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Since 1996 we’ve built a reputation on being a rock solid cross-platform utility.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.Since 1950 orally administered capsules with radio frequency transmission capability have been prototyped with an aim to study the physiological parameters of the gastrointestinal tract. 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. Promising research efforts are presented with an emphasis on enabling active capsule locomotion. Clinical capsule applications are discussed with respect to each portion of the gastrointestinal tract. This review outlines clinical standards of the technology as well as recent advances in CE research. 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. ![]() Who was, in turn, acquired by Medtronic Inc. Was acquired by Covidien Ltd. The PillCam® series of capsules now encompasses about 95% of the CE market and has been used in over 1.7 million procedures worldwide and in more than 1,900 clinical studies ( Today, leading CE companies include: Medtronic Inc. Since the first FDA CE approval, over 2 million capsules have been ingested worldwide ( 3). The second capsule to gain FDA approval was the M2A Plus, which was later remarketed under the now familiar name: PillCam®. Esophageal capsule primary indications include diagnosing reflux esophagitis, Barrett’s esophagus, and varices ( 5). This review will examine current technology in clinical CE as well as the latest developments in image enhancement, investigation of active locomotion, and therapeutic possibilities.As opposed to the slow CE propagation through the small bowel, CE traversing the esophagus can reach speeds as high as 20 cm/s, leading to difficulties in assessing for pathology ( 4). CE is still most widely used in the small bowel due to a lack of a noninvasive alternative. Originally developed for diagnostic use in the small bowel, CE application has spread to use in the esophagus, stomach, and colon. Ltd., (South Korea), and CapsoVision Inc. Ltd, (China), IntroMedic Co. Excel for mac printing separate pagesThe diagnostic sensitivity and specificity reported for the ESO was 85.8% and 80.5% for varices, 98% and 100% for GERD, and 97% and 100% for Barrett’s esophagus ( 6). 12%, P<0.01) making higher frame capture rate essential for esophageal CE ( 4). The higher image capture rate was observed to be superior in visualization of the entire esophagus (76% vs. During a 2006 study of 42 patients with GERD, a PillCam ESO capturing images at 4 fps was compared to one capturing at 14 fps. Having undergone human trials ( 11), the CapsoCam takes a novel approach in providing a 360° panoramic view using 4 centralized cameras, each with >90° field of view. The MiroCam® (IntroMedic Co., Ltd., South Korea) has similar parameters but is the only capsule to use electrical field propagation through the body – what is referred to as Human Body Communication (HBD) ( The EndoCapsule® (Olympus Corporation, Japan) operates similarly to the PillCam SB but uses high-resolution Charge Coupled Device technology for imaging rather than a CMOS sensor ( ( 6).CapsoCam®SV-2 (CapsoVision® Inc., Saratoga, CA, USA) is the newest commercial CE and is the only one to employ on-board flash memory therefore requiring the patient to retrieve the capsule after passing it in their stool. This bidirectional communication allows for real time adjustment of image capture rate and light intensity ( 10). The PillCam® (Given Imaging Ltd.) is the most widely used capsule worldwide and the latest version, SB3 (FDA approved in 2013), acquires images at an adaptive rate of 2–6 fps.The OMOM® Smart Capsule (Chongqing Jinshan Science and Technology Co., Chongqing, China) is the first capsule to include two-way data transmission via wearable RF sensors. CEs in the esophagus are well tolerated but remain limited by poor visualization, passive motion, and lack of therapeutic ability and thus have not replaced flexible endoscopy for esophageal evaluation ( 5).CE is considered the gold standard for small bowel evaluation in patients with inflammatory bowel disease, suspected small bowel neoplastic lesions, and obscure GI bleeding ( 6– 9). Introducing a less invasive platform could prevent millions of patients from evading colonoscopy due to fear of an invasive procedure, procedural discomfort, bowel preparation, risk of adverse events, and the potential need for sedation ( 16, 17). As reported by nearly 100,000 cases of colon cancer are being diagnosed annually in the US alone while the number of occurrences is expected to increase by 62% by the year 2030 ( 15). Various commercial capsules and related specifications are reported in Table 1.Each year, colorectal cancer is the cause of nearly 608,000 deaths with approximately 14.5 million colonoscopies performed worldwide ( 13, 14). Head to head trials with the aforementioned small bowel capsules have suggested comparable diagnostic yield, image quality, and completion rate ( 3). The CapsoVision® system consists of the capsule, a stool retrieval tool: CapsoRetrieve®, the CapsoAccess® data retrieval system, and the CapsoView® application for viewing the images. The PillCam® COLON2 is actively used in Europe and Japan and has gained FDA clearance in 2014 in the United States for use in patients following an incomplete colonoscopy ( Capsule colonoscopy is not yet considered a replacement to traditional colonoscopy due to specificity rates recorded as low as 64% ( 20). To accelerate CE transit through the colon and distend the lumen around the capsule, sodium phosphate has been added to the traditional pre-procedural patient solution of polyethylene glycol ( 19). In a study of 104 patients, the PillCam® COLON2’s sensitivity and specificity for polyps ≥ 6 mm and ≥ 10 mm was 89% and 76%, and 88% and 89%, respectively ( 18). The 31.5 mm × 11.6 mm capsule, which like the PillCam® ESO2, has a camera at both longitudinal ends and has capability of adjusting image capture rate from 4 fps in stasis, to 35 fps when in motion ( 6).
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