All-reflective tethered capsule endoscope for multimodal optical coherence tomography in the esophagus.

Significance: Esophageal cancer is becoming increasingly prevalent in Western countries. Early detection is crucial for effective treatment. Multimodal imaging combining optical coherence tomography (OCT) with complementary optical imaging techniques may provide enhanced diagnostic capabilities by simultaneously assessing tissue morphology and biochemical content. Aim: We aim to develop a tethered capsule endoscope (TCE) that can accommodate a variety of point-scanning techniques in addition to OCT without requiring design iterations on the optical or mechanical design. Approach: We propose a TCE utilizing exclusively reflective optics to focus and steer light from and to a double-clad fiber. Specifically, we use an ellipsoidal mirror to achieve finite conjugation between the fiber tip and the imaging plane. Results: We demonstrate a functional all-reflective TCE. We first detail the design, fabrication, and assembly steps required to obtain such a device. We then characterize its performance and demonstrate combined OCT at 1300 nm and visible spectroscopic imaging in the 500- to 700-nm range. Finally, we discuss the advantages and limitations of the proposed design. Conclusions: An all-reflective TCE is feasible and allows for achromatic high-quality imaging. Such a device could be utilized as a platform for testing various combinations of modalities to identify the optimal candidates without requiring design iterations.

Design of a Compact Circularly Polarized Implantable Antenna for Capsule Endoscopy Systems.

This research proposes a miniature circular polarization antenna used in a wireless capsule endoscopy system at 2.45 GHz for industrial, scientific, and medical bands. We propose a method of cutting a chamfer rectangular slot on a circular radiation patch and introducing a curved radiation structure into the centerline position of the chamfer rectangular slot, while a short-circuit probe is added to achieve miniaturization. Therefore, we significantly reduced the size of the antenna and made it exhibit circularly polarized radiation characteristics. A cross-slot is cut in the GND to enable the antenna to better cover the operating band while being able to meet the complex human environment. The effective axis ratio bandwidth is 120 MHz (2.38-2.50 GHz). Its size is π × 0.032λ02 × 0.007λ0 (where λ0 is the free-space wavelength of at 2.4 GHz). In addition, the effect of different organs such as muscle, stomach, small intestine, and big intestine on the antenna when it was embedded into the wireless capsule endoscopy (WCE) system was further discussed, and the results proved that the WCE system has better robustness in different organs. The antenna's specific absorption rate can follow the IEEE Standard Safety Guidelines (IEEE C95.1-1999). A prototype is fabricated and measured. The experimental results are consistent with the simulation results.

Robotic wireless capsule endoscopy: recent advances and upcoming technologies.

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".

The environmental impact of small-bowel capsule endoscopy.

INTRODUCTION: The environmental impact of endoscopy, including small-bowel capsule endoscopy (SBCE), is a topic of growing attention and concern. This study aimed to evaluate the greenhouse gas (GHG) emissions (kgCO2) generated by an SBCE procedure. METHODS: Life cycle assessment methodology (ISO 14040) was used to evaluate three brands of SBCE device and included emissions generated by patient travel, bowel preparation, capsule examination, and video recording. A survey of 87 physicians and 120 patients was conducted to obtain data on travel, activities undertaken during the procedure, and awareness of environmental impacts. RESULTS: The capsule itself (4 g) accounted for < 6 % of the total product weight. Packaging (43-119 g) accounted for 9 %-97 % of total weight, and included deactivation magnets (5 g [4 %-6 %]) and paper instructions (11-50 g [up to 40 %]). A full SBCE procedure generated approximately 20 kgCO2, with 0.04 kgCO2 (0.2 %) attributable to the capsule itself and 18 kgCO2 (94.7 %) generated by patient travel. Capsule retrieval using a dedicated device would add 0.98 kgCO2 to the carbon footprint. Capsule deconstruction revealed materials (e. g. neodymium) that are prohibited from environmental disposal; 76 % of patients were not aware of the illegal nature of capsule disposal via wastewater, and 63 % would have been willing to retrieve it. The carbon impact of data storage and capsule reading was negligible. CONCLUSION: The carbon footprint of SBCE is mainly determined by patient travel. The capsule device itself has a relatively low carbon footprint. Given that disposal of capsule components via wastewater is illegal, retrieval of the capsule is necessary but would likely be associated with an increase in device-related emissions.

Resistance model of an active capsule endoscope in a peristaltic intestine.

In the past studies, the resistance of magnetically controlled capsules running through the small intestine has been modeled assuming that the small intestine was a circular tube with a constant diameter. Peristalsis is an important character of the human gastrointestinal system, and it would result in some changes in the diameter of the intestine, meaning that the existing resistance models would no longer be applicable. In this paper, based on the assumption that intestinal peristalsis is actually a sinusoidal wave, a resistance model of the capsule running in the peristaltic intestine is established, and then it is validated experimentally. The model provides a realistic foundation for the optimization and control of the magnetically controlled endoscopy.

