Capsule endoscopy was initially developed 18 years ago with the first small bowel imaging capsule. Since its initial creation, improvements have been made to capsule design across many areas. These include improve imaging with higher resolution, improved frame rates to capture more events, increased battery life to allow imaging of the colon as well as the small bowel, and artificial intelligence to enhance detection of bleeding lesions. 360-degree imaging to allow examination of the entire mucosal surface has become reality though the amount of data now is straining the data transmission systems and capsules now need to be retrieved which seems to be a step backwards. Magnetic steering of the capsule for increased inspection of potential lesions has been developed in Asia and is now making its way into the Western market. In essence, many of the proposed imaging functionalities that were discussed in the first decade of capsule development have come to fruition.
The next frontier for capsule endoscopy will be therapeutic applications which are under development. The near-term projects in the therapeutic realm have not yet been transitioned to clinical studies at this time and undoubtedly challenged by both engineering and regulatory issues. In particular, drug delivery systems have been promoted such as hemospray within a capsule that would allow for treatment of bleeding lesions. This could allow targeted drug delivery using steering with potential targeting of bleeding sites. Although, regulatory approval of these combination devices have more challenges for manufacturers. The ability to steer the capsule allows the potential delivery system to be more precise. Additional applications of this technology would include inflammatory bowel disease that often has spotty involvement of the gastrointestinal tract. Longer term development of nano-robots seems to be even a greater challenge but may be possible within the next decade. In particular, having capsule endoscopes releasing nano-robots that could be targeted towards neoplasia and bleeding are within the capabilities of bioengineering. Finally using self-propelled capsules as a robotic platform that can actually perform intraluminal operations also appears to be potentially feasible in the long term. A steerable incision device would allow potential treatment of small bowel luminal lesions would be a major advancement. |
