization scores, higher scores equating to better image quality. RESULTS The total cleanliness scores were (mean±SD) 15.83±2.41 (A), 21.35±1.23 (B), and 20.82±1.90 (C). The total visualization scores (mean±SD) were 10.75±2.02 (A), 15.20±1.32 (B), and 15.08±1.86 (C). While the image quality of the whole stomach in groups B and C were significantly better than group A (P<0.0001), there was no statistical difference between group B and C (P>0.05). MCE detected positive findings in 21 (52.5%), 27 (67.5%) and 21 (53.8%) patients in group A, B and C respectively, with no significant difference between groups (P>0.5). CONCLUSIONS Simethicone swallowed with water prior to MCE produced the optimal gastric mucosal image quality. The addition of pronase had no demonstrable additional benefit.
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Feasibility and safety of a novel magnetic-assisted capsule endoscope system in a preliminary examination for upper gastrointestinal tract. Surg Endosc 2017; 32:1937-1944. [PMID: 29071416 DOI: 10.1007/s00464-017-5887-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 09/13/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND STUDY AIM Current capsule endoscopy procedures are ineffective for upper gastrointestinal (GI) tract examination because they do not allow for operator-controlled navigation of the capsule. External controllability of a capsule endoscope with an applied magnetic field is a possible solution to this problem. We developed a novel magnetic-assisted capsule endoscope (MACE) system to visualize the entire upper GI tract. The present study evaluated the safety and feasibility of the MACE system for the examination of the upper GI tract, including the esophagus, stomach, and duodenum. METHODS The present open clinical study enrolled ten healthy volunteers. All participants swallowed a MACE, and an external magnetic field navigator was used for magnetic capsule manipulation in the upper GI tract. We assessed the maneuverability of the magnetic capsule and completeness of the MACE examination as well as the safety and tolerability of the procedure. RESULTS The present study enrolled ten healthy volunteers with a mean age and body mass index of 47.7 years and 25.6 kg/m2, respectively. One volunteer withdrew because of difficulty in swallowing the capsule. In total, nine volunteers underwent the MACE examination. The average examination time was 27.1 min. The maneuverability of the capsule was assessed as good and fair in 55.6 and 44.4% of the participants, respectively. The overall completeness of the examination in the esophagus, stomach, and duodenum was 100, 85.2, and 86.1%, respectively. No severe adverse events occurred during this study. All participants exhibited satisfactory tolerance of the MACE examination. CONCLUSION The MACE system has satisfactory maneuverability and visualization completeness with excellent acceptance and tolerance.
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Shamsudhin N, Zverev VI, Keller H, Pane S, Egolf PW, Nelson BJ, Tishin AM. Magnetically guided capsule endoscopy. Med Phys 2017; 44:e91-e111. [PMID: 28437000 DOI: 10.1002/mp.12299] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/22/2017] [Accepted: 04/13/2017] [Indexed: 12/18/2022] Open
Abstract
Wireless capsule endoscopy (WCE) is a powerful tool for medical screening and diagnosis, where a small capsule is swallowed and moved by means of natural peristalsis and gravity through the human gastrointestinal (GI) tract. The camera-integrated capsule allows for visualization of the small intestine, a region which was previously inaccessible to classical flexible endoscopy. As a diagnostic tool, it allows to localize the sources of bleedings in the middle part of the gastrointestinal tract and to identify diseases, such as inflammatory bowel disease (Crohn's disease), polyposis syndrome, and tumors. The screening and diagnostic efficacy of the WCE, especially in the stomach region, is hampered by a variety of technical challenges like the lack of active capsular position and orientation control. Therapeutic functionality is absent in most commercial capsules, due to constraints in capsular volume and energy storage. The possibility of using body-exogenous magnetic fields to guide, orient, power, and operate the capsule and its mechanisms has led to increasing research in Magnetically Guided Capsule Endoscopy (MGCE). This work shortly reviews the history and state-of-art in WCE technology. It highlights the magnetic technologies for advancing diagnostic and therapeutic functionalities of WCE. Not restricting itself to the GI tract, the review further investigates the technological developments in magnetically guided microrobots that can navigate through the various air- and fluid-filled lumina and cavities in the body for minimally invasive medicine.