Rotational Platform for Real-Time Localization for Active Implantable Medical Devices.

This paper presents a sensor based localization system to localize active implantable medical devices i.e., Wireless Capsule Endoscopy (WCE). The importance of localizing the capsule arises once the images from the capsule detect the abnormalities in the Gastrointestinal tract (GI). A successful system can determine the location that associated with the abnormality for further medical investigation or treatment. The system proposed in this paper comprises a rotational platform that consists of magnetic sensors to detect the position of the embedded magnet in the capsule. The rotational platform provides advantageousness in terms of reducing the number of the sensors and increasing the monitoring accuracy during the real time movement.

Drug-induced entero-colitis due to interleukin-17 inhibitor use; capsule endoscopic findings and pathological characteristics: A case report.

BACKGROUND: Interleukin-17 (IL-17) inhibitors are known to cause exacerbation or new onset of inflammatory bowel disease upon administration. However, few reports have described characteristic endoscopic and histopathologic findings, and no small intestinal lesions have been reported so far. CASE SUMMARY: A woman in her 60s with psoriasis was administered ixekizumab (IXE), an anti-IL-17A antibody, for the treatment of psoriasis. Twenty months after commencing treatment, the patient visited our hospital because of persistent diarrhea. Blood tests performed at the time of the visit revealed severe inflammation, and colonoscopy revealed multiple round ulcers throughout the colon. A tissue biopsy of the ulcer revealed infiltration of inflammatory cells and granuloma-like findings in the submucosal layer. Capsule endoscopy revealed multiple jejunal erosions. After the withdrawal of IXE, the symptoms gradually improved, and ulcer reduction and scarring of the colon were endoscopically confirmed. CONCLUSION: To the best of our knowledge, 17 reports have documented IL-17 inhibitor-induced entero-colitis with endoscopic images, endoscopic findings, and pathological characteristics, including the present case. Nine of these cases showed diffuse loss of vascular pattern, coarse mucosa/ulcer formation in the left colon, and endoscopic findings similar to those of ulcerative colitis. In the remaining eight cases, discontinuous erosions and ulcerations from the terminal ileum to the rectum were seen, with endoscopic findings similar to those of Crohn's disease. In this case, the findings were confirmed by capsule endoscopy, which has not been previously reported.

Evaluating clinical diversity and plausibility of synthetic capsule endoscopic images.

Wireless Capsule Endoscopy (WCE) is being increasingly used as an alternative imaging modality for complete and non-invasive screening of the gastrointestinal tract. Although this is advantageous in reducing unnecessary hospital admissions, it also demands that a WCE diagnostic protocol be in place so larger populations can be effectively screened. This calls for training and education protocols attuned specifically to this modality. Like training in other modalities such as traditional endoscopy, CT, MRI, etc., a WCE training protocol would require an atlas comprising of a large corpora of images that show vivid descriptions of pathologies, ideally observed over a period of time. Since such comprehensive atlases are presently lacking in WCE, in this work, we propose a deep learning method for utilizing already available studies across different institutions for the creation of a realistic WCE atlas using StyleGAN. We identify clinically relevant attributes in WCE such that synthetic images can be generated with selected attributes on cue. Beyond this, we also simulate several disease progression scenarios. The generated images are evaluated for realism and plausibility through three subjective online experiments with the participation of eight gastroenterology experts from three geographical locations and a variety of years of experience. The results from the experiments indicate that the images are highly realistic and the disease scenarios plausible. The images comprising the atlas are available publicly for use in training applications as well as supplementing real datasets for deep learning.

Magnetic controlled capsule endoscope (MCCE)'s diagnostic performance for H. pylori infection status based on the Kyoto classification of gastritis.

BACKGROUND: Previous studies have shown that the Kyoto classification of gastritis can accurately predict H. pylori infection status on conventional gastroscopy. The aim of this study was to test whether the Kyoto classification of gastritis applies well to magnetic controlled capsule endoscopy (MCCE). METHODS: We consecutively recruited 227 participants who underwent both MCCE and urea breath tests (UBTs). Two physicians who were blinded to the UBT results independently made the diagnosis of H. pylori infection status according to 10 findings listed in the Kyoto classification of gastritis after reviewing MCCE images. We also developed 2 predictive models to assess H. pylori infection status by combining these 10 findings. RESULTS: The MCCE's overall diagnostic accuracy for H. pylori infection status was 80.2%. The sensitivity, specificity and diagnostic odds ratio (DOR) for current infection were 89.4%, 90.1% and 77.1, respectively. Major specific findings were mucosal swelling and spotty redness for current infection, regular arrangement of collecting venules (RAC), streak redness, fundic gland polyp (FGP) for noninfection, and map-like redness for past-infection. In the two prediction models, the area under the curve (AUC) values for predicting noninfection and current infection were 84.7 and 84.9, respectively. CONCLUSIONS: The Kyoto classification of gastritis applied well to MCCE. H. pylori infection status could be accurately assessed on MCCE according to the Kyoto classification of gastritis.

