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Ghorbani Siavashani A, Rehan M, Travas-Sejdic J, Thomas D, Diller E, Stine J, Ghodssi R, Avci E. Ingestible Smart Capsules for Chemical Sensing in the Gut. Anal Chem 2025; 97:5343-5354. [PMID: 40047504 DOI: 10.1021/acs.analchem.4c04683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
The development of novel ingestible sensors can aid physicians and patients in obtaining precise data on the health status of the gut at a local level. This in turn can facilitate earlier and more accurate disease diagnosis, improve the delivery of point-of-care medicine, and allow monitoring of the gastrointestinal (GI) tract status. This Tutorial overviews characteristics of the gut for inexpert readers and reviews emerging chemical sensing technologies for the GI tract from an analytical chemistry viewpoint.
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Affiliation(s)
| | - Muhammad Rehan
- Sir Syed University of Engineering and Technology, Karachi 75300, Pakistan
| | - Jadranka Travas-Sejdic
- Centre for Innovative Materials for Health, School of Chemical Sciences, University of Auckland, Auckland 1010, New Zealand
- The MacDiarmid Institute for Advanced Materials and Nanotechnology, Wellington 6140, New Zealand
| | - David Thomas
- School of Agriculture and Environment, Massey University, Palmerston North 4410, New Zealand
| | - Eric Diller
- Microrobotics Lab, Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College St., Toronto, ON M5S 3G8, Canada
| | - Justin Stine
- Department of Electrical and Computer Engineering, Institute for Systems Research, and Robert E. Fischell Institute for Biomedical Devices, University of Maryland, College Park, Maryland 20742, United States
| | - Reza Ghodssi
- Department of Electrical and Computer Engineering, Institute for Systems Research, and Robert E. Fischell Institute for Biomedical Devices, University of Maryland, College Park, Maryland 20742, United States
| | - Ebubekir Avci
- The MacDiarmid Institute for Advanced Materials and Nanotechnology, Wellington 6140, New Zealand
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2
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Tawheed A, Ismail A, Amer MS, Elnahas O, Mowafy T. Capsule endoscopy: Do we still need it after 24 years of clinical use? World J Gastroenterol 2025; 31:102692. [PMID: 39926220 PMCID: PMC11718605 DOI: 10.3748/wjg.v31.i5.102692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 11/20/2024] [Accepted: 12/02/2024] [Indexed: 12/30/2024] Open
Abstract
In this letter, we comment on a recent article published in the World Journal of Gastroenterology by Xiao et al, where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions during capsule endoscopy (CE). CE was first presented in 2000 and was approved by the Food and Drug Administration in 2001. The indications of CE overlap with those of regular diagnostic endoscopy. However, in clinical practice, CE is usually used to detect lesions in areas inaccessible to standard endoscopies or in cases of bleeding that might be missed during conventional endoscopy. Since the emergence of CE, many physiological and technical challenges have been faced and addressed. In this letter, we summarize the current challenges and briefly mention the proposed methods to overcome these challenges to answer a central question: Do we still need CE?
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Affiliation(s)
- Ahmed Tawheed
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Alaa Ismail
- Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Mohab S Amer
- Faculty of Medicine, Helwan University, Cairo 11795, Egypt
- Department of Research, SMART Company for Research Services, Cairo 11795, Egypt
| | - Osama Elnahas
- Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Tawhid Mowafy
- Department of Internal Medicine, Gardenia Medical Center, Doha 0000, Qatar
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3
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Cao Q, Deng R, Pan Y, Liu R, Chen Y, Gong G, Zou J, Yang H, Han D. Robotic wireless capsule endoscopy: recent advances and upcoming technologies. Nat Commun 2024; 15:4597. [PMID: 38816464 PMCID: PMC11139981 DOI: 10.1038/s41467-024-49019-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/21/2024] [Indexed: 06/01/2024] Open
Abstract
Wireless capsule endoscopy (WCE) offers a non-invasive evaluation of the digestive system, eliminating the need for sedation and the risks associated with conventional endoscopic procedures. Its significance lies in diagnosing gastrointestinal tissue irregularities, especially in the small intestine. However, existing commercial WCE devices face limitations, such as the absence of autonomous lesion detection and treatment capabilities. Recent advancements in micro-electromechanical fabrication and computational methods have led to extensive research in sophisticated technology integration into commercial capsule endoscopes, intending to supersede wired endoscopes. This Review discusses the future requirements for intelligent capsule robots, providing a comparative evaluation of various methods' merits and disadvantages, and highlighting recent developments in six technologies relevant to WCE. These include near-field wireless power transmission, magnetic field active drive, ultra-wideband/intrabody communication, hybrid localization, AI-based autonomous lesion detection, and magnetic-controlled diagnosis and treatment. Moreover, we explore the feasibility for future "capsule surgeons".
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Affiliation(s)
- Qing Cao
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Runyi Deng
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Yue Pan
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Ruijie Liu
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Yicheng Chen
- Sir Run-Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Guofang Gong
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Jun Zou
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Huayong Yang
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Dong Han
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China.
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China.
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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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Liu W, Choi SJ, George D, Li L, Zhong Z, Zhang R, Choi SY, Selaru FM, Gracias DH. Untethered shape-changing devices in the gastrointestinal tract. Expert Opin Drug Deliv 2023; 20:1801-1822. [PMID: 38044866 PMCID: PMC10872387 DOI: 10.1080/17425247.2023.2291450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/01/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Advances in microfabrication, automation, and computer engineering seek to revolutionize small-scale devices and machines. Emerging trends in medicine point to smart devices that emulate the motility, biosensing abilities, and intelligence of cells and pathogens that inhabit the human body. Two important characteristics of smart medical devices are the capability to be deployed in small conduits, which necessitates being untethered, and the capacity to perform mechanized functions, which requires autonomous shape-changing. AREAS COVERED We motivate the need for untethered shape-changing devices in the gastrointestinal tract for drug delivery, diagnosis, and targeted treatment. We survey existing structures and devices designed and utilized across length scales from the macro to the sub-millimeter. These devices range from triggerable pre-stressed thin film microgrippers and spring-loaded devices to shape-memory and differentially swelling structures. EXPERT OPINION Recent studies demonstrate that when fully enabled, tether-free and shape-changing devices, especially at sub-mm scales, could significantly advance the diagnosis and treatment of GI diseases ranging from cancer and inflammatory bowel disease (IBD) to irritable bowel syndrome (IBS) by improving treatment efficacy, reducing costs, and increasing medication compliance. We discuss the challenges and possibilities associated with ensuring safe, reliable, and autonomous operation of these smart devices.
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Affiliation(s)
- Wangqu Liu
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Soo Jin Choi
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Derosh George
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Ling Li
- Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Zijian Zhong
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Ruili Zhang
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Si Young Choi
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Florin M. Selaru
- Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - David H. Gracias
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Chemistry, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD 21218, USA
- Sidney Kimmel Comprehensive Cancer Center (SKCCC), Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Center for MicroPhysiological Systems (MPS), Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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6
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Koumar OC, Beaufils R, Chesneau C, Normand H, Bessot N. Validation of e-Celsius gastrointestinal telemetry system as measure of core temperature. J Therm Biol 2023; 112:103471. [PMID: 36796916 DOI: 10.1016/j.jtherbio.2023.103471] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
The main objective of this study was to validate gastrointestinal measurement with the e-Celsius® system composed of an ingestible electronic capsule and a monitor. Twenty-three healthy volunteers aged 18-59 years stayed at the hospital for 24 h under fasting conditions. They were only allowed for quiet activity and were asked to keep their sleeping habits. Subjects ingested a Jonah capsule and an e-Celsius® capsule, and a rectal probe and an esophageal probe were inserted. Mean temperature measured by the e-Celsius® device was lower than that measured by Vitalsense® (-0.12 ± 0.22°C; p < 0.001) and the rectal probe (-0.11 ± 0.03°C; p = 0.003) and higher than that measured by the esophageal probe (0.17 ± 0.05; p = 0.006). Mean difference (bias) and 95% confidence intervals between temperature of e-Celsius capsule, Vitalsense Jonah capsule, esophageal probe, and rectal probe were computed using Bland and Altman procedure. The magnitude of the measurement bias is significantly greater when comparing the e-Celsius® and the Vitalsense® device pair with any other device pairs containing the esophageal probe. Amplitude of confidence interval between the e-Celsius® system and the Vitalsense® system was 0.67°C. This amplitude was significantly lower than those of the esophageal probe-e-Celsius® pairing (0.83°C; p = 0.027), of the esophageal probe-Vitalsense (0.78°C; p = 0.046) and of the esophageal probe-rectal probe (0.83°C; p = 0.002). The statistical analysis did not reveal any effect of time on the amplitude of bias, whatever the device concerned. When comparing missing data rate of the e-Celsius® system (0.23 ± 0.15%) and the Vitalsense® devices (0.70 ± 0.11%) during the whole experiment, no differences was observed (p = 0.09). The e-Celsius® system could be used when a continuous following of internal temperature is needed.