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Affiliation(s)
- Naveen Shamsudhin
- Multi-Scale Robotics Lab, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, CH 8092, Switzerland
| | - Vladimir I Zverev
- Faculty of Physics, M.V. Lomonosov Moscow State University, Moscow, 119991, Russia
| | - Henrik Keller
- KUKA Roboter GmbH, Zugspitzstrasse 140, Augsburg, 86165, Germany
| | - Salvador Pane
- Multi-Scale Robotics Lab, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, CH 8092, Switzerland
| | - Peter W Egolf
- Institute of Thermal Sciences and Engineering, University of Applied Sciences of Western Switzerland, Yverdon-les-Bains, CH 1401, Switzerland
| | - Bradley J Nelson
- Multi-Scale Robotics Lab, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, CH 8092, Switzerland
| | - Alexander M Tishin
- Faculty of Physics, M.V. Lomonosov Moscow State University, Moscow, 119991, Russia.,Pharmag LLC, Promyshlennaya st 4, Troitsk, Moscow, 142190, Russia
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Eliakim R. Where do I see minimally invasive endoscopy in 2020: clock is ticking. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:202. [PMID: 28567382 DOI: 10.21037/atm.2017.04.17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Since it was introduced 17 years ago, capsule endoscopy has become an important diagnostic tool for the small bowel. Three generations of the original small bowel capsule have been developed since (PillCam SB3, Medtronic, USA), and four competitors were introduced for the small bowel. A non-video patency capsule (Agile patency capsule, Medtronic, USA) was also developed, in order to confirm patency and thus avoid retention in the GI tract. Moreover, capsules viewing other organs of the body (esophagus, colon) as well as three different magnetic guided capsules that visualize the stomach as good as optical endoscopy (OE) have been developed. Over 2,000 articles looking at the efficacy of the small bowel capsule in different clinical situations were published since then. Studies are comparing capsule endoscopy versus other modalities in various indications, looking at preparations aiming to improve the diagnostic yield and at technical aspects. The present paper, describes the available capsules in the market and my biased future expectations.
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Affiliation(s)
- Rami Eliakim
- Department of Gastroenterology & Hepatology, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel
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Romero-Vázquez J, Caunedo-Álvarez Á, Belda-Cuesta A, Jiménez-García VA, Pellicer-Bautista F, Herrerías-Gutiérrez JM. Extracolonic findings with the PillCam Colon: is panendoscopy with capsule endoscopy closer? Endosc Int Open 2016; 4:E1045-E1051. [PMID: 27747276 PMCID: PMC5063639 DOI: 10.1055/s-0042-115406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 07/29/2016] [Indexed: 02/08/2023] Open
Abstract
Background and study aims: Colon capsules display images from the moment they are ingested, making the study of other extracolonic areas possible. The aim of this study was to analyze the significance of these extracolonic findings. Patients and methods: In this single-center, prospective study, 165 patients underwent colon capsule endoscopy (CCE) between September 2009 and October 2012 to rule out colonic pathology. Images were recorded, without interruptions, from the moment the capsule was ingested until its battery ran out. The study was deemed complete when the capsule had traveled from the esophagus to excretion or until the hemorrhoidal plexus was observed. Results: CCE was used for colorectal cancer (CRC) screening (81.2 %), to investigate for chronic diarrhea (9.7 %) and chronic iron deficiency anemia (6.1 %), and for patients with incomplete colonoscopy (3.0 %). The capsule returned findings in the esophagus in 52.1 % of patients, in the stomach in 45.5 % of patients, and in the small bowel in 70.7 % of patients, with the findings being considered relevant in 4.9 %, 9.7 %, and 22.6 % of patients, respectively. The whole extent of the digestive tract was fully recorded in 86.1 % of patients and the Z line could be fully observed in 57.6 % of patients. There were no adverse events. Conclusions: CCE allows the recording of images from almost the whole extent of the digestive tract in most patients, enabling relevant pathologies to be identified in extracolonic areas, particularly the small bowel. Technical and procedural improvements are still necessary in order to achieve better observation of the stomach and esophagus.
