Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2019; 25(30): 4051-4060
Published online Aug 14, 2019. doi: 10.3748/wjg.v25.i30.4051
Miniature gastrointestinal endoscopy: Now and the future
John J McGoran, Mark E McAlindon, Prasad G Iyer, Eric J Seibel, Rehan Haidry, Laurence B Lovat, Sarmed S Sami
John J McGoran, Digestive Diseases Centre, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
Mark E McAlindon, Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF, United Kingdom
Prasad G Iyer, Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN 55905, United States
Eric J Seibel, Department of Mechanical Engineering, University of Washington, 4000 Mason St, Seattle, WA 98195, United States
Rehan Haidry, Laurence B Lovat, Sarmed S Sami, Division of Surgery and Interventional Science, University College London, London WC1E 6BT, United Kingdom
Author contributions: McGoran JJ and Sami SS wrote the paper; McAlindon ME, Iyer PG, Seibel E, Haidry R and Lovat LB reviewed the manuscript and provided feedback.
Conflict-of-interest statement: Iyer PG has received research funding from Exact Sciences, Pentax Medical, Intromedic, Nine Point Medical, Symple Surgical, Medtronic and has acted as a consultant for Pentax Medical, Medtronic; Seibel EJ has a patent US# 10080484, 7813538 with royalties paid to VerAvanti, Inc, a patent US# 9872613, 9161684, 7530948 with royalties paid to NinePoint Medical, a patent US # 9872606, 9561078, 8537203, 7791009, 7616986, 7583872 with royalties paid to VerAvanti, Inc., a patent US# 9226687, 8840566, 8382662, 7901348 with royalties paid to Intuitive Surgical, and a patent US# 7068878, 6959130, 6845190, 6856712, 6975898, 6563105, 6294775 with royalties paid to VerAvanti, Inc; Haidry R has received educational grants to support research from Medtronic Ltd., Cook Endoscopy (fellowship support), Pentax Europe, C2 Therapeutics, Beamline diagnostics, Fractyl Ltd; Lovat LB has received research funding from Pentax Europe and Medtronic.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: John J McGoran, BM BCh, MRCP, MSc, Doctor, Research Fellow, Digestive Diseases Centre, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, United Kingdom. jmcgoran01@qub.ac.uk
Telephone: +44-300-3031573
Received: March 21, 2019
Peer-review started: March 21, 2019
First decision: May 24, 2019
Revised: June 22, 2019
Accepted: July 1, 2019
Article in press: July 3, 2019
Published online: August 14, 2019

Since its original application, gastrointestinal (GI) endoscopy has undergone many innovative transformations aimed at expanding the scope, safety, accuracy, acceptability and cost-effectiveness of this area of clinical practice. One method of achieving this has been to reduce the caliber of endoscopic devices. We propose the collective term “Miniature GI Endoscopy”. In this Opinion Review, the innovations in this field are explored and discussed. The progress and clinical use of the three main areas of miniature GI endoscopy (ultrathin endoscopy, wireless endoscopy and scanning fiber endoscopy) are described. The opportunities presented by these technologies are set out in a clinical context, as are their current limitations. Many of the positive aspects of miniature endoscopy are clear, in that smaller devices provide access to potentially all of the alimentary canal, while conferring high patient acceptability. This must be balanced with the costs of new technologies and recognition of device specific challenges. Perspectives on future application are also considered and the efforts being made to bring new innovations to a clinical platform are outlined. Current devices demonstrate that miniature GI endoscopy has a valuable place in investigation of symptoms, therapeutic intervention and screening. Newer technologies give promise that the potential for enhancing the investigation and management of GI complaints is significant.

Keywords: Ultrathin endoscopy, Capsule endoscopy, Single fiber endoscopy

Core tip: Miniature endoscopic devices play a growing role in the practice of gastroenterology and can come in many forms. They can offer easier access to the gastrointestinal tract, are often tolerated better than standard endoscopy and have the potential to boost diagnostic accuracy. Those properties give promise to advancements in therapeutic intervention and to screening for luminal disorders. Pitfalls remain, particularly with regard to cost, but the trend towards the application of miniature gastrointestinal endoscopy is clear and justifiable.