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Affiliation(s)
- O C Koumar
- Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000, Caen, France
| | - R Beaufils
- Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000, Caen, France
| | - C Chesneau
- LMNO, CNRS, UNICAEN, Normandie Université, 14000, Caen, France
| | - H Normand
- Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000, Caen, France
| | - N Bessot
- Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000, Caen, France.
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7
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Cui Y, Thompson CC, Chiu PWY, Gross SA. Robotics in therapeutic endoscopy (with video). Gastrointest Endosc 2022; 96:402-410. [PMID: 35667390 DOI: 10.1016/j.gie.2022.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/13/2022] [Accepted: 05/24/2022] [Indexed: 02/08/2023]
Abstract
Since its inception, endoscopy has evolved from a solely diagnostic procedure to an expanding therapeutic field within gastroenterology. The incorporation of robotics in gastroenterology initially addressed shortcomings of flexible endoscopes in natural orifice transluminal endoscopy. Developing therapeutic endoscopic robotic platforms now offer operators improved ergonomics, visualization, dexterity, precision, and control and the possibility of increasing proficiency and standardization of complex endoscopic procedures including endoscopic submucosal dissection, endoscopic full-thickness resection, and endoscopic suturing. The following review discusses the history, potential applications, and tools currently available and in development for robotics in therapeutic endoscopy.
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Affiliation(s)
- YongYan Cui
- Department of Gastroenterology, New York University Medical Center, New York, New York, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Wai Yan Chiu
- Department of Surgery, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Seth A Gross
- Department of Gastroenterology, New York University Medical Center, New York, New York, USA
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Barducci L, Scaglioni B, Martin J, Obstein KL, Valdastri P. Active Stabilization of Interventional Tasks Utilizing a Magnetically Manipulated Endoscope. Front Robot AI 2022; 9:854081. [PMID: 35494547 PMCID: PMC9047764 DOI: 10.3389/frobt.2022.854081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/17/2022] [Indexed: 01/16/2023] Open
Abstract
Magnetically actuated robots have become increasingly popular in medical endoscopy over the past decade. Despite the significant improvements in autonomy and control methods, progress within the field of medical magnetic endoscopes has mainly been in the domain of enhanced navigation. Interventional tasks such as biopsy, polyp removal, and clip placement are a major procedural component of endoscopy. Little advancement has been done in this area due to the problem of adequately controlling and stabilizing magnetically actuated endoscopes for interventional tasks. In the present paper we discuss a novel model-based Linear Parameter Varying (LPV) control approach to provide stability during interventional maneuvers. This method linearizes the non-linear dynamic interaction between the external actuation system and the endoscope in a set of equilibria, associated to different distances between the magnetic source and the endoscope, and computes different controllers for each equilibrium. This approach provides the global stability of the overall system and robustness against external disturbances. The performance of the LPV approach is compared to an intelligent teleoperation control method (based on a Proportional Integral Derivative (PID) controller), on the Magnetic Flexible Endoscope (MFE) platform. Four biopsies in different regions of the colon and at two different system equilibria are performed. Both controllers are asked to stabilize the endoscope in the presence of external disturbances (i.e. the introduction of the biopsy forceps through the working channel of the endoscope). The experiments, performed in a benchtop colon simulator, show a maximum reduction of the mean orientation error of the endoscope of 45.8% with the LPV control compared to the PID controller.
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Affiliation(s)
- Lavinia Barducci
- STORM Lab United Kingdom, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Bruno Scaglioni
- STORM Lab United Kingdom, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - James Martin
- STORM Lab United Kingdom, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Keith L. Obstein
- STORM Lab United States, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Pietro Valdastri
- STORM Lab United Kingdom, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
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9
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Chen W, Sui J, Wang C. Magnetically Actuated Capsule Robots: A Review. IEEE ACCESS 2022; 10:88398-88420. [DOI: 10.1109/access.2022.3197632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Affiliation(s)
- Weiyuan Chen
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, China
| | - Jianbo Sui
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, China
| | - Chengyong Wang
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, China
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10
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Sekhon Inderjit Singh HK, Armstrong ER, Shah S, Mirnezami R. Application of robotic technologies in lower gastrointestinal tract endoscopy: A systematic review. World J Gastrointest Endosc 2021; 13:673-697. [PMID: 35070028 PMCID: PMC8716978 DOI: 10.4253/wjge.v13.i12.673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/31/2021] [Accepted: 12/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Conventional optical colonoscopy is considered the gold standard investigation for colorectal tract pathology including colorectal malignancy, polyps and inflammatory bowel disease. Inherent limitations exist with current generation endoscopic technologies, including, but not limited to, patient discomfort, endoscopist fatigue, narrow field of view and missed pathology behind colonic folds. Rapid developments in medical robotics have led to the emergence of a variety of next-generation robotically-augmented technologies that could overcome these limitations.
AIM To provide a comprehensive summary of recent developments in the application of robotics in lower gastrointestinal tract endoscopy.
METHODS A systematic review of the literature was performed from January 1, 2000 to the January 7, 2021 using EMBASE, MEDLINE and Cochrane databases. Studies reporting data on the use of robotic technology in ex vivo or in vivo animal and human experiments were included. In vitro studies (studies using synthetic colon models), studies evaluating non-robotic technology, robotic technology aimed at the upper gastrointestinal tract or paediatric endoscopy were excluded. System ergonomics, safety, visualisation, and diagnostic/therapeutic capabilities were assessed.
RESULTS Initial literature searching identified 814 potentially eligible studies, from which 37 were deemed suitable for inclusion. Included studies were classified according to the actuation modality of the robotic device(s) as electromechanical (EM) (n = 13), pneumatic (n = 11), hydraulic (n = 1), magnetic (n = 10) and hybrid (n = 2) mechanisms. Five devices have been approved by the Food and Drug Administration, however most of the technologies reviewed remain in the early phases of testing and development. Level 1 evidence is lacking at present, but early reports suggest that these technologies may be associated with improved pain and safety. The reviewed devices appear to be ergonomically capable and efficient though to date no reports have convincingly shown diagnostic or therapeutic superiority over conventional colonoscopy.
CONCLUSION Significant progress in robotic colonoscopy has been made over the last couple of decades. Improvements in design together with the integration of semi-autonomous and autonomous systems over the next decade will potentially result in robotic colonoscopy becoming more commonplace.
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Affiliation(s)
| | - Emily Rose Armstrong
- Colorectal Surgery, The Royal Free Hospital, London NW3 2QG, Hampstead, United Kingdom
| | - Sujay Shah
- Colorectal Surgery, The Royal Free Hospital, London NW3 2QG, Hampstead, United Kingdom
| | - Reza Mirnezami
- Colorectal Surgery, The Royal Free Hospital, London NW3 2QG, Hampstead, United Kingdom
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11
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Byrne J, Huang HW, McRae JC, Babaee S, Soltani A, Becker SL, Traverso G. Devices for drug delivery in the gastrointestinal tract: A review of systems physically interacting with the mucosa for enhanced delivery. Adv Drug Deliv Rev 2021; 177:113926. [PMID: 34403749 DOI: 10.1016/j.addr.2021.113926] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/14/2021] [Accepted: 08/09/2021] [Indexed: 12/14/2022]
Abstract
The delivery of macromolecules via the gastrointestinal (GI) tract remains a significant challenge. A variety of technologies using physical modes of drug delivery have been developed and investigated to overcome the epithelial cell layer of the GI tract for local and systemic delivery. These technologies include direct injection, jetting, ultrasound, and iontophoresis, which have been largely adapted from transdermal drug delivery. Direct injection of agents using needles through endoscopy has been used clinically for over a century. Jetting, a needle-less method of drug delivery where a high-speed stream of fluid medication penetrates tissue, has been evaluated pre-clinically for delivery of agents into the buccal mucosa. Ultrasound has been shown to be beneficial in enhancing delivery of macromolecules, including nucleic acids, in pre-clinical animal models. The application of an electric field gradient to drive drugs into tissues through the technique of iontophoresis has been shown to deliver highly toxic chemotherapies into GI tissues. Here in, we provide an in-depth overview of these physical modes of drug delivery in the GI tract and their clinical and preclinical uses.
