Endoscopy Is Evolving With Ground Breaking Technology

With evolving technology and a demanding customer, newer versions of endoscopes including capsule and robot-assisted models are gaining traction.

Endoscopy has evolved since its humble beginnings. Over the past decade advances have been made in the rapid evolution of endoscopic visual assessment of the bowel and its role in the management and prevention of colorectal cancer. Specialized endoscopes with larger channels, smaller diameters, enhanced imaging capabilities, and other unique differences are now becoming available to help doctors choose exactly the right tool for each patient’s care.

With the elevation in the requirement for ground-breaking techs, newer editions of endoscopes are attaining limelight (comprising robot and capsule assisted endoscopes), which propel the global endoscopy devices market.  With augmentation in the number of minimally invasive surgeries, the requirement for endoscopy devices is anticipated to increase in years to come. As these surgeries considerably reduce the duration of hospital stay for the patients, the number of endoscopy procedures performed around the world is increasing at a significant rate. The global endoscopy equipment market is projected to reach USD 34.82 billion by 2022 from a value of USD 25.58 billion in 2017, reflecting a CAGR of 6.4 percent, projects MarketsandMarkets. The key factors driving growth include favorable government initiatives, rising number of hospitals and growing hospital investments in endoscopy facilities, technological advancements, and rising prevalence of diseases that require endoscopy.

Indian market
The Indian endoscopy equipment in 2017 is estimated at Rs 943 crore, with the rigid endoscopes segment valued at Rs 650 crore and the flexible endoscopes segment at Rs 280 crore. Capsules contributed Rs 13 crore in 2017.

The flexible segment is dominated by Olympus. Karl Storz, Fujifilm, and Pentax are also aggressive. 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, Escolab, and Surgdent. Local, regional, and Chinese players continue to offer flexible and rigid endoscopes. The capsule endoscopes market is dominated by Medtronic.

Flexible endoscopy is expected to maintain its lead due to its high precision, sensitivity, specificity, and safety as compared to others at economical cost. The scope of flexible endoscopy has increased too. Fueled by the demand for less invasive treatment options, and by improvements in instrument design and manufacturing, it is now possible to avoid open surgery in some cases. Flexible endoscopic surgical components are becoming smaller and more complex every day, and surgeons are now able, with the right tools, to see internal tissues clearly, remove samples for biopsies, make incisions, and create sutures. The concept of submucosal endoscopy with a mucosal flap safety valve has enabled endoscopists to securely use the submucosal space, or third space. In stomach cancer cases, the endoscopic procedures help screen high-risk patients and diagnose this disease earlier; and endoscopic mucosal resection, a less invasive alternative to surgery for removing abnormal tissues from the lining of the digestive tract is recommended to remove certain early-stage cancers or precancerous growth.

Technological advances
The advances and innovation in technology have brought a revolution in the field of endoscopy and abdominal imaging and have improved beyond the expectations of traditional imaging techniques and explorative surgeries. Increasing progress has recently been made in endoscopic technologies such as improvement in illumination source, narrow band imaging, and visualization of the vascular and tissue characterization with a focus on infection control for more precise diagnosis.

Lately, the focus seems to be less on enhancing image quality and more so on efficiency and cleanliness. In response to current incidents involving cross-contamination with conventional endoscopy, there has been development and testing of single use video endoscopes as well as a disposable sheath prototype for both a gastroscope and colonoscope. This endoscope allows complete isolation of the scope itself encapsulated with a disposable sheath system. The disposable sheath system includes a sheath cover and cuff which incorporates all working channels for suction, irrigation, and tool passage. This allows the contaminated part of the procedure, the disposable sheath, to be discarded after patient use reducing the risk of endoscopic bioburden cross-contamination and infections. As for the single use endoscope, upon completion of the procedure the entire scope is discarded.

Flexible endoscopes for gastroenterology and pulmonology are continuing to evolve along multiple vectors in order to meet the simultaneous needs of doctors for better access to hard-to-reach parts of the anatomy, better image quality, and advanced modes of visualization, more ergonomic handling, and durability that holds up under heavy daily use. Significant advancements also have been made in flexible scope technologies. Leveraging distal-chip technology, for instance, the industry is migrating more fully to the use of digital imaging versus traditional coherent glass fiber endoscopes, such as video endoscope systems for ENT and GI applications, among others.

There have been significant advances in the light output of rigid endoscopes over the past 5–10 years. Other milestones have occurred in the functional aspects of rigid scopes, which have added new capabilities at times.

NBI, classified as an optical-digital method, is an advanced endoscopic imaging technology that has recently been developed, in which spectral bandwidth filters are used to improve the accuracy of diagnosis. Although endoscopy using NBI is remarkably useful for differential diagnosis of superficial gastric lesions that are identified under white light, there seems to be very little evidence to justify routine use of NBI during routine screening endoscopy. NBI processors with higher light intensities have been developed that may potentially improve detection rates and these newer-generation NBI processors are currently being launched commercially.

Today, endoscopic visualization is significantly influenced by video algorithms that are usually part of the camera head and/or camera control unit. The goal of using such algorithms in endoscopic camera settings is to improve the image quality automatically to give the user the best performance. One of the biggest problems in the past for end users was the need to deal with defective pixel errors of the image sensor, which can be caused by issues such as cosmic radiation during shipment in an aircraft. Such errors can be disrupting and may interfere with a procedure. Modern cameras are equipped with dynamic pixel-error detection and correction that eliminate such pixel errors continuously.

Way forward
As time advances so does the technology. Every year newer versions of the tools that are smarter, smaller, lighter, and more accurate than before are launched. Recent improvements in technology have paved the way for miniaturized and disposable endoscopes. Moreover, with the increase in demand for ground-breaking technologies, newer versions of endoscopes including capsule and robot-assisted endoscopes will gain traction in the near future.