Gastroenterology

Gastroenterology

Volume 139, Issue 5, November 2010, Pages 1468-1471.e1
Gastroenterology

Imaging and Advanced Technology
Video Capsule Colonoscopy: Where Will We Be in 2015?

https://doi.org/10.1053/j.gastro.2010.09.026Get rights and content

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Minimize or Preclude Bowel Preparation

The system will produce easier preparations, which will replace the use of 4-L polyethylene glycol solution with some ‘pill cleansers’ that are enteric coated, allowing them to open and start their effect in distal small bowel/cecum, as the basic cleansing materials of the colonic content. Produce safer materials than sodium phosphate, that will help to propel the capsule faster to the colon, or even better, smart visualization through colonic content should be developed to minimize or preclude

Home Procedure

The system should be capable of home use. In the future, the patient should receive the Colon Capsule Endoscopy kit, containing the capsule, sensors, and data recorder that will allow him or her to perform the entire procedure in the privacy of its home, possibly as a weekend procedure, thereby avoiding the need to take time off from work. The new data recorder can alert the patient of each and every move of the capsule and of actual instruction to take certain boosts as needed. If necessary,

Short Video Reading Time

Currently, the typical reading time of PillCam COLON2 video is 40 minutes. Future systems should allow significantly shorter reading times, possibly by automated detection and alerts to the person interpreting the video of existing pathologies, be it polyps, arteriovenous malformations, inflammation, and so on (ie, a “pathology indicator”).

Whole Gut Visualization (Mouth to Anus)

Whole gut visualization can provide a comprehensive examination and diagnosis of pathologies of the entire gut in a single procedure, just as the original inventors dreamt. Because the colon capsule has 2 domes and an adaptive frame rate, it can nicely visualize the esophagus. One can use an external maneuvering device to control capsule movement, examine the stomach, and move the capsule faster to the small bowel, which can then be visualized, followed by the colon without extra burden to the

Maximal Angle of View and Better Definition

We need to maximize the angle of view to 180 degrees from each dome, to not miss pathologies. The conventional small bowel capsules have an angle of view ranging between 140 and 154 degrees. The new PillCam Colon capsule has a 172-degree angle of view from each side, allowing almost 380-degree views of the bowel wall.

A Japanese company describes a small, 23 × 9-mm capsule endoscope on its website, the Sayaka Endoscope, which maps the inner gut while rotating through the digestive system, taking

External/Internal Maneuvering of Capsule

Transforming the existing capsule into a more active device requires adding either external or internal appendages that will allow it to propel through the GI tract. Recently, Swain et al6 have conducted the first human volunteer study in which they transformed a wireless colon-based capsule (Given Imaging) so that it could contain a stack of neodymium–iron–boron magnets in one of its domes, allowing it to be manipulated with an external, handheld magnet (joy stick). The capsule was manipulated

Biopsy (Virtual?)

Current guidelines referring patients from diagnostic procedure based on polyp visualization, such as virtual colonoscopy, to therapeutic treatment rely mostly on lesion sizes. Thus, patients with polyps ≥10 mm are referred to colonoscopy and those with polyps <6 mm may not even be reported, debate remaining for polyps ranging between 6 and 10 mm. This may expose patient to risks associated with small cancers or unnecessary colonoscopy. Thus, biopsy capability (virtual?) can identify the risky

Therapeutic Options

Apart from the VECTOR project, other companies such as Phillips, has launched a drug delivery pill (intelligent pill [iPill]), which incorporates a microprocessor, batter, pH sensor, temperature sensor, a radiofrequency transceiver, a fluid pump, and a drug reservoir, all in an 11 × 26-mm pill that will open and deliver the drug in the designated area in the bowel, allowing targeted therapy to inflamed sites, arteriovenous malformations, and tumors (Supplemental Figure 3).

Summary

Thus, as I foresee it, in the future we will probably have 2 kinds of capsules. There will be a diagnostic capsule applying the improvements in image quality, angle of view, pathology detection, virtual biopsies, and advances in software and communication. This capsule will practically cover all the GI tract—from mouth to anus (just as the original inventors dreamt and named it). Another capsule will be a therapeutic capsule applying the advances of the maneuvering abilities via a joystick,

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References (5)

  • G. Iddan et al.

    Wireless capsule endoscopy

    Nature

    (2000)
  • C. Spada et al.

    Meta-analysis shows colon capsule endoscopy is effective in detecting colorectal polyps

    Clin Gastroenterol Hepatol

    (2010)
There are more references available in the full text version of this article.

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    It is particularly important for the examination of the small intestine, since this organ is not easily reached by conventional endoscopic techniques. The first capsule was developed by Given Imaging (Yoqneam, Israel) in 2000 [1] and after its approval in Europe and the United States in 2001, it has been widely used by the medical community as a means of investigating small bowel diseases, namely GI bleeding and obscure GI bleeding (a bleeding of unknown origin that persists or recurs) [2–4]. This first capsule, for the small bowel examination, is a very small device with the size and shape of a vitamin pill.

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Conflicts of interest Dr Eliakim has served as consultant and speaker for Given Imaging.

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