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Affiliation(s)
- James Byrne
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02142, USA; Harvard Radiation Oncology Program, Boston, MA 02114, USA; Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA; Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52240, USA
| | - Hen-Wei Huang
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - James C McRae
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Sahab Babaee
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Amin Soltani
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Sarah L Becker
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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12
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Capsule Endoscopy: Pitfalls and Approaches to Overcome. Diagnostics (Basel) 2021; 11:diagnostics11101765. [PMID: 34679463 PMCID: PMC8535011 DOI: 10.3390/diagnostics11101765] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022] Open
Abstract
Capsule endoscopy of the gastrointestinal tract is an innovative technology that serves to replace conventional endoscopy. Wireless capsule endoscopy, which is mainly used for small bowel examination, has recently been used to examine the entire gastrointestinal tract. This method is promising for its usefulness and development potential and enhances convenience by reducing the side effects and discomfort that may occur during conventional endoscopy. However, capsule endoscopy has fundamental limitations, including passive movement via bowel peristalsis and space restriction. This article reviews the current scientific aspects of capsule endoscopy and discusses the pitfalls and approaches to overcome its limitations. This review includes the latest research results on the role and potential of capsule endoscopy as a non-invasive diagnostic and therapeutic device.
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Bhandari P, Longcroft-Wheaton G, Libanio D, Pimentel-Nunes P, Albeniz E, Pioche M, Sidhu R, Spada C, Anderloni A, Repici A, Haidry R, Barthet M, Neumann H, Antonelli G, Testoni A, Ponchon T, Siersema PD, Fuccio L, Hassan C, Dinis-Ribeiro M. Revising the European Society of Gastrointestinal Endoscopy (ESGE) research priorities: a research progress update. Endoscopy 2021; 53:535-554. [PMID: 33822332 DOI: 10.1055/a-1397-3005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND One of the aims of the European Society of Gastrointestinal Endoscopy (ESGE) is to encourage high quality endoscopic research at a European level. In 2016, the ESGE research committee published a set of research priorities. As endoscopic research is flourishing, we aimed to review the literature and determine whether endoscopic research over the last 4 years had managed to address any of our previously published priorities. METHODS As the previously published priorities were grouped under seven different domains, a working party with at least two European experts was created for each domain to review all the priorities under that domain. A structured review form was developed to standardize the review process. The group conducted an extensive literature search relevant to each of the priorities and then graded the priorities into three categories: (1) no longer a priority (well-designed trial, incorporated in national/international guidelines or adopted in routine clinical practice); (2) remains a priority (i. e. the above criterion was not met); (3) redefine the existing priority (i. e. the priority was too vague with the research question not clearly defined). RESULTS The previous ESGE research priorities document published in 2016 had 26 research priorities under seven domains. Our review of these priorities has resulted in seven priorities being removed from the list, one priority being partially removed, another seven being redefined to make them more precise, with eleven priorities remaining unchanged. This is a reflection of a rapid surge in endoscopic research, resulting in 27 % of research questions having already been answered and another 27 % requiring redefinition. CONCLUSIONS Our extensive review process has led to the removal of seven research priorities from the previous (2016) list, leaving 19 research priorities that have been redefined to make them more precise and relevant for researchers and funding bodies to target.
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Affiliation(s)
- Pradeep Bhandari
- Department of Gastroenterology, Portsmouth University Hospital NHS Trust, Portsmouth, UK
| | | | - Diogo Libanio
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| | - Eduardo Albeniz
- Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Navarrabiomed-UPNA-IdiSNA, Pamplona, Spain
| | - Mathieu Pioche
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
| | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - Cristiano Spada
- Digestive Endoscopy and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, Rome, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Digestive Endoscopy Unit, IRCSS Humanitas Research Hospital, Milan, Italy
| | - Rehan Haidry
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Marc Barthet
- Department of Gastroenterology, Hôpital Nord, Assistance publique des hôpitaux de Marseille, Marseille, France
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
- GastroZentrum Lippe, Bad Salzuflen, Germany
| | - Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, Rome, Italy
- Nuovo Regina Margherita Hospital, Rome, Italy
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Thierry Ponchon
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Mario Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
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Intelligent automated drug administration and therapy: future of healthcare. Drug Deliv Transl Res 2021; 11:1878-1902. [PMID: 33447941 DOI: 10.1007/s13346-020-00876-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
In the twenty-first century, the collaboration of control engineering and the healthcare sector has matured to some extent; however, the future will have promising opportunities, vast applications, and some challenges. Due to advancements in processing speed, the closed-loop administration of drugs has gained popularity for critically ill patients in intensive care units and routine life such as personalized drug delivery or implantable therapeutic devices. For developing a closed-loop drug delivery system, the control system works with a group of technologies like sensors, micromachining, wireless technologies, and pharmaceuticals. Recently, the integration of artificial intelligence techniques such as fuzzy logic, neural network, and reinforcement learning with the closed-loop drug delivery systems has brought their applications closer to fully intelligent automatic healthcare systems. This review's main objectives are to discuss the current developments, possibilities, and future visions in closed-loop drug delivery systems, for providing treatment to patients suffering from chronic diseases. It summarizes the present insight of closed-loop drug delivery/therapy for diabetes, gastrointestinal tract disease, cancer, anesthesia administration, cardiac ailments, and neurological disorders, from a perspective to show the research in the area of control theory.
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Miley D, Machado LB, Condo C, Jergens AE, Yoon KJ, Pandey S. Video Capsule Endoscopy and Ingestible Electronics: Emerging Trends in Sensors, Circuits, Materials, Telemetry, Optics, and Rapid Reading Software. ADVANCED DEVICES & INSTRUMENTATION 2021; 2021. [DOI: 10.34133/2021/9854040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
Real-time monitoring of the gastrointestinal tract in a safe and comfortable manner is valuable for the diagnosis and therapy of many diseases. Within this realm, our review captures the trends in ingestible capsule systems with a focus on hardware and software technologies used for capsule endoscopy and remote patient monitoring. We introduce the structure and functions of the gastrointestinal tract, and the FDA guidelines for ingestible wireless telemetric medical devices. We survey the advanced features incorporated in ingestible capsule systems, such as microrobotics, closed-loop feedback, physiological sensing, nerve stimulation, sampling and delivery, panoramic imaging with adaptive frame rates, and rapid reading software. Examples of experimental and commercialized capsule systems are presented with descriptions of their sensors, devices, and circuits for gastrointestinal health monitoring. We also show the recent research in biocompatible materials and batteries, edible electronics, and alternative energy sources for ingestible capsule systems. The results from clinical studies are discussed for the assessment of key performance indicators related to the safety and effectiveness of ingestible capsule procedures. Lastly, the present challenges and outlook are summarized with respect to the risks to health, clinical testing and approval process, and technology adoption by patients and clinicians.