A method for evaluating sensitivity of electromagnetic localization systems for wireless capsule endoscopes.

This paper studies the use of electromagnetic induction in localization of wireless capsule endoscopes (WECs). There is still currently a need for an accurate localization system to enable localizing possible findings in the gastrointestinal tract, and to develop an active steering system for the capsule. Developing an optimal localization system requires the sensitivity of the system to be analyzed. In this paper, three different coil geometries are modelled with a computer simulation platform, and their sensitivities and target responses are compared. In order to do that, a formulation for the sensitivity based on the dipole model approximation is presented. The first coil array is based on literature and is used as a reference. The second array presents how having more transmit-receive channels in the array effects the sensitivity. The third coil array simulates the effect of increasing the field excitation intensity in different directions by using a three-axial Helmholtz array. In addition, both proposed coil arrays utilize larger coils than the reference. As a result, it seems that both increasing the coil size and the number of field projections interrogating the target increase the overall sensitivity in the region of interest and the target response. The findings suggest that an optimal coil array could utilize both large coils and multiple transmit-receive channels to increase the number of independent fields incident onto the target.

A Wearable Capsule Endoscope Electromagnetic Localization System Based on a Novel WCL Algorithm.

The wearable localization system for wireless capsule endoscopy (WCE) is a potential technology to realize rapid diagnosis and treatment of the gastrointestinal (GI). However, the electromagnetic localization accuracy of WCE still needs to be improved. In this paper, based on RSSI electromagnetic fading model, the accurate fitting parameter values are obtained by Kalman filter and the least square method. A novel weighted centroid localization (WCL) algorithm based on exponential weights is proposed, which can achieve high-accuracy localization by using only sparse reception matrix. The simulation results show that when the standard deviation of the localization data is 7.85, the localization root mean square error (RMSE) is 25.4 mm; when the standard deviation of the localization data is 5.475, the localization RMSE is 2.5 mm. These two localization RMSEs are 38% and 79% less than those of the conventional centroid localization algorithm, respectively. An experimental platform of wearable wireless communication and localization system using 24 array receiving antennas is developed in human phantom environment. The experimental results show that the wearable WCE electromagnetic localization system based on the proposed algorithm achieves a localization RMSE of 36.3 mm, which is 17% lower than that of the conventional centroid localization algorithm and meets the needs of clinical diagnosis.

In vivo animal study of the magnetic navigation system for capsule endoscope manipulation within the esophagus, stomach, and colorectum.

BACKGROUND/PURPOSES: Magnetic navigation capsule endoscopy (MNCE) is considered to be an important means to realize the controllable and precise examination of capsule endoscopy (CE) in the unstructured gastrointestinal (GI) tract. For the current magnetic navigation system (MNS), due to the limitation of workspace, driving force, and control method of the CE, only clinical application in the stomach has been realized, whereas the examination of other parts of the GI tract is still in the experimental stage. More preclinical studies are needed to achieve the multisite examination of the GI tract. METHODS: Based on the MNS (Supiee) developed in the laboratory, an X-ray imaging system with magnetic shielding and a commercial CE are integrated to form the MNCE system. Then, in vivo GI tract experiments with a porcine model are performed to verify the clinical feasibility and safety of this system. Moreover, the effects of different control modes on the efficiency and effect of GI tract examination are studied. RESULTS: Animal experiments demonstrate that with the MNCE system, it is convenient to achieve steering control in any direction and multiple reciprocating movements of CE in the GI tract. Benefiting from the flexibility of the three basic control modes, the achieved swing movement pattern of CE can effectively reduce the inspection time. It is demonstrated that the esophageal examination time can be reduced from 13.2 to 9.2 min with a maximum movement speed of 5 mm/s. CONCLUSION: In this paper, the feasibility, safety, and efficacy of the MNCE system for a one-stop examination of the in vivo GI tract (esophagus, stomach, and colorectum) is first demonstrated. In addition, complex movement patterns of CE such as the swinging are proved to effectively improve examination efficiency and disease detection rates. This study is crucial for the clinical application of the MNCE system.

A compact and wideband MIMO antenna for high-data-rate biomedical ingestible capsules.

