On October 23rd, 2014, we updated our
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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
ARCHITECTURE OF CAPSULE CAMERA
♦ 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
FLOW OF CAPSULE
♦ 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.
DERIVATION OF RESULTS
RECEIVER WITH CAPSULE
♦ 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.