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Affiliation(s)
- Dylan Miley
- Department of Electrical and Computer Engineering, Iowa State University, Ames, Iowa, USA
| | | | - Calvin Condo
- Department of Electrical and Computer Engineering, Iowa State University, Ames, Iowa, USA
| | - Albert E. Jergens
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Kyoung-Jin Yoon
- Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Santosh Pandey
- Department of Electrical and Computer Engineering, Iowa State University, Ames, Iowa, USA
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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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da Veiga T, Chandler JH, Lloyd P, Pittiglio G, Wilkinson NJ, Hoshiar AK, Harris RA, Valdastri P. Challenges of continuum robots in clinical context: a review. ACTA ACUST UNITED AC 2020. [DOI: 10.1088/2516-1091/ab9f41] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Current conventional endoscopes have restricted the accuracy of treatment delivery and monitoring. Over the past decade, there have been major developments in nanotechnology and light triggered therapy, potentially allowing a better detection of challenging lesions and targeted treatment of malignancies in the gastrointestinal tract. Theranostics is a developing form of personalized medicine because it combines diagnosis and targeted treatment delivered in one step using advances in nanotechnology. This review describes the light-triggered therapies (including photodynamic, photothermal, and photoimmunotherapies), nanotechnological advances with nanopowder, nanostent, nanogels, and nanoparticles, enhancements brought to endoscopic ultrasound, in addition to experimental endoscopic techniques, combining both enhanced diagnoses and therapies, including a developed prototype of a “smart” multifunctional endoscope for localized colorectal cancer, near-infrared laser endoscope targeting the gastrointestinal stromal tumors, the concept of endocapsule for obscure gastrointestinal bleed, and a proof-of-concept therapeutic capsule using ultrasound-mediated targeted drug delivery. Hence, the following term has been proposed encompassing these technologies: “Theranostic gastrointestinal endoscopy.” Future efforts for integration of these technologies into clinical practice would be directed toward translational and clinical trials translating into a more personalized and interdisciplinary diagnosis and treatment, shorter procedural time, higher precision, higher cost-effectiveness, and less need for repetitive procedures.
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Beardslee LA, Banis GE, Chu S, Liu S, Chapin AA, Stine JM, Pasricha PJ, Ghodssi R. Ingestible Sensors and Sensing Systems for Minimally Invasive Diagnosis and Monitoring: The Next Frontier in Minimally Invasive Screening. ACS Sens 2020; 5:891-910. [PMID: 32157868 DOI: 10.1021/acssensors.9b02263] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ingestible electronic systems that are capable of embedded sensing, particularly within the gastrointestinal (GI) tract and its accessory organs, have the potential to screen for diseases that are difficult if not impossible to detect at an early stage using other means. Furthermore, these devices have the potential to (1) reduce labor and facility costs for a variety of procedures, (2) promote research for discovering new biomarker targets for associated pathologies, (3) promote the development of autonomous or semiautonomous diagnostic aids for consumers, and (4) provide a foundation for epithelially targeted therapeutic interventions. These technological advances have the potential to make disease surveillance and treatment far more effective for a variety of conditions, allowing patients to lead longer and more productive lives. This review will examine the conventional techniques, as well as ingestible sensors and sensing systems that are currently under development for use in disease screening and diagnosis for GI disorders. Design considerations, fabrication, and applications will be discussed.
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Affiliation(s)
- Luke A. Beardslee
- Institute for Systems Research, University of Maryland, College Park, Maryland 20742, United States
| | - George E. Banis
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland 20742, United States
| | - Sangwook Chu
- Institute for Systems Research, University of Maryland, College Park, Maryland 20742, United States
| | - Sanwei Liu
- Institute for Systems Research, University of Maryland, College Park, Maryland 20742, United States
| | - Ashley A. Chapin
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland 20742, United States
| | - Justin M. Stine
- Department of Electrical and Computer Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Pankaj Jay Pasricha
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, United States
| | - Reza Ghodssi
- Institute for Systems Research, University of Maryland, College Park, Maryland 20742, United States
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland 20742, United States
- Department of Electrical and Computer Engineering, University of Maryland, College Park, Maryland 20742, United States
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Barducci L, Pittiglio G, Norton JC, Obstein KL, Valdastri P. Adaptive Dynamic Control for Magnetically Actuated Medical Robots. IEEE Robot Autom Lett 2019; 4:3633-3640. [PMID: 31406915 PMCID: PMC6690374 DOI: 10.1109/lra.2019.2928761] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In the present work we discuss a novel dynamic control approach for magnetically actuated robots, by proposing an adaptive control technique, robust towards parametric uncertainties and unknown bounded disturbances. The former generally arise due to partial knowledge of the robots' dynamic parameters, such as inertial factors, the latter are the outcome of unpredictable interaction with unstructured environments. In order to show the application of the proposed approach, we consider controlling the Magnetic Flexible Endoscope (MFE) which is composed of a soft-tethered Internal Permanent Magnet (IPM), actuated with a single External Permanent Magnet (EPM). We provide with experimental analysis to show the possibility of levitating the MFE - one of the most difficult tasks with this platform - in case of partial knowledge of the IPM's dynamics and no knowledge of the tether's behaviour. Experiments in an acrylic tube show a reduction of contact of the 32% compared to non-levitating techniques and 1.75 times faster task completion with respect to previously proposed levitating techniques. More realistic experiments, performed in a colon phantom, show that levitating the capsule achieves faster and smoother exploration and that the minimum time for completing the task is attained by the proposed approach.
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Affiliation(s)
- Lavinia Barducci
- STORM Lab UK, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - Giovanni Pittiglio
- STORM Lab UK, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - Joseph C Norton
- STORM Lab UK, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - Keith L Obstein
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA, and with the STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Pietro Valdastri
- STORM Lab UK, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
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21
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Affiliation(s)
- Jihong Min
- Andrew and Peggy Cherng Department of Medical EngineeringDivision of Engineering and Applied ScienceCalifornia Institute of Technology Pasadena CA 91125 USA
| | - Yiran Yang
- Andrew and Peggy Cherng Department of Medical EngineeringDivision of Engineering and Applied ScienceCalifornia Institute of Technology Pasadena CA 91125 USA
| | - Zhiguang Wu
- Andrew and Peggy Cherng Department of Medical EngineeringDivision of Engineering and Applied ScienceCalifornia Institute of Technology Pasadena CA 91125 USA
| | - Wei Gao
- Andrew and Peggy Cherng Department of Medical EngineeringDivision of Engineering and Applied ScienceCalifornia Institute of Technology Pasadena CA 91125 USA
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22
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The large intestine from fetal period to adulthood and its impact on the course of colonoscopy. Ann Anat 2019; 224:17-22. [PMID: 30914345 DOI: 10.1016/j.aanat.2019.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 12/19/2022]
Abstract
The human large intestine in the living adult has a total length of about 1300 mm, ranging from 1100 to 2108 mm. The development of the gut continues after birth, up to the age 4-5. The large intestine ascends at the beginning in the right abdominal quadrant, then it traverses the abdominal cavity, and finally it descends to the anus. The left and right colic flexures are the basic flexions between the transverse, ascending and descending colon, respectively. Additionally, there are secondary bendings between intestinal segments. The angles between the neighbouring parts can vary between examined subjects. Most of the angulations can be found in the transverse (range 2-9) and sigmoid colon (range 1-9), making them the most troublesome parts to pass with a colonoscope. Colonoscopy (usually performed in the left lateral or supine position) is one of the most important examination of the large intestine mucus membrane. During this procedure the endoscope is passed through the colon into the cecum or terminal ilium. The individual anatomical features (tortuosity, supernumerary loops and elongation) may slow down or interfere with the progress of the scope. We summarize current knowledge on the human large intestine from the fetal period to adulthood and carve out some aspects that are currently less known to colonoscopists.
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23
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Pittiglio G, Barducci L, Martin JW, Norton JC, Avizzano CA, Obstein KL, Valdastri P. Magnetic Levitation for Soft-Tethered Capsule Colonoscopy Actuated With a Single Permanent Magnet: A Dynamic Control Approach. IEEE Robot Autom Lett 2019; 4:1224-1231. [PMID: 31304240 DOI: 10.1109/lra.2019.2894907] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The present letter investigates a novel control approach for magnetically driven soft-tethered capsules for colonoscopy-a potentially painless approach for colon inspection. The focus of this work is on a class of devices composed of a magnetic capsule endoscope actuated by a single external permanent magnet. Actuation is achieved by manipulating the external magnet with a serial manipulator, which in turn produces forces and torques on the internal magnetic capsule. We propose a control strategy which, counteracting gravity, achieves levitation of the capsule. This technique, based on a nonlinear backstepping approach, is able to limit contact with the colon walls, reducing friction, avoiding contact with internal folds, and facilitating the inspection of nonplanar cavities. The approach is validated on an experimental setup, which embodies a general scenario faced in colonoscopy. The experiments show that we can attain 19.5% of contact with the colon wall, compared to the almost 100% of previously proposed approaches. Moreover, we show that the control can be used to navigate the capsule through a more realistic environment-a colon phantom-with reasonable completion time.
