Flexible and capsule endoscopy for screening, diagnosis and treatment

Abstract

Endoscopy dates back to the 1860s, but many of the most significant advancements have been made within the past decade. With the integration of robotics, the ability to precisely steer and advance traditional flexible endoscopes has been realized, reducing patient pain and improving clinician ergonomics. Additionally, wireless capsule endoscopy, a revolutionary alternative to traditional scopes, enables inspection of the digestive system with minimal discomfort for the patient or the need for sedation, mitigating some of the risks of flexible endoscopy. This review presents a research update on robotic endoscopic systems, including both flexible scope and capsule technologies, detailing actuation methods and therapeutic capabilities. A future perspective on endoscopic potential for screening, diagnostic and therapeutic gastrointestinal procedures is also presented.

Keywords::

• actuation mechanisms for probe navigation
• capsule endoscope locomotion
• colonoscopy
• diagnostic and therapeutic capability
• endoscopic capsule
• endoscopy of the gastrointestinal tract
• flexible endoscopy
• robotic endoscopic systems
• screening
• wireless capsule endoscopy

Financial & competing interests disclosure

This work was funded in part by the Fulbright US Student Program and the Whitaker International Program. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Today, endoscopy can be divided into two categories, flexible endoscopy and capsule endoscopy.

• Flexible endoscopy encompasses traditional flexible scopes, scopes with steering and actuation mechanisms for less invasive advancement into the GI tract, and soft-tethered capsules with active actuation.

• Capsule endoscopy encompasses passive or active wireless, pill-shaped devices, which are capable of screening, diagnosis and/or therapy within the GI tract.

• The major drawbacks of flexible endoscopy include patient and clinician discomfort and procedure effectiveness, all of which are being improved by the advent of steering and actuation methods for both flexible and capsule endoscopes (CEs).

• Current commercialized (US FDA approved) CEs are limited by passive actuation, and thus to screening and passive diagnostic procedures.

• Several CEs with a magnetic actuation method are near commercialization (e.g., OMOM Capsule Robot and MiroCam MC1000-WM), but the methods utilize handheld control.

• Magnetic locomotion of CEs is the most promising control technology, and we will likely see fully autonomous immersive capsule endoscope control systems within the next 5 years.

• Autonomous locomotion will require precise spatial control (e.g., multiple passive electromagnets, and a robotically controlled permanent magnet or electromagnet) and high-level sensorization (e.g., localization, image processing, force mapping) for feedback.

• Diagnostic and therapeutic CEs include devices that can perform biopsy, mitigate hemorrhage, deliver drugs, insufflate, three-dimensionally reconstruct the GI tract and sense GI physiological parameters such as pH, temperature and intraluminal pressure.

• Development should be focused on reliable and accurate capsule sensorization to close the control loop, imaging techniques for improved quality, efficiency and acquisition rates.

Notes