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Affiliation(s)
- Javier Romero-Vázquez
- Gastroenterology Service, Virgen Macarena University Hospital, Seville, Spain,Corresponding author Javier Romero Vázquez, MD Gastroenterology ServiceVirgen Macarena University HospitalAvenida Dr. Fedriani s/nSeville 40171Spain+34-955-008805
| | | | - Alba Belda-Cuesta
- Gastroenterology Service, Virgen Macarena University Hospital, Seville, Spain
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A magnetic levitation robotic camera for minimally invasive surgery: Useful for NOTES? Surg Endosc 2016; 31:2529-2533. [DOI: 10.1007/s00464-016-5255-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
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Ching HL, Hale MF, McAlindon ME. Current and future role of magnetically assisted gastric capsule endoscopy in the upper gastrointestinal tract. Therap Adv Gastroenterol 2016; 9:313-21. [PMID: 27134661 PMCID: PMC4830104 DOI: 10.1177/1756283x16633052] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Capsule endoscopy first captivated the medical world when it provided a means to visualize the small bowel, which was previously out of endoscopic reach. In the subsequent decade and a half we continue to learn of the true potential that capsule endoscopy has to offer. Of particular current interest is whether capsule endoscopy has any reliable investigative role in the upper gastrointestinal tract. Much research has already been dedicated to enhancing the diagnostic and indeed therapeutic properties of capsule endoscopy. Specific modifications to tackle the challenges of the gut have already been described in the current literature. In the upper gastrointestinal tract, the capacious anatomy of the stomach represents one of many challenges that capsule endoscopy must overcome. One solution to improving diagnostic yield is to utilize external magnetic steering of a magnetically receptive capsule endoscope. Notionally this would provide a navigation system to direct the capsule to different areas of the stomach and allow complete gastric mucosal examination. To date, several studies have presented promising data to support the feasibility of this endeavour. However the jury is still out as to whether this system will surpass conventional gastroscopy, which remains the gold standard diagnostic tool in the foregut. Nevertheless, a minimally invasive and patient-friendly alternative to gastroscopy remains irresistibly appealing, warranting further studies to test the potential of magnetically assisted capsule endoscopy. In this article the authors would like to share the current state of magnetically assisted capsule endoscopy and anticipate what is yet to come.
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Affiliation(s)
| | - Melissa Fay Hale
- Clinical Investigations Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
| | - Mark Edward McAlindon
- Clinical Investigations Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
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Magnetic-assisted capsule endoscopy in the upper GI tract by using a novel navigation system (with video). Gastrointest Endosc 2016; 83:889-895.e1. [PMID: 26405045 DOI: 10.1016/j.gie.2015.09.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 09/14/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Capsule endoscopy for visualization of the upper GI tract has thus far been experimental and potentially expensive. Our aim was to demonstrate the maneuverability and evaluate the ability to completely visualize and maintain views in the upper GI tract by using a simple magnetic-assisted capsule endoscopy (MACE) system. METHODS Twenty-six volunteers were recruited. The hand-held magnet was placed at strategic points on the body surface and rotated to hold and maneuver the capsule. The ability to view the upper GI tract landmarks was noted: esophagogastric junction (EGJ), cardia, fundus, body, incisura, antrum, and pylorus. Control was assessed by the ability to hold the capsule for 1 minute at 5 positions: the lower esophagus and 4 designated positions in the proximal and distal stomach and also traversing the stomach and through the pylorus. Volunteers subsequently underwent a standard gastroscopy. RESULTS The median data are as follows: age, 38 years (range 26-45 years); BMI, 24 (range 19-38); and procedure time, 24 minutes (range 12-39 minutes). Successful visualization of each landmark was EGJ, 92%; cardia, 88%; fundus, 96%; body, 100%; incisura, 96%; antrum, 96%; and pylorus, 100%; with fewer clear views of the EGJ and fundus. The capsule could be held in 88% of designated positions for 1 minute, moved from the fundus to the antrum in all cases, and traversed the pylorus in 50% (n = 13). An age of 40 years and older was associated with successful pyloric traversing (P = .04). There was positive concordance for 8 of 9 minor pathological findings on standard gastroscopy. CONCLUSION MACE in the upper GI tract is feasible. There is a high degree of visualization and control, with some improvement required for optimizing proximal gastric views and traversing the pylorus.