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Affiliation(s)
- Giovanni Pittiglio
- STORM Lab UK, School of Electronic and Electrical Engineering, University of Leeds, Leeds LS2 9JT, U.K
| | - Lavinia Barducci
- STORM Lab UK, School of Electronic and Electrical Engineering, University of Leeds, Leeds LS2 9JT, U.K
| | - James W Martin
- STORM Lab UK, School of Electronic and Electrical Engineering, University of Leeds, Leeds LS2 9JT, U.K
| | - Joseph C Norton
- STORM Lab UK, School of Electronic and Electrical Engineering, University of Leeds, Leeds LS2 9JT, U.K
| | - Carlo A Avizzano
- Perceptual Robotics Laboratory, Scuola Superiore SantAnna, Pisa 56100, Italy
| | - Keith L Obstein
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37232 USA; STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235 USA
| | - Pietro Valdastri
- STORM Lab UK, School of Electronic and Electrical Engineering, University of Leeds, Leeds LS2 9JT, U.K
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Nam SJ, Lee HS, Lim YJ. Evaluation of Gastric Disease with Capsule Endoscopy. Clin Endosc 2018; 51:323-328. [PMID: 30078305 PMCID: PMC6078934 DOI: 10.5946/ce.2018.092] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 12/15/2022] Open
Abstract
The clinical indication for capsule endoscopy has expanded from small bowel evaluation to include esophagus or colon evaluation.Nevertheless, the role of capsule endoscopy in evaluation of the stomach is very limited because of the large volume and surface.However, efforts to develop an active locomotion system for capsule manipulation in detailed gastric evaluation are ongoing, becausethe technique is non-invasive, convenient, and safe, and requires no sedation. Studies have successfully reported gastric evaluation usinga magnetic-controlled capsule endoscopy system. Advances in technology suggest that capsule endoscopy will have a major role notonly in the evaluation of gastric disorders but also in the pathologic diagnosis, intervention, and treatment of any gastrointestinal tractdisorder.
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Affiliation(s)
- Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hyun Seok Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University, College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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Fracczak L, Kobierska A, Koter K, Zak P, Czkwianiac E, Kolejwa M, Nowak A, Socha-Banasiak A, Slezak J. The diagnostic gastroenterology needs in relation to exisiting tools, research and design work on a new tool in endoscopy field. 2017 22ND INTERNATIONAL CONFERENCE ON METHODS AND MODELS IN AUTOMATION AND ROBOTICS (MMAR) 2017:705-710. [DOI: 10.1109/mmar.2017.8046914] [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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Mapara SS, Patravale VB. Medical capsule robots: A renaissance for diagnostics, drug delivery and surgical treatment. J Control Release 2017; 261:337-351. [PMID: 28694029 DOI: 10.1016/j.jconrel.2017.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 12/11/2022]
Abstract
The advancements in electronics and the progress in nanotechnology have resulted in path breaking development that will transform the way diagnosis and treatment are carried out currently. This development is Medical Capsule Robots, which has emerged from the science fiction idea of robots travelling inside the body to diagnose and cure disorders. The first marketed capsule robot was a capsule endoscope developed to capture images of the gastrointestinal tract. Today, varieties of capsule endoscopes are available in the market. They are slightly larger than regular oral capsules, made up of a biocompatible case and have electronic circuitry and mechanisms to capture and transmit images. In addition, robots with diagnostic features such as in vivo body temperature detection and pH monitoring have also been launched in the market. However, a multi-functional unit that will diagnose and cure diseases inside the body has not yet been realized. A remote controlled capsule that will undertake drug delivery and surgical treatment has not been successfully launched in the market. High cost, inadequate power supply, lack of control over drug release, limited space for drug storage on the capsule, inadequate safety and no mechanisms for active locomotion and anchoring have prevented their entry in the market. The capsule robots can revolutionize the current way of diagnosis and treatment. This paper discusses in detail the applications of medical capsule robots in diagnostics, drug delivery and surgical treatment. In diagnostics, detailed analysis has been presented on wireless capsule endoscopes, issues associated with the marketed versions and their corresponding solutions in literature. Moreover, an assessment has been made of the existing state of remote controlled capsules for targeted drug delivery and surgical treatment and their future impact is predicted. Besides the need for multi-functional capsule robots and the areas for further research have also been highlighted.
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Affiliation(s)
- Sanyat S Mapara
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, Matunga East, Mumbai 400019, India
| | - Vandana B Patravale
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, Matunga East, Mumbai 400019, India.
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27
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Stewart FR, Qiu Y, Lay HS, Newton IP, Cox BF, Al-Rawhani MA, Beeley J, Liu Y, Huang Z, Cumming DRS, Näthke I, Cochran S. Acoustic Sensing and Ultrasonic Drug Delivery in Multimodal Theranostic Capsule Endoscopy. SENSORS 2017; 17:s17071553. [PMID: 28671642 PMCID: PMC5539857 DOI: 10.3390/s17071553] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 12/22/2022]
Abstract
Video capsule endoscopy (VCE) is now a clinically accepted diagnostic modality in which miniaturized technology, an on-board power supply and wireless telemetry stand as technological foundations for other capsule endoscopy (CE) devices. However, VCE does not provide therapeutic functionality, and research towards therapeutic CE (TCE) has been limited. In this paper, a route towards viable TCE is proposed, based on multiple CE devices including important acoustic sensing and drug delivery components. In this approach, an initial multimodal diagnostic device with high-frequency quantitative microultrasound that complements video imaging allows surface and subsurface visualization and computer-assisted diagnosis. Using focused ultrasound (US) to mark sites of pathology with exogenous fluorescent agents permits follow-up with another device to provide therapy. This is based on an US-mediated targeted drug delivery system with fluorescence imaging guidance. An additional device may then be utilized for treatment verification and monitoring, exploiting the minimally invasive nature of CE. While such a theranostic patient pathway for gastrointestinal treatment is presently incomplete, the description in this paper of previous research and work under way to realize further components for the proposed pathway suggests it is feasible and provides a framework around which to structure further work.
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Affiliation(s)
- Fraser R Stewart
- School of Life Sciences, University of Dundee, Dundee DD1 5EH, Scotland, UK.
| | - Yongqiang Qiu
- School of Engineering, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.
| | - Holly S Lay
- School of Engineering, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.
| | - Ian P Newton
- School of Life Sciences, University of Dundee, Dundee DD1 5EH, Scotland, UK.
| | - Benjamin F Cox
- School of Medicine, University of Dundee, Dundee DD1 9SY, Scotland, UK.
| | | | - James Beeley
- School of Engineering, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.
| | - Yangminghao Liu
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK.
| | - Zhihong Huang
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK.
| | - David R S Cumming
- School of Engineering, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.
| | - Inke Näthke
- School of Life Sciences, University of Dundee, Dundee DD1 5EH, Scotland, UK.
| | - Sandy Cochran
- School of Engineering, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.
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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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Abstract
PURPOSE OF REVIEW The breakthrough success of capsule endoscopy and device-assisted enteroscopy has inspired researchers to test and push the boundary of these technologies. The authors herein summarize the latest and most significant studies with clinical impact. RECENT FINDINGS Competing capsule endoscopy models have enriched the platform of this wireless device. The role of capsule endoscopy in Crohn's disease is expanding as we learn more of the significance of disease distribution and response to treatment. The benefit of capsule endoscopy in abdominal pain has previously been sceptical, but may have a role. Device-assisted enteroscopy demonstrates significant benefit in the management of patients with Crohn's disease and Peutz-Jeghers syndrome. On the contrary, long-term data suggest that endotherapy to small bowel angioectasia may not be as beneficial to patients as we once thought. The role of device-assisted enteroscopy in novel territory, including coeliac disease and endoscopic retrograde cholangiopancreatography, continues to be tested. SUMMARY The limit of capsule endoscopy and enteroscopy is yet to be reached. Accumulating long-term data alludes to the benefits of our current practice while spawning novel indications for small bowel endoscopy.
