Antes da conferência, a News Farma falou com o Dr. Anastasios Koulaouzidis, gastrenterologista com especialidade em Endoscopia, no Royal Infirmary of Edinburg. Leia na íntegra a opinião do especialista sobre a cápsula digestiva.
Different perspective(s) on digestive capsule
Capsule endoscopy (CE) is a major breakthrough and an invaluable supplement to conventional endoscopy. However, it will require further development before becoming a suitable replacement able to provide complete panenteroscopy. Major drawbacks of current, commercially-available CE models are their passive locomotion and lack of therapeutic and (accurate) diagnostic capabilities1. Recently, significant progress has been made to address the aforementioned issues2. In the near future, we will continue to see novel steering and actuation techniques, and continued development of existing soft-tethered capsules1,3. Magnetic locomotion seems to be the favorable method for untethered control of CE actuation1,4. Although the magnetic control platform might be a large initial investment, it is expected that it will be –eventually– offset by a cheaper production cost for consumables. Furthermore, optical enhancing techniques, such as improved image resolution, contrast and tissue penetration and provision of biochemical and molecular information could lead to in situ optical (instead of mechanical) biopsy1,5; realizing current limits is just a step to a subsequent exciting development2.
Power consumption continues to be a relevant challenge, which is limited by the size of the capsule; it will be further limited when additional power is consumed by magnets and feedback sensors, and/or integrated mechanisms for therapy1. Volume/size compression can be achieved, as the technological frenzy of our days will eventually lead to the production of remarkable small parts and this might allow the production of dissolvable capsules, including the use of non- toxic batteries6. The mainstream small bowel endoscopy in the third decade of the new millennium should be provided by an enhanced, next-generation capsule-based based platform, such as the one proposed by Iakovidis et al5. Furthermore, computational methods that can be implemented in software can enhance the diagnostic yield of VCE both in terms of efficiency and diagnostic accuracy7.
However, in an ‘remote’ environment like the small-bowel, the main requirement should not be how to make micro-capsules; instead, the attention should focus on how to utilize the existing carrier shape and size, but with miniaturized components such as microscopic batteries, that will leave internal space and provide enough power for internal lens rotation, space for microscopic labs (lab-in-a-pill) and other sensing capacities and -hopefully- deliver powder medication for bleeding2.
References
1 Sliker LJ, Ciuti G. Flexible and capsule endoscopy for screening, diagnosis and treatment. Expert Rev Med Devices 2014;11:649-66.
2 Koulaouzidis A, Iakovidis DK, Karargyris A, Rondonotti E. Wireless endoscopy in 2020: Will it still be a capsule? World J Gastroenterol 2015;21:5119-30.
3 Ciuti G, Menciassi A, Dario P. Capsule endoscopy: from current achievements to open challenges. IEEE Rev Biomed Eng 2011;4:59-72.
4 Arezzo A, Menciassi A, Valdastri P, Ciuti G, Lucarini G, Salerno M, Di Natali C, Verra M, Dario P, Morino M. Experimental assessment of a novel robotically-driven endoscopic capsule compared to traditional colonoscopy. Dig Liver Dis 2013;45:657-62.
5 Iakovidis DK, Sarmiento R, Silva JS, Histace A, Romain O, Koulaouzidis A, Dehollain C, Pinna A, Granado B, Dray X. Towards Intelligent Capsules for Robust Wireless Endoscopic Imaging of the Gut. IEEE International Conference on Imaging Systems and Techniques; 2014 Oct. Santorini, Greece: IEEE; 2014. pp.95–100.
6 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.
7 Iakovidis DK, Koulaouzidis A. Software for enhanced video capsule endoscopy: challenges for essential progress. Nat Rev Gastroenterol Hepatol 2015;12:172-86.