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Song HJ, Shim KN. Current status and future perspectives of capsule endoscopy. Intest Res 2016; 14:21-9. [PMID: 26884731 PMCID: PMC4754518 DOI: 10.5217/ir.2016.14.1.21] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 02/06/2023] Open
Abstract
Small bowel capsule endoscopy (CE) was first introduced 15 years ago, and a large amount of literature has since been produced, focused on its indication, diagnostic yields, and safety. Guidelines that have made CE the primary diagnostic tool for small bowel disease have been created. Since its initial use in the small bowel, CE has been used for the esophagus, stomach, and colon. The primary indications for small bowel CE are obscure gastrointestinal bleeding, unexplained iron deficiency anemia, suspected Crohn's disease, small bowel tumors, nonsteroidal anti-inflammatory drug enteropathy, portal hypertensive enteropathy, celiac disease, etc. Colon CE provides an alternative to conventional colonoscopy, with possible use in colorectal cancer screening. Guidelines for optimal bowel preparation of CE have been suggested. The main challenges in CE are the development of new devices with the ability to provide therapy, air inflation for better visualization of the small bowel, biopsy sampling systems attached to the capsule, and the possibility of guiding and moving the capsule by an external motion controller. We review the current status and future directions of CE, and address all aspects of clinical practice, including the role of CE and long-term clinical outcomes.
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Affiliation(s)
- Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Slawinski PR, Obstein KL, Valdastri P. Capsule endoscopy of the future: What's on the horizon? World J Gastroenterol 2015; 21:10528-41. [PMID: 26457013 PMCID: PMC4588075 DOI: 10.3748/wjg.v21.i37.10528] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/22/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopes have evolved from passively moving diagnostic devices to actively moving systems with potential therapeutic capability. In this review, we will discuss the state of the art, define the current shortcomings of capsule endoscopy, and address research areas that aim to overcome said shortcomings. Developments in capsule mobility schemes are emphasized in this text, with magnetic actuation being the most promising endeavor. Research groups are working to integrate sensor data and fuse it with robotic control to outperform today's standard invasive procedures, but in a less intrusive manner. With recent advances in areas such as mobility, drug delivery, and therapeutics, we foresee a translation of interventional capsule technology from the bench-top to the clinical setting within the next 10 years.
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The role of magnetic assisted capsule endoscopy (MACE) to aid visualisation in the upper GI tract. Comput Biol Med 2015; 65:359-63. [DOI: 10.1016/j.compbiomed.2015.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 03/14/2015] [Indexed: 12/21/2022]
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Dong DH, Liu WY, Feng HB, Fu YL, Huang S, Xiang JX, Lyu Y. Study of Individual Characteristic Abdominal Wall Thickness Based on Magnetic Anchored Surgical Instruments. Chin Med J (Engl) 2015; 128:2040-2044. [PMID: 26228215 PMCID: PMC4717944 DOI: 10.4103/0366-6999.161360] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Magnetic anchored surgical instruments (MASI), relying on magnetic force, can break through the limitations of the single port approach in dexterity. Individual characteristic abdominal wall thickness (ICAWT) deeply influences magnetic force that determines the safety of MASI. The purpose of this study was to research the abdominal wall characteristics in MASI applied environment to find ICAWT, and then construct an artful method to predict ICAWT, resulting in better safety and feasibility for MASI. METHODS For MASI, ICAWT is referred to the thickness of thickest point in the applied environment. We determined ICAWT through finding the thickest point in computed tomography scans. We also investigated the traits of abdominal wall thickness to discover the factor that can be used to predict ICAWT. RESULTS Abdominal wall at C point in the middle third lumbar vertebra plane (L3) is the thickest during chosen points. Fat layer thickness plays a more important role in abdominal wall thickness than muscle layer thickness. "BMI-ICAWT" curve was obtained based on abdominal wall thickness of C point in L3 plane, and the expression was as follow: f(x) = P1 × x 2 + P2 × x + P3, where P1 = 0.03916 (0.01776, 0.06056), P2 = 1.098 (0.03197, 2.164), P3 = -18.52 (-31.64, -5.412), R-square: 0.99. CONCLUSIONS Abdominal wall thickness of C point at L3 could be regarded as ICAWT. BMI could be a reliable predictor of ICAWT. In the light of "BMI-ICAWT" curve, we may conveniently predict ICAWT by BMI, resulting a better safety and feasibility for MASI.