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Leung BHK, Poon CCY, Zhang R, Zheng Y, Chan CKW, Chiu PWY, Lau JYW, Sung JJY. A Therapeutic Wireless Capsule for Treatment of Gastrointestinal Haemorrhage by Balloon Tamponade Effect. IEEE Trans Biomed Eng 2016; 64:1106-1114. [PMID: 27416587 DOI: 10.1109/tbme.2016.2591060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Wireless capsule endoscope (WCE) is a revolutionary approach to diagnose small bowel pathologies. Currently available WCEs are mostly passive devices with image capturing function only, while on-going efforts have been placed on robotizing WCEs or to enhance them with therapeutic functions. In this paper, the authors present a novel inflatable WCE for haemostasis in the gastrointestinal (GI) tracts by balloon tamponade effect. METHODS The proposed wireless capsule consists of a balloon that can be inflated using the endothermic reaction of acid and base. When the balloon reached a precalculated pressure level, it is able to stop at a bleeding site in the bowel, and achieve haemostasis by tamponade effect. The prototype is 14 mm in diameter, with three sections of 13, 35, and 12 mm in length, respectively. The three sections are linked together with flexible joints and enclosed in a silicone balloon. The prototypes were tested in ex vivo porcine intestine models. RESULTS In the ten ex vivo trials conducted, the inflatable wireless capsule achieved average balloon pressure of 46.0 mmHg and withstood average maximum longitudinal pulling force at 1.46 N. An in vivo study was carried out as a proof-of-concept for treating bleeding in a porcine model. The proposed inflatable WCE succeeded in the animal test by controlling haemostasis within 5 min. No rebleeding was observed in the next 20 min. CONCLUSION The results suggested that the inflatable capsule with a real-time bleeding detection algorithm can be implemented. Moreover, the proposed inflatable WCE prototype can achieve haemorrhage control in the lower GI. SIGNIFICANCE To our best knowledge, this is the first study that demonstrated the potential to treat GI haemorrhage by an inflatable WCE. The proposed capsule enables the development of a closed-loop system based on a body sensor network to provide early treatment of GI bleeding for p-medicine.
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Ciuti G, Caliò R, Camboni D, Neri L, Bianchi F, Arezzo A, Koulaouzidis A, Schostek S, Stoyanov D, Oddo CM, Magnani B, Menciassi A, Morino M, Schurr MO, Dario P. Frontiers of robotic endoscopic capsules: a review. JOURNAL OF MICRO-BIO ROBOTICS 2016; 11:1-18. [PMID: 29082124 PMCID: PMC5646258 DOI: 10.1007/s12213-016-0087-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 12/15/2022]
Abstract
Digestive diseases are a major burden for society and healthcare systems, and with an aging population, the importance of their effective management will become critical. Healthcare systems worldwide already struggle to insure quality and affordability of healthcare delivery and this will be a significant challenge in the midterm future. Wireless capsule endoscopy (WCE), introduced in 2000 by Given Imaging Ltd., is an example of disruptive technology and represents an attractive alternative to traditional diagnostic techniques. WCE overcomes conventional endoscopy enabling inspection of the digestive system without discomfort or the need for sedation. Thus, it has the advantage of encouraging patients to undergo gastrointestinal (GI) tract examinations and of facilitating mass screening programmes. With the integration of further capabilities based on microrobotics, e.g. active locomotion and embedded therapeutic modules, WCE could become the key-technology for GI diagnosis and treatment. This review presents a research update on WCE and describes the state-of-the-art of current endoscopic devices with a focus on research-oriented robotic capsule endoscopes enabled by microsystem technologies. The article also presents a visionary perspective on WCE potential for screening, diagnostic and therapeutic endoscopic procedures.
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Affiliation(s)
- Gastone Ciuti
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - R Caliò
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - D Camboni
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - L Neri
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy.,Ekymed S.r.l., Livorno, Italy
| | - F Bianchi
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - A Arezzo
- Department of Surgical Disciplines, University of Torino, Torino, Italy
| | - A Koulaouzidis
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | | | - D Stoyanov
- Centre for Medical Image Computing and the Department of Computer Science, University College London, London, UK
| | - C M Oddo
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | | | - A Menciassi
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - M Morino
- Department of Surgical Disciplines, University of Torino, Torino, Italy
| | - M O Schurr
- Ovesco Endoscopy AG, Tübingen, Germany.,Steinbeis University Berlin, Berlin, Germany
| | - P Dario
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
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Gao J, Yan G. Locomotion Analysis of an Inchworm-Like Capsule Robot in the Intestinal Tract. IEEE Trans Biomed Eng 2016; 63:300-10. [DOI: 10.1109/tbme.2015.2456103] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Saurin JC, Beneche N, Chambon C, Pioche M. Challenges and Future of Wireless Capsule Endoscopy. Clin Endosc 2016; 49:26-9. [PMID: 26855920 PMCID: PMC4743730 DOI: 10.5946/ce.2016.49.1.26] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/30/2015] [Indexed: 01/17/2023] Open
Abstract
In 2015, capsule endoscopy was introduced as the main investigation method for small bowel mucosal diseases, and its role in colonic diseases has been gradually revealed. Future challenges for capsule endoscopy, besides improvements of image quality and visualization of each part of the small bowel and colonic mucosa, include the development of gastric capsules, the capacity to perform histological examination of the mucosa, and maybe in the future, some capsule endoscopy-driven therapeutics. The aim of this review was to evaluate the clinical demands and feasibility of achieving the aforementioned objectives.
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Affiliation(s)
- Jean-Christophe Saurin
- Department of Gastroenterology, E. Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Beneche
- Department of Gastroenterology, E. Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Christine Chambon
- Department of Gastroenterology, E. Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mathieu Pioche
- Department of Gastroenterology, E. Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Kwack WG, Lim YJ. Current Status and Research into Overcoming Limitations of Capsule Endoscopy. Clin Endosc 2016; 49:8-15. [PMID: 26855917 PMCID: PMC4743729 DOI: 10.5946/ce.2016.49.1.8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 12/13/2022] Open
Abstract
Endoscopic investigation has a critical role in the diagnosis and treatment of gastrointestinal (GI) diseases. Since 2001, capsule endoscopy (CE) has been available for small-bowel exploration and is under continuous development. During the past decade, CE has achieved impressive improvements in areas such as miniaturization, resolution, and battery life. As a result, CE is currently a first-line tool for the investigation of the small bowel in obscure gastrointestinal bleeding and is a useful alternative to wired enteroscopy. Nevertheless, CE still has several limitations, such as incomplete examination and limited diagnostic and therapeutic capabilities. To resolve these problems, many groups have suggested several models (e.g., controlled CO2 insufflation system, magnetic navigation system, mobile robotic platform, tagging and biopsy equipment, and targeted drug-delivery system), which are in development. In the near future, new technological advances will improve the capabilities of CE and broaden its spectrum of applications not only for the small bowel but also for the colon, stomach, and esophagus. The purpose of this review is to introduce the current status of CE and to review the ongoing development of solutions to address its limitations.
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Affiliation(s)
- Won Gun Kwack
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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35
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Alazmani A, Hood A, Jayne D, Neville A, Culmer P. Quantitative assessment of colorectal morphology: Implications for robotic colonoscopy. Med Eng Phys 2016; 38:148-54. [PMID: 26762775 DOI: 10.1016/j.medengphy.2015.11.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/16/2015] [Accepted: 11/15/2015] [Indexed: 01/14/2023]
Abstract
This paper presents a method of characterizing the distribution of colorectal morphometrics. It uses three-dimensional region growing and topological thinning algorithms to determine and visualize the luminal volume and centreline of the colon, respectively. Total and segmental lengths, diameters, volumes, and tortuosity angles were then quantified. The effects of body orientations on these parameters were also examined. Variations in total length were predominately due to differences in the transverse colon and sigmoid segments, and did not significantly differ between body orientations. The diameter of the proximal colon was significantly larger than the distal colon, with the largest value at the ascending and cecum segments. The volume of the transverse colon was significantly the largest, while those of the descending colon and rectum were the smallest. The prone position showed a higher frequency of high angles and consequently found to be more torturous than the supine position. This study yielded a method for complete segmental measurements of healthy colorectal anatomy and its tortuosity. The transverse and sigmoid colons were the major determinant in tortuosity and morphometrics between body orientations. Quantitative understanding of these parameters may potentially help to facilitate colonoscopy techniques, accuracy of polyp spatial distribution detection, and design of novel endoscopic devices.
