The future of capsule endoscopy in clinical practice: from diagnostic to therapeutic experimental prototype capsules.

Capsule endoscopy (CE) is indicated as a first-line clinical examination for the detection of small-bowel pathology, and there is an ever-growing drive for it to become a method for the screening of the entire gastrointestinal tract (GI). Although CE's main function is diagnosis, the research for therapeutic capabilities has intensified to make therapeutic capsule endoscopy (TCE) a target within reach. This manuscript presents the research evolution of CE and TCE through the last 5 years and describes notable problems, as well as clinical and technological challenges to overcome. This review also reports the state-of-the-art of capsule devices with a focus on CE research prototypes promising an enhanced diagnostic yield (DY) and treatment. Lastly, this article provides an overview of the research progress made in software for enhancing DY by increasing the accuracy of abnormality detection and lesion localisation.

Current Advances in Drug Delivery Systems for Capsule Endoscopy.

BACKGROUND: Oral administration of medications and current oral modified-release systems are the most preferred drug delivery routes, but they provide efficacy up to 12-24 hours per administration and are not useful when the patient has short transit time. The once-daily administered formulations are the endpoint of many types of drug development, and some innovations in capsule endoscopy (CE) can solve this problem. OBJECTIVE: This review aims to reveal recent advances in drug delivery systems (DDS) for CE as an essential field of research for more precise drug targeting at the gastrointestinal (GI) tract. METHODS: We performed a narrative overview of the MEDLINE database from 1991-2020 using the keywords of DDS and CE with synthesizing the findings, hand searches, and authoritative articles. RESULTS: There are microelectromechanical systems and non-mechanical patent technologies for DDS for CE, and the implementation of wireless-capsule medical devices into the human body will provide new diagnostic and therapeutic options. Integrating biomedical CE with DDS and the cloud technology will bring remote real-time feedbackbased automated treatment or responsive medication. CONCLUSION: Swallowable drug delivery systems for capsule endoscopy brings an entirely new approach for diagnostic and therapeutic methods in digestive diseases.

Capsule endoscopy of the future: What's on the horizon?

Capsule endoscopes have evolved from passively moving diagnostic devices to actively moving systems with potential therapeutic capability. In this review, we will discuss the state of the art, define the current shortcomings of capsule endoscopy, and address research areas that aim to overcome said shortcomings. Developments in capsule mobility schemes are emphasized in this text, with magnetic actuation being the most promising endeavor. Research groups are working to integrate sensor data and fuse it with robotic control to outperform today's standard invasive procedures, but in a less intrusive manner. With recent advances in areas such as mobility, drug delivery, and therapeutics, we foresee a translation of interventional capsule technology from the bench-top to the clinical setting within the next 10 years.

Capsule endoscopy: Future horizons.

Capsule endoscopy (CE) was launched at the beginning of this millennium and has since become a well established methodology for evaluating the entire small bowel for manifold pathologies. CE far exceeded early expectations by providing a tool for establishing the correct diagnosis for elusive gastrointestinal (GI) conditions such as obscure GI bleeding, Crohn's disease, polyposis syndrome and others. Contemporary CE, like radiology, gives results that can only be read, unlike conventional endoscopic procedures which enable concomitant biopsy when indicated. This is one of the major limitations of the technique. The ideal CE should improve the quality of the image and have a faster frame rate than the currently available one. There should be a therapeutic capsule capable of performing a biopsy, aspirating fluid, delivering drugs as well as measuring the motility of the small bowel wall. Another major leap forward would be the capability of remote control of the capsule's movement in order to navigate it to reach designated anatomical areas for carrying out a variety of therapeutic options. Technology for improving the capability of the future generation capsule is almost within grasp and it would not be surprising to witness the realization of these giant steps within the coming decade.