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Affiliation(s)
- Ding-Hui Dong
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi 710061, China
| | - Wen-Yan Liu
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi 710061, China
| | - Hai-Bo Feng
- School of Mechatronics Engineering, State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, Heilongjiang 150001, China
| | - Yi-Li Fu
- School of Mechatronics Engineering, State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, Heilongjiang 150001, China
| | - Shi Huang
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi 710061, China
| | - Jun-Xi Xiang
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi 710061, China
| | - Yi Lyu
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi 710061, China
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Magnets for therapy in the GI tract: a systematic review. Gastrointest Endosc 2015; 82:237-45. [PMID: 25936447 DOI: 10.1016/j.gie.2014.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 11/04/2014] [Indexed: 12/13/2022]
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Koulaouzidis A, Iakovidis DK, Karargyris A, Rondonotti E. Wireless endoscopy in 2020: Will it still be a capsule? World J Gastroenterol 2015; 21:5119-5130. [PMID: 25954085 PMCID: PMC4419052 DOI: 10.3748/wjg.v21.i17.5119] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 01/26/2015] [Accepted: 03/19/2015] [Indexed: 02/06/2023] Open
Abstract
Currently, the major problem of all existing commercial capsule devices is the lack of control of movement. In the future, with an interface application, the clinician will be able to stop and direct the device into points of interest for detailed inspection/diagnosis, and therapy delivery. This editorial presents current commercially-available new designs, European projects and delivery capsule and gives an overview of the progress required and progress that will be achieved -according to the opinion of the authors- in the next 5 year leading to 2020.
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Mahoney AW, Abbott JJ. Five-degree-of-freedom manipulation of an untethered magnetic device in fluid using a single permanent magnet with application in stomach capsule endoscopy. Int J Rob Res 2015. [DOI: 10.1177/0278364914558006] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This paper demonstrates magnetic three-degree-of-freedom (3-DOF) closed-loop position and 2-DOF open-loop orientation control of a mockup magnetic capsule endoscope in fluid with a single permanent magnet positioned by a commercial 6-DOF robotic manipulator, using feedback of only the 3-DOF capsule position measured by a localization system, with application in capsule endoscopy of a fluid-distended stomach. We analyze the kinematics of magnetic manipulation using a single permanent magnet as the end-effector of a serial-link robot manipulator, and we formulate a control method that enables the capsule’s position and direction to be controlled when the robot manipulator is not in a kinematic singularity, and that sacrifices control over the capsule’s direction to maintain control over the capsule’s position when the manipulator enters a singularity. We demonstrate the method’s robustness to a reduced control rate of 25 Hz, reduced localization rates down to 30 Hz, deviation in the applied magnetic field from that expected, and the presence of manipulator singularities. Five-DOF manipulation of an untethered magnetic device has been previously demonstrated by electromagnetic systems only.
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Affiliation(s)
| | - Jake J. Abbott
- Department of Mechanical Engineering,
University of Utah, USA
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Denzer UW, Rösch T, Hoytat B, Abdel-Hamid M, Hebuterne X, Vanbiervielt G, Filippi J, Ogata H, Hosoe N, Ohtsuka K, Ogata N, Ikeda K, Aihara H, Kudo SE, Tajiri H, Treszl A, Wegscheider K, Greff M, Rey JF. Magnetically guided capsule versus conventional gastroscopy for upper abdominal complaints: a prospective blinded study. J Clin Gastroenterol 2015; 49:101-107. [PMID: 24618504 DOI: 10.1097/mcg.0000000000000110] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Upper gastrointestinal endoscopy is mostly performed under sedation and has a low yield of relevant gastric lesions in patients without alarm symptoms. Simpler screening tests such as capsule endoscopy could be helpful, but gastric visualization is insufficient with the current passive capsules. A magnetically guided gastric capsule was prospectively evaluated in patients with routine indications for gastroscopy. METHODS A total of 189 symptomatic patients (105 male; mean age 53 y) from 2 French centers subsequently and blindly underwent capsule and conventional gastroscopy by 9 and 6 examiners, respectively. The final gold standard was unblinded conventional gastroscopy with biopsy under propofol sedation. Main outcome was accuracy (sensitivity/specificity) of capsule gastroscopy for diagnosis of major gastric lesions, defined as those lesions requiring conventional gastroscopy for biopsy or removal. RESULTS Twenty-three major lesions were found in 21 patients. Capsule accuracy was 90.5% [95% confidence interval (CI), 85.4%-94.3%] with a specificity of 94.1% (95% CI, 89.3%-97.1%) and a sensitivity of 61.9% (95% CI, 38%-82%). Accuracy did not correlate with lesion location, gastric luminal visibility, examiner case volume, or examination time. Of the remaining 168 patients, 94% had minor and mostly multiple lesions; the capsule made a correct diagnosis in 88.1% (95% CI, 82.2%-92.6%), with gastric visibility and lesion location in the proximal stomach having significant influence. All patients preferred capsule gastroscopy. CONCLUSIONS In a prospective and strictly blinded study, magnetically guided capsule gastroscopy was shown to be feasible in clinical practice and was clearly preferred by patients. Improvements in capsule technology may render this technique a future alternative to gastroscopy.