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Affiliation(s)
- A Alazmani
- Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK.
| | - A Hood
- Academic Surgical Unit, St. James's University Hospital, Leeds LS9 7TF, UK
| | - D Jayne
- Academic Surgical Unit, St. James's University Hospital, Leeds LS9 7TF, UK
| | - A Neville
- Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - P Culmer
- Institute of Engineering Systems and Design, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
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36
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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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37
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Tseng YC, Hsu HC, Han P, Tsai CM. Color multiplexing method to capture front and side images with a capsule endoscope. APPLIED OPTICS 2015; 54:E241-E248. [PMID: 26479660 DOI: 10.1364/ao.54.00e241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper proposes a capsule endoscope (CE), based on color multiplexing, to simultaneously record front and side images. Only one lens associated with an X-cube prism is employed to catch the front and side view profiles in the CE. Three color filters and polarizers are placed on three sides of an X-cube prism. When objects locate at one of the X-cube's three sides, front and side view profiles of different colors will be caught through the proposed lens and recorded at the color image sensor. The proposed color multiplexing CE (CMCE) is designed with a field of view of up to 210 deg and a 180 lp/mm resolution under f-number 2.8 and overall length 13.323 mm. A ray-tracing simulation in the CMCE with the color multiplexing mechanism verifies that the CMCE not only records the front and side view profiles at the same time, but also has great image quality at a small size.
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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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Koulaouzidis A, Iakovidis DK, Karargyris A, Plevris JN. Optimizing lesion detection in small-bowel capsule endoscopy: from present problems to future solutions. Expert Rev Gastroenterol Hepatol 2015; 9:217-35. [PMID: 25169106 DOI: 10.1586/17474124.2014.952281] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This review presents issues pertaining to lesion detection in small-bowel capsule endoscopy (SBCE). The use of prokinetics, chromoendoscopy, diagnostic yield indicators, localization issues and the use of 3D reconstruction are presented. The authors also review the current status (and future expectations) in automatic lesion detection software development. Automatic lesion detection and reporting, and development of an accurate lesion localization system are the main software challenges of our time. The 'smart', selective and judicious use (before as well as during SBCE) of prokinetics in combination with other modalities (such as real time and/or purge) improves the completion rate of SBCE. The tracking of the capsule within the body is important for the localization of abnormal findings and planning of further therapeutic interventions. Currently, localization is based on transit time. Recently proposed software and hardware solutions are proposed herein. Moreover, the feasibility of software-based 3D representation (attempt for 3D reconstruction) is examined.
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40
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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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Bouchard S, Ibrahim M, Gossum AV. Video capsule endoscopy: perspectives of a revolutionary technique. World J Gastroenterol 2014; 20:17330-17344. [PMID: 25516644 PMCID: PMC4265591 DOI: 10.3748/wjg.v20.i46.17330] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 07/25/2014] [Accepted: 09/12/2014] [Indexed: 02/06/2023] Open
Abstract
Video capsule endoscopy (VCE) was launched in 2000 and has revolutionized direct endoscopic imaging of the gut. VCE is now a first-line procedure for exploring the small bowel in cases of obscure digestive bleeding and is also indicated in some patients with Crohn's disease, celiac disease, and polyposis syndrome. A video capsule has also been designed for visualizing the esophagus in order to detect Barrett's esophagus or esophageal varices. Different capsules are now available and differ with regard to dimensions, image acquisition rate, battery life, field of view, and possible optical enhancements. More recently, the use of VCE has been extended to exploring the colon. Within the last 5 years, tremendous developments have been made toward increasing the capabilities of the colon capsule. Although colon capsule cannot be proposed as a first-line colorectal cancer screening procedure, colon capsule may be used in patients with incomplete colonoscopy or in patients who are unwilling to undergo colonoscopy. In the near future, new technological developments will improve the diagnostic yield of VCE and broaden its therapeutic capabilities.
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Marco B, Ekawahyu S, Christian Di N, Pietro V. SMAC — A Modular Open Source Architecture for Medical Capsule Robots. INT J ADV ROBOT SYST 2014. [DOI: 10.5772/59505] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The field of Medical Capsule Robots (MCRs) is gaining momentum in the robotics community, with applications spanning from abdominal surgery to gastrointestinal (GI) endoscopy. MCRs are miniature multifunctional devices usually constrained in both size and on-board power supply. The design process for MCRs is time consuming and resource intensive, as it involves the development of custom hardware and software components. In this work, we present the STORM Lab Modular Architecture for Capsules (SMAC), a modular open source architecture for MCRs aiming to provide the MCRs research community with a tool for shortening the design and development time for capsule robots. The SMAC platform consists of both hardware modules and firmware libraries that can be used for developing MCRs. In particular, the SMAC modules are miniature boards of uniform diameter (i.e., 9.8 mm) that are able to fulfill five different functions: signal coordination combined with wireless data transmission, sensing, actuation, powering and vision/illumination. They are small in size, low power, and have reconfigurable software libraries for the Hardware Abstraction Layer (HAL), which has been proven to work reliably for different types of MCRs. A design template for a generic SMAC application implementing a robust communication protocol is presented in this work, together with its finite state machine abstraction, capturing all the architectural components involved. The reliability of the wireless link is assessed for different levels of data transmission power and separation distances. The current consumption for each SMAC module is quantified and the timing of a SMAC radio message transmission is characterized. Finally, the applicability of SMAC in the field of MCRs is discussed by analysing examples from the literature.
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Affiliation(s)
- Beccani Marco
- STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Susilo Ekawahyu
- STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Natali Christian Di
- STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Valdastri Pietro
- STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
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Neumann H, Fry LC, Nägel A, Neurath MF. Wireless capsule endoscopy of the small intestine: a review with future directions. Curr Opin Gastroenterol 2014; 30:463-71. [PMID: 25029549 DOI: 10.1097/mog.0000000000000101] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Here, we review the clinical applications of small bowel capsule endoscopy. Moreover, we provide an outlook on the exceptional future developments of small bowel capsule endoscopy. We discuss clinical algorithms for diagnosis of small bowel diseases. Multiple studies have shown the potential of capsule endoscopy for identification of the bleeding source located in the small bowel and the increased diagnostic yield over radiographic studies. Capsule endoscopy could detect villous atrophy and severe complications in patients with nonresponsive celiac disease. In addition, small bowel capsule endoscopy was proven as a valid tool to diagnose polyps and tumors and Crohn's disease. SUMMARY Major current clinical indications of capsule endoscopy in the small bowel include evaluation of obscure gastrointestinal bleeding, diagnosis and surveillance of small bowel polyps and tumors, celiac disease and Crohn's disease. Recent developments have also passed the way for small bowel capsule endoscopy to become a therapeutic instrument.
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Affiliation(s)
- Helmut Neumann
- aDepartment of Medicine I, University of Erlangen-Nürnberg, Erlangen bLudwig Demling Endoscopic Center of Excellence, University Hospital Erlangen, Erlangen, Germany cDivision of Gastroenterology and Hepatology, Basil Hirschowitz Endoscopic Center of Excellence, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Sliker LJ, Ciuti G. Flexible and capsule endoscopy for screening, diagnosis and treatment. Expert Rev Med Devices 2014; 11:649-66. [PMID: 25148269 DOI: 10.1586/17434440.2014.941809] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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.
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Affiliation(s)
- Levin J Sliker
- Department of Mechanical Engineering, University of Colorado, 114 ECME, Engineering Center, 1111 Engineering Drive, Boulder, CO 80309-0427, USA
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Munoz F, Alici G, Li W, Tan Z, Xiong K, Li Y, Ye Y, Luo ZP, He F, Gong Y. A review of drug delivery systems for capsule endoscopy. Adv Drug Deliv Rev 2014; 71:77-85. [PMID: 24384373 DOI: 10.1016/j.addr.2013.12.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 12/10/2013] [Accepted: 12/19/2013] [Indexed: 12/12/2022]
Abstract
The development of a highly controllable drug delivery system (DDS) for capsule endoscopy has become an important field of research due to its promising applications in therapeutic treatment of diseases in the gastrointestinal (GI) tract and drug absorption studies. Several factors need to be considered to establish the minimum requirements for a functional DDS. Environmental factors of the GI tract and also pharmaceutical factors can help determine the requirements to be met by a DDS in an endoscopic capsule. In order to minimize the influence of such factors on the performance of an effective DDS, at least two mechanisms should be incorporated into a capsule endoscope: an anchoring mechanism to control the capsule position and a drug release mechanism to control variables such as the drug release rate, number of doses and amount of drug released. The implementation of such remotely actuated mechanisms is challenging due to several constraints, including the limited space available in a swallowable capsule endoscope and the delicate and complex environment within the GI tract. This paper presents a comprehensive overview of existing DDS. A comparison of such DDS for capsule endoscopy based on the minimum DDS requirements is presented and future work is also discussed.