Due to recent advancements in complementary metal-oxide-semiconductor (CMOS) cameras, transferring high resolution images and videos are possible in wireless capsule endoscopy. High-data-rates communication is required for such data, which is possible using multiple-input-multiple-output (MIMO) antennas. In this paper, a low-sized, compact, high-data-rate, highly isolated two-element MIMO antenna with a large bandwidth has been proposed at 2.45 GHz for wireless capsule endoscopy. The geometry of the antenna ([Formula: see text]) is kept small using meandered geometry, defected ground structure, and high permittivity of the substrate. A wider bandwidth of 620 MHz (2.15-2.77 GHz) is achieved by exciting dual-modes of the antenna using defected ground structure. Furthermore, a lower mutual coupling between the antennas (30.1 dB at 2.45 GHz) is realized, despite the small edge-to-edge gap of 0.5 mm, using combination of defected ground structure and I-shaped stub. Keeping in mind of system level configuration, this antenna is simulated and measured inside a capsule device by considering effects of the other components and the device itself. The practical measurements are performed by inserting the capsule device (containing the MIMO antenna) inside minced meat. To check the safety and effectiveness of the proposed MIMO antenna, it's specific absorption rate (SAR) and link budget are calculated and validated. In addition, the [Formula: see text] channel specifications are verified which shows satisfactory performance. This antenna has high channel capacity ([Formula: see text] at [Formula: see text]) than single-input-single-output (SISO) antennas, thus, is a suitable choice for high-data-rate capsule endoscopic devices. To the best of the authors' knowledge, this is the first implantable MIMO antenna reported so far with such lower dimension and wider bandwidth.

First prospective European study for the feasibility and safety of magnetically controlled capsule endoscopy in gastric mucosal abnormalities.

BACKGROUND: While capsule endoscopy (CE) is the gold standard diagnostic method of detecting small bowel (SB) diseases and disorders, a novel magnetically controlled capsule endoscopy (MCCE) system provides non-invasive evaluation of the gastric mucosal surface, which can be performed without sedation or discomfort. During standard SBCE, passive movement of the CE may cause areas of the complex anatomy of the gastric mucosa to remain unexplored, whereas the precision of MCCE capsule movements inside the stomach promises better visualization of the entire mucosa. AIM: To evaluate the Ankon MCCE system's feasibility, safety, and diagnostic yield in patients with gastric or SB disorders. METHODS: Of outpatients who were referred for SBCE, 284 (male/female: 149/135) were prospectively enrolled and evaluated by MCCE. The stomach was examined in the supine, left, and right lateral decubitus positions without sedation. Next, all patients underwent a complete SBCE study protocol. The gastric mucosa was explored with the Ankon MCCE system with active magnetic control of the capsule endoscope in the stomach, applying three standardized pre-programmed computerized algorithms in combination with manual control of the magnetic movements. RESULTS: The urea breath test revealed Helicobacter pylori positivity in 32.7% of patients. The mean gastric and SB transit times with MCCE were 0 h 47 min 40 s and 3 h 46 min 22 s, respectively. The average total time of upper gastrointestinal MCCE examination was 5 h 48 min 35 s. Active magnetic movement of the Ankon capsule through the pylorus was successful in 41.9% of patients. Overall diagnostic yield for detecting abnormalities in the stomach and SB was 81.9% (68.6% minor; 13.3% major pathologies); 25.8% of abnormalities were in the SB; 74.2% were in the stomach. The diagnostic yield for stomach/SB was 55.9%/12.7% for minor and 4.9%/8.4% for major pathologies. CONCLUSION: MCCE is a feasible, safe diagnostic method for evaluating gastric mucosal lesions and is a promising non-invasive screening tool to decrease morbidity and mortality in upper gastro-intestinal diseases.

Image Aided Recognition of Wireless Capsule Endoscope Based on the Neural Network.

Wireless capsule endoscopy is an important method for diagnosing small bowel diseases, but it will collect thousands of endoscopy images that need to be diagnosed. The analysis of these images requires a huge workload and may cause manual reading errors. This article attempts to use neural networks instead of artificial endoscopic image analysis to assist doctors in diagnosing and treating endoscopic images. First, in image preprocessing, the image is converted from RGB color mode to lab color mode, texture features are extracted for network training, and finally, the accuracy of the algorithm is verified. After inputting the retained endoscopic image verification set into the neural network algorithm, the conclusion is that the accuracy of the neural network model constructed in this study is 97.69%, which can effectively distinguish normal, benign lesions, and malignant tumors. Experimental studies have proved that the neural network algorithm can effectively assist the endoscopist's diagnosis and improve the diagnosis efficiency. This research hopes to provide a reference for the application of neural network algorithms in the field of endoscopic images.