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Affiliation(s)
- Ulrike W Denzer
- Departments of *Interdisciplinary Endoscopy #Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany †Department of Gastroenterology, Institut Arnault Tzanck, St. Laurent du Var ‡Department of Gastroenterology, Centre Hospitalier Universitaire and University of Nice Sophia Antipolis, Nice, France §Keio University School of Medicine ¶The Jikei University School of Medicine, Tokyo ∥Showa University Northern Yokohama Hospital, Yokohama, Japan
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Ohta H, Katsuki S. Subject-friendly entire gastrointestinal screening with a single capsule endoscope by magnetic navigation and the Internet. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:6997-7000. [PMID: 25571606 DOI: 10.1109/embc.2014.6945238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Ever since capsule endoscopy (CE) was introduced into clinical practice, we gastroenterologists have been dreaming of using this less invasive modality to explore the entire gastrointestinal (GI) tract. To realize this dream, we have developed a magnetic navigation system which includes real-time internet streaming of endoscopic video and some useful gadgets (position detection by means of magnetic impedance (MI) sensors and a modified capsule that is "weightless" in water). The design of the weightless capsule made it possible with 0.5T (Tesla) extracorporeal magnets to control the capsule beyond 20cm. A pair of MI sensors on the body surface could detect subtle magnetic flux generated by an intra-capsular magnet in the GI tract by utilizing the space diversity effect which eliminated the interference of terrestrial magnetism. Subjects underwent CE, during which they were free from confinement in the hospital, except for 1 hour when the capsule was manipulated in the stomach and colon. This study had a completion rate of 97.5%. The high completion rate indicates that our system (single capsule endoscopy-SCE) with further improvements could become a viable modality for screening of the entire GI tract.
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Parker CE, Spada C, McAlindon M, Davison C, Panter S. Capsule endoscopy--not just for the small bowel: a review. Expert Rev Gastroenterol Hepatol 2015; 9:79-89. [PMID: 25484107 DOI: 10.1586/17474124.2014.934357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Video capsule endoscopy is being increasingly used to investigate the esophagus and colon as well as the small bowel. With the advancement of technology used in capsule endoscopy there have been marked improvements in diagnostic rates for colon capsule endoscopy in the detection of colonic polyps and colorectal cancer. It is also being increasingly used in the field if inflammatory bowel disease to investigate for mucosal inflammation and could potentially be used to assess mucosal healing. It also has role in completing the evaluation of colonic pathology in those in whom colonoscopy is incomplete. Esophageal capsule is preferred by patients over esophagogastroduodenoscopy (EGD) but as yet does not rival EGD in terms of diagnostic accuracy however the advent of magnetically steerable capsules may improve this. This review covers advances in the field of colon and esophageal capsule endoscopy; it covers diagnostic capabilities of these 2 tools as well as technical aspects of both procedures and preparation.