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Affiliation(s)
| | | | | | - Zifang Tan
- School of Engineering, Sun Yat-sen University, Guangzhou 510006, China
| | - Ke Xiong
- Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yan Li
- School of Engineering, Sun Yat-sen University, Guangzhou 510006, China; Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instruments, Sun Yat-sen University, Guangzhou 510006, China
| | - Yun Ye
- School of Engineering, Sun Yat-sen University, Guangzhou 510006, China; Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instruments, Sun Yat-sen University, Guangzhou 510006, China
| | - Zong-Ping Luo
- Orthopaedic Institute, Soochow University, Suzhou 215006, China; Department of Orthopaedics, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Fan He
- School of Engineering, Sun Yat-sen University, Guangzhou 510006, China; Orthopaedic Institute, Soochow University, Suzhou 215006, China; Department of Orthopaedics, First Affiliated Hospital of Soochow University, Suzhou 215006, China.
| | - Yihong Gong
- School of Engineering, Sun Yat-sen University, Guangzhou 510006, China; Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instruments, Sun Yat-sen University, Guangzhou 510006, China.
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Quaglia C, Tognarelli S, Sinibaldi E, Funaro N, Dario P, Menciassi A. Wireless Robotic Capsule for Releasing Bioadhesive Patches in the Gastrointestinal Tract. J Med Device 2013. [DOI: 10.1115/1.4025450] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A novel, miniature wireless robotic capsule for releasing bioadhesive patches in the gastrointestinal (GI) tract was designed, fabricated, and preliminarily tested. In particular, the assembled prototype was successfully navigated in a GI phantom, up to a target site where the release mechanism was verified. Then, deployment of a bioadhesive patch onto ex vivo porcine tissue was accomplished, and patch adhesion strength was verified. The main application of the present system is the deployment of anchoring patches for miniature robotic modules to be operated in the targeted anatomical domain. Such an innovative application stems from the wise blend of robotics and bioadhesion. Obtained results, which are consistent with previous investigations by the group, confirm the viability of the adopted bioadhesives for the envisaged anchoring tasks. The present feasibility study complies with the spirit of minimally invasive, wireless diagnosis, and therapy, and provides a preliminary contribution for their advancement.
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Affiliation(s)
| | | | - Edoardo Sinibaldi
- Istituto Italiano di Tecnologia, Center for Micro-BioRobotics@SSSA, Pontedera, Italy e-mail:
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Koulaouzidis A, Rondonotti E, Karargyris A. Small-bowel capsule endoscopy: a ten-point contemporary review. World J Gastroenterol 2013; 19:3726-46. [PMID: 23840112 PMCID: PMC3699039 DOI: 10.3748/wjg.v19.i24.3726] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/27/2013] [Accepted: 06/01/2013] [Indexed: 02/06/2023] Open
Abstract
The introduction of capsule endoscopy (CE) in clinical practice increased the interest for the study of the small-bowel. Consequently, in about 10 years, an impressive quantity of literature on indications, diagnostic yield (DY), safety profile and technical evolution of CE has been published as well as several reviews. At present time, there are 5 small-bowel capsule enteroscopy (SBCE) models in the worldwide market. Head-to-head trials have showed in the great majority of studies comparable results in terms of DY, image quality and completion rate. CE meta-analyses formed the basis of national/international guidelines; these guidelines place CE in a prime position for the diagnostic work-up of patients with obscure gastrointestinal bleeding, known and/or suspected Crohn's disease and possible small-bowel neoplasia. A 2-L polyethylene glycol-based purge, administered the day before the procedure, is the most widely practiced preparation regimen. Whether this regimen can be further improved (i.e., by further decreasing its volume, changing the timing of administration, coupling it with prokinetics and/or other factors) or if it can really affect the DY, is still under discussion. Faecal calprotectin has been used in SBCE studies in two settings: in patients taking non-steroidal anti-inflammatory drugs, to evaluate the type and extent of mucosal damage and, more importantly from a clinical point of view, in patients with known or suspected Crohn's disease for assessment of inflammation activity. Although there is still a lot of debate around the exact reasons of SBCE poor performance in various small-bowel segments, it is worth to remember that the capsule progress is non-steerable, hence more rapid in the proximal than in lower segments of the small-bowel. Capsule aspiration, a relatively unexpected complication, has been reported with increasing frequency. This is probably related with the increase in the mean age of patients undergoing CE. CE video review is a time-consuming procedure. Therefore, several attempts have been made to develop technical software features, in order to make CE video analysis easier and shorter (without jeopardizing its accuracy). Suspected Blood Indicator, QuickView and Fujinon Intelligent Chromo Endoscopy are some of the software tools that have been checked in various clinical studies to date.
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Gorlewicz JL, Battaglia S, Smith BF, Ciuti G, Gerding J, Menciassi A, Obstein KL, Valdastri P, Webster RJ. Wireless insufflation of the gastrointestinal tract. IEEE Trans Biomed Eng 2013; 60:1225-33. [PMID: 23212312 PMCID: PMC3850772 DOI: 10.1109/tbme.2012.2230631] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite clear patient experience advantages, low specificity rates have thus far prevented swallowable capsule endoscopes from replacing traditional endoscopy for diagnosis of colon disease. One explanation for this is that capsule endoscopes lack the ability to provide insufflation, which traditional endoscopes use to distend the intestine for a clear view of the internal wall. To provide a means of insufflation from a wireless capsule platform, in this paper we use biocompatible effervescent chemical reactions to convert liquids and powders carried onboard a capsule into gas. We experimentally evaluate the quantity of gas needed to enhance capsule visualization and locomotion, and determine how much gas can be generated from a given volume of reactants. These experiments motivate the design of a wireless insufflation capsule, which is evaluated in ex vivo experiments. These experiments illustrate the feasibility of enhancing visualization and locomotion of endoscopic capsules through wireless insufflation.
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Handa O, Naito Y, Okayama T, Yoshida N, Kamada K, Katada K, Uchiyama K, Ishikawa T, Takagi T, Konishi H, Yagi N, Kokura S, Yoshikawa T. Endoscopic diagnosis of small intestinal diseases. Clin J Gastroenterol 2013; 6:94-98. [PMID: 26181444 DOI: 10.1007/s12328-013-0364-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/18/2013] [Indexed: 01/26/2023]
Abstract
The technological development in endoscopy is directed toward improved accuracy of the diagnoses of novel diseases. The capsule endoscope and balloon-assisted endoscope are examples of such technological development. By these novel technologies, the small intestine can be examined in more detail. Therefore, an increasing number of novel diseases have been discovered, requiring the establishment of diagnosis and treatment strategies for these unknown diseases. In particular, obscure gastrointestinal bleeding, Crohn's disease, and nonsteroidal anti-inflammatory drug-induced enteropathy are of great interest to endoscopists. The capsule endoscope is the best method for screening the small intestine; however, the development of supporting methods such as the patency capsule is eagerly desired.
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Affiliation(s)
- Osamu Handa
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji Agaru, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji Agaru, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Tetsuya Okayama
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji Agaru, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji Agaru, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuhiro Kamada
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji Agaru, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuhiro Katada
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji Agaru, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji Agaru, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Ishikawa
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji Agaru, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tomohisa Takagi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji Agaru, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji Agaru, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Nobuaki Yagi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji Agaru, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoshi Kokura
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji Agaru, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshikazu Yoshikawa
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji Agaru, Kamigyo-ku, Kyoto, 602-8566, Japan
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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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