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♦ Patients can now swallow pill-sized, disposable
♦ This new esophageal capsule endoscope is a
smooth plastic capsule about the size of a large
vitamin pill that has tiny video cameras at each
♦ The pill takes about 2,600 color pictures, which
are transmitted to a recording device worn by the
♦ The disposable capsule is passed naturally,
usually within 24 hours.
♦ The technology available to doctors has evolved
dramatically over the past 40 years.
♦ Basic endoscopy was introduced in the late 1960s,
and about 20 years later, ultrasound was added,
enabling us to look at internal GI structures as
♦ Now, with EUS, we can determine the extent to
which tumors in the esophagus, stomach,
pancreas, or rectum have spread in a less invasive
♦ One technology that has been available for about
30 years is Endoscopic Retrograde Cholangio
USES OF ERCP:
• ERCP's is used to place stents within bile ducts,
remove difficult bile duct stones, and obtain
• Used in motility treatment.
• Motility is the movement of food from one
place to another along the digestive tract.
• Passive capsule observation endoscopes
compact low-power consumption imaging
compact low-power consumption wireless
Capsule guidance system
Wireless power supply system
Drug delivery system
Body fluid sampling technology
♦ Ultra-Low-Power Wireless Technology is Used
in Swallowable Camera Capsule.
♦ improvement of the signal-to-noise ratio (SNR)
in CMOS detectors,
♦ development of white LEDs, and development
of application-specific integrated circuits
♦ CMOS detectors have active pixel resolutions
that provide comparable performance to CCDs,
while drawing less power than CCDs
• Mrs.Judy Shuhala, a retired school teacher,
had Gastritis,an inflammation of the stomach
• Mr.Norman Cullen, a 76-year-old Bay Area
resident, Suffering from an undetected GI
♦ 01 August 2001Physicians and patients in the
European Union, the United States of America,
Australia, and Israel will now be able to benefit
from a new medical technology .
♦ The Israeli company Given Imaging Ltd., which
manufactures the diagnostic system, has
received official approval to market the video
capsule to physicians within European Union
♦ the United States Food and Drug Administration
(FDA) cleared the marketing of the cameracapsule in the U.S.
♦ The system is also currently being used in
clinical trials in Belgium, France, Germany, Italy,
♦ The Given system will be available to doctors in
selected markets within 90 days of placing an
♦ The M2A capsule consists of a microchip camera,
light emitting diodes that act as flash, an antenna,
two 1.5 V silver oxide batteries and Zarlink's RF
transmitter chip .
♦ The RF transmitter chip is manufactured in
0.35µm CMOS technology
♦ It re-quires a voltage of 2.6 to 3.2 V and transmits
on a 403, 432 or 434 MHz carrier
♦ This allows a data rate of 2,700 kbit/s over a distance of 1 m while having a power consumption of
♦ All this is run by two ultra low-power silver
oxide batteries that will operate for 6-8 hours.
♦ weighs 3.5 grams and can display a 140° field of
view of the patients insides at 1:8 magnification.
♦ This information is then transmitted via an array
of sensors secured to the abdomen, to the Data
Recorder affixed to a belt worn around the
♦ The silver oxide batteries in the capsule power
the CMOS detector, as well as the LEDs and
♦ white-light LEDs are important because
pathologists distinguish diseased tissue by color.
♦ The developers provided a novel optical design
that uses a wide-angle lens over the imager, and
manages to integrate both the LEDs and imager
under one dome while handling stray light and
♦ Eliminates Procrastination
♦ Views the Entire GI Tract
♦ Traditional endoscopy can view only the upper GI
♦ Earliest Cancer Detection
♦ Advances Treatment of Irritable Bowel Capsule
♦ Capsule Endoscopy :
Patient has to swallow a vitamin pill
sized video capsule as an endoscope.
Capsule Endoscopy helps the doctor to determine
the cause for:~
♦ Recurrent abdominal pain
♦ It is useful to detect small bowel tumors
♦ Patients who are on medications for joint
♦ Inflammatory bowel diseases
♦ Irritable bowel
♦ To monitor the therapeutic effects
How should the patient prepare himself or herself
for the study?
♦ Patient will be given written instructions the day
♦ An empty stomach allows better visualization (10
hrs before the examination).
♦ The doctor will inform the time of fasting.
♦ If the patient is on medications inform the doctor.
♦ Cardiac patients have to inform about pace
makers & other devices.
♦ Patient can eat ,4 hrs after ingestion of the
RESEARCH AND DEVELOPMENT
• The torpedo-shaped capsule can provide more
than five hours of real-color images.
• The patient need not be in a hospital or clinic
during this time
• The images are transmitted from the capsule using
UHF signals to an antenna array attached to the
patient (much like an ECG test).
♦ The data indicate where in the abdomen the
capsule was at the time.
♦ These promote greater efficiency in medical
institutions and help improve quality of life for
♦ Gastrointestinal endoscopes are now recognized
as the only medical devices that can
simultaneously perform observations, diagnoses
(tissue extraction), and treatment.
CONVERGENCE OF TECHNOLOGY
The different technologies used are:
• Information Technology.
♦ In an FDA-organized trial conducted in New York, the
♦ Given Imaging Diagnostic System 12 patients, or 60
♦ push enterosc
♦ opy 7 of 20 patients, or 35 percent.
In total, 14 lesions were detected
♦ The Given Imaging Diagnostic System 12 of the 14
lesions, or 86 percent,
♦ push enteroscopy 7 out of 14, or 50 percent.
♦ The FDA also noted that the Given system was able to
identify sources of bleeding in five cases which were
beyond the reach of the traditional enteroscope.
♦ Endoscopy is the most common diagnostic tool
for GI problems; however, the endoscope is not
long enough to view the entire small intestine.
♦ If the patient’s problem lies further down the
intestinal tract, it’s more difficult for the
physician to diagnose and treat.
♦ Now amazing new technology—a wireless,
allowable video capsule— allows physicians to
capture images of the small intestine with no pain
to the patient.
♦ The capsule’s greatest benefit is its ability to
survey the entire GI tract, possibly eliminating
the need for further diagnostic studies.
♦ the Given system is user-friendly and painless,
allowing patients to return to work on the same
day of ingestion
♦ it increases accuracy when compared to some
other endoscopic devices.
♦ this product may also offer cost savings by
reducing the number of diagnostic tests
required to obtain an accurate diagnosis.
FUTURE OF TECHNOLOGY
♦ At this time, the capsule is not a replacement for
♦ Photodynamic therapy is one of the new
treatments that will soon be available to patients
with certain types of Barrett's esophagus or GI
♦ hotodynamic therapy uses lasers to destroy the
precancerous esophagus cells (identified by a
photosensitive chemical marker), but leaves
normal cells alone.