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Affiliation(s)
- Clare Elizabeth Parker
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Tyneside District Hospital Harton Lane, South Shields NE34 0PL, UK
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Hosoe N, Naganuma M, Ogata H. Current status of capsule endoscopy through a whole digestive tract. Dig Endosc 2015; 27:205-215. [PMID: 25208463 DOI: 10.1111/den.12380] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/05/2014] [Indexed: 02/06/2023]
Abstract
More than a decade has passed since small-bowel capsule endoscopy (CE) was first reported. Small-bowel CE is a non-invasive tool that allows visualization of the entire small-intestinal mucosa and facilitates detection of small-intestinal abnormalities. Several studies have shown benefit of small-bowel CE for certain disorders. Because it is non-invasive, CE has been applied to other organs including the esophagus, stomach, and colon. The main indications for esophageal CE (ECE) are screening for gastroesophageal reflux disease/Barrett's esophagus, and esophageal varices. However, the clinical benefit of ECE is unconfirmed. Magnetically guided CE (MGCE) was developed to visualize the gastric mucosa. MGCE is a new concept with room for improvement of capsule navigation and the preparation protocol. Recently, two new small-bowel CE tools were released. First-generation colon CE (CCE-1) has moderate sensitivity and specificity compared with colonoscopy for colorectal neoplasia surveillance. To obtain higher accuracy, a second-generation CCE (CCE-2) was developed with a high sensitivity for detecting clinically relevant polypoid lesions. A possible application of CCE is for inflammatory bowel disease. In the near future, CE may include diagnostic and therapeutic functions such as magnifying endoscopy systems, targeted biopsy forceps, and drug delivery systems.
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Affiliation(s)
- Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
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Slawinski PR, Obstein KL, Valdastri P. Emerging Issues and Future Developments in Capsule Endoscopy. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2015; 17:40-46. [PMID: 26028956 PMCID: PMC4445887 DOI: 10.1016/j.tgie.2015.02.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Capsule endoscopy (CE) has transformed from a research venture into a widely used clinical tool and the primary means for diagnosing small bowel pathology. These orally administered capsules traverse passively through the gastrointestinal tract via peristalsis and are used in the esophagus, stomach, small bowel, and colon. The primary focus of CE research in recent years has been enabling active CE manipulation and extension of the technology to therapeutic functionality; thus, widening the scope of the procedure. This review outlines clinical standards of the technology as well as recent advances in CE research. Clinical capsule applications are discussed with respect to each portion of the gastrointestinal tract. Promising research efforts are presented with an emphasis on enabling active capsule locomotion. The presented studies suggest, in particular, that the most viable solution for active capsule manipulation is actuation of a capsule via exterior permanent magnet held by a robot. Developing capsule procedures adhering to current healthcare standards, such as enabling a tool channel or irrigation in a therapeutic device, is a vital phase in the adaptation of CE in the clinical setting.
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Affiliation(s)
- Piotr R. Slawinski
- STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235-1592, USA
| | - Keith L. Obstein
- STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235-1592, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37235-1592, USA
| | - Pietro Valdastri
- STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235-1592, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37235-1592, USA
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Evaluation of the Small Bowel and Colon. Gastrointest Endosc 2015. [DOI: 10.1007/978-1-4939-2032-7_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Yang W, Tang C, Qin F. Investigation of a cuboidal permanent magnet's force exerted on a robotic capsule. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:283-9. [PMID: 25170283 PMCID: PMC4146328 DOI: 10.2147/mder.s60189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
To control and drive a robotic capsule accurately from outside a patient's body, we present a schema in which the capsule enclosing the imaging device, circuits, batteries, etc is looped by a permanent magnet ring that acts as an actuator. A cuboidal permanent magnet situated outside the patient's body attracts or pushes the magnet ring from different directions to make the capsule move or rotate. A mathematic model of attractive or repulsive force that the cuboidal magnet exerts on the magnet ring is presented for accurate calculation of force. The experiments showed that the measuring force was in agreement with the theoretical one, and the relations between the dimensions of the cuboidal magnet and force are useful to produce a cuboidal magnet with optimal shape to get appropriate force.
