Developing Multifunctional Endoscopes

The endoscopic instrument is now smaller, more flexible, and better controlled with better visual imagery of the areas. The computer used to control the process is faster, with better graphical and communications capabilities. The more advanced the technology, the less invasive the treatment for gastrointestinal issues that might have involved surgical procedures in the past. The rise of video laparoscopes allowed for further technology advancement beyond the confinement of gastrointestinal tracts. Patient’s recovery time is shorter and the postoperative risks, that is, infections or other complications are much less than those of the traditional surgical procedures.

Indian Market Dynamics
The Indian endoscopy equipment in 2016 is estimated at Rs. 835 crore, with the rigid endoscopes segment valued at Rs. 580 crore and the flexible endoscopes segment at Rs. 245 crore. Capsules contributed a miniscule 10 crore in 2016.

The flexible segment is dominated by Olympus, with Karl Storz, Fujifilm, and Pentax being aggressive players. Karl Storz is the clear leader in the rigid segment. Olympus and Stryker are also aggressive players. Other brands which are present are Richard Wolf and Surgdent. Capsule endoscopes are dominated by Medtronics, with some presence from J Mitra and SISCO (representing Omom, China).

Vendors are adopting various strategies and competitive pricing to sustain themselves in the market and increase their shares. In January 2017, Pentax Medical acquired C2 Therapeutics. This acquisition strengthened the company’s therapeutic endoscopy portfolio, including the role in gastroenterology suites. Subsequently in July 2017, Pentax and Aohua (Shanghai Aohua Photoelectricity Endoscope Co., Ltd.), China announced the creation of a joint venture to develop products in the field of flexible medical endoscopy. The new company offers global endoscopy solutions and is initially focusing on the emerging markets. The company has also launched a high-definition (HD) pulmonology endoscopy system in the European, Middle Eastern, & African (EMEA) markets. Defina system in pulmonology combines a state-of-the-art HD processor with i-scan imaging technology and two highly maneuverable HD bronchoscopes.

In September 2016, Olympus launched the Visera 4K UHD system for ear, nose, and throat procedures allowing big-screen surgery with ultra-high definition endoscopy.

The major factor driving the endoscopy market in India is the patient preference for minimally invasive surgeries and procedures that are increasingly being covered by insurance. Due to the rising population that is now armed with higher spending power, a lot of people are opting for health insurance. The upcoming state-of-the-art private hospitals, diagnostic facilities, and relatively low cost are other factors that are driving the endoscopy market in India.

Research Updates
The technology in the endoscopy equipment has reached milestones over the past few years, opening a new era in endoscopic diagnosis. With research groups focusing on the development of miniaturized, HD systems, these advances in endoscopy equipment have extended the realm of applicability of these systems.

MEMS sensors and actuators. Over the last decade, optical fiber-based forms of microscopy and endoscopy have extended the realm of applicability for many imaging modalities. Optical fiber-based imaging modalities permit the use of remote illumination sources and enable flexible forms supporting the creation of portable and handheld imaging instrumentations to interrogate within hollow tissue cavities. Microelectromechanical systems (MEMS) sensors and actuators have been playing a key role in shaping the miniaturization of optical and mechanical components.

Advanced MEMS-based optical fiber endoscopy can provide cellular and molecular features with deep tissue penetration enabling guided resections and early cancer assessment to better treatment outcomes. The precise dimensions and alignment of MEMS devices, combined with the mechanical stability that comes with miniaturization, make MEMS components well-suited to incorporate into these various endoscopy techniques.

Handheld fiber optic probes. In an important step toward endoscopic diagnosis of cancer, researchers have developed a handheld fiber optic probe that can be used to perform multiple nonlinear imaging techniques without the need for tissue staining. The new multimodal imaging probe uses an ultrafast laser to create nonlinear optical effects in tissues that can reveal cancer and other diseases. The ability for doctors to skip the biopsy and use a multimodal imaging endoscope to diagnose cancer on the spot would save valuable time and could also allow surgeons to differentiate between cancerous and healthy tissue during surgery more easily.

Hybrid endoscopes. In an ongoing research project Hybrid Optical and Optoacoustic Endoscope for Esophageal Tracking (ESOTRAC), engineers and physicians have been aiming to develop a novel hybrid endoscopic instrument for early diagnosis and staging of esophageal cancer. The hybrid endoscope combines sensing of pathophysiological tissue signatures resolved by multispectral optoacoustic (photoacoustic) tomography (MSOT) with morphological disease signatures provided by optical coherence tomography (OCT).

Outlook
The field of endoscopy is still expanding, in particular in gastroenterology and surgery. It is becoming impossible for a single endoscopist to master all aspects of flexible endoscopy. Accessories will continue to grow in number and variety with accessories specific for a single type of procedure and specific indication; for instance, a device to flatten colon folds may only be used for those who undergo colonoscopy for colorectal cancer prevention. New endoscopes will be designed to allow easier performance of existing procedures, or to enable altogether new procedures.

All the mechanisms in the handling of current flexible endoscopes (e.g., navigation, lens cleaning, instrument manipulation) need to be electronically controlled, instruments need to be packed within the body of the device but the artificial intelligence driving the scope may reside outside the body where it controls the scope and instruments using wireless communication. There is no doubt that the field of endoscopy – using as much as possible natural orifices – will continue to grow and expand.