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Affiliation(s)
- Wan’an Yang
- School of Computer and Information Engineering, Yibin University, Yibin, People’s Republic of China
| | - Chengbing Tang
- CNPC Chuanqing Geophysical Prospecting Company Research Center Computer Department, Chengdu, Sichuan, People’s Republic of China
| | - Fengqing Qin
- School of Computer and Information Engineering, Yibin University, Yibin, People’s Republic of China
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Bergeles C, Yang GZ. From passive tool holders to microsurgeons: safer, smaller, smarter surgical robots. IEEE Trans Biomed Eng 2013; 61:1565-76. [PMID: 24723622 DOI: 10.1109/tbme.2013.2293815] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Within only a few decades from its initial introduction, the field of surgical robotics has evolved into a dynamic and rapidly growing research area with increasing clinical uptake worldwide. Initially introduced for stereotaxic neurosurgery, surgical robots are now involved in an increasing number of procedures, demonstrating their practical clinical potential while propelling further advances in surgical innovations. Emerging platforms are also able to perform complex interventions through only a single-entry incision, and navigate through natural anatomical pathways in a tethered or wireless fashion. New devices facilitate superhuman dexterity and enable the performance of surgical steps that are otherwise impossible. They also allow seamless integration of microimaging techniques at the cellular level, significantly expanding the capabilities of surgeons. This paper provides an overview of the significant achievements in surgical robotics and identifies the current trends and future research directions of the field in making surgical robots safer, smaller, and smarter.
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Abstract
PURPOSE OF REVIEW Small bowel capsule endoscopy (SBCE) was introduced 13 years ago by Given Imaging (Yokneam, Israel). It has become one of the most important investigational tools of the small bowel. The capsule is swallowed with water after a 12 h fast, propelled via peristalsis through the gastrointestinal tract and excreted naturally. A nonvideo patency capsule was developed to confirm functional patency of the gastrointestinal tract. RECENT FINDINGS Four additional companies have introduced competitive small bowel video capsules, some of which are Food and Drug Admistration (FDA) approved. Due to the easiness of the procedure, SBCE has become a first-line tool to detect small bowel abnormalities. The main indications for SBCE include obscure gastrointestinal bleeding, suspected Crohn's disease, small bowel tumors and practically any abnormal small bowel imaging. New indications are emerging like small bowel motility and monitoring of drug therapy and mucosal healing. The present review will describe the available capsules in the market, the procedure itself, present indications and future expectations. It will focus on the PillCam SB of Given Imaging as it is the one on which most of the literature is written. SUMMARY Over the past 10 years, SBCE has become a routine, first-line investigational tool of many small bowel pathologies.
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Obstein KL, Valdastri P. Advanced endoscopic technologies for colorectal cancer screening. World J Gastroenterol 2013; 19:431-9. [PMID: 23382621 PMCID: PMC3558566 DOI: 10.3748/wjg.v19.i4.431] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/23/2012] [Accepted: 08/26/2012] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is the third most common cancer in men and the second most common cancer in women worldwide. Diagnosing colorectal has been increasingly successful due to advances in technology. Flexible endoscopy is considered to be an effective method for early diagnosis and treatment of gastrointestinal cancer, making it a popular choice for screening programs. However, millions of people who may benefit from endoscopic colorectal cancer screening fail to have the procedure performed. Main reasons include psychological barriers due to the indignity of the procedure, fear of procedure related pain, bowel preparation discomfort, and potential need for sedation. Therefore, an urgent need for new technologies addressing these issues clearly exists. In this review, we discuss a set of advanced endoscopic technologies for colorectal cancer screening that are either already available or close to clinical trial. In particular, we focus on visual-inspection-only advanced flexible colonoscopes, interventional colonoscopes with alternative propulsion mechanisms, wireless capsule colonoscopy, and technologies for intraprocedural bowel cleansing. Many of these devices have the potential to reduce exam related patient discomfort, obviate the need for sedation, increase diagnostic yield, reduce learning curves, improve access to screening, and possibly avert the need for a bowel preparation.
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Keller J, Fibbe C, Rosien U, Layer P. Recent advances in capsule endoscopy: development of maneuverable capsules. Expert Rev Gastroenterol Hepatol 2012; 6:561-6. [PMID: 23061707 DOI: 10.1586/egh.12.26] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
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. Other projects try to develop biologically inspired steering mechanisms such as capsules that can move on legs or they use electrical stimulation of the intestinal wall in order to induce contractions for propulsion of the videocapsule.
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Affiliation(s)
- Jutta Keller
- Department of Internal Medicine, University of Hamburg, Israelitic Hospital, Hamburg, Germany.
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