Trends are already visible from expensive optical high-end endoscopes toward optimized visualization systems that integrate the endoscope and the camera.
For years, the trend on improving the quality of endoscopy has been the launch of new models where the aim was – thinner and better looking. As a result of these advancements, doctors now have scopes with a reduced diameter, making them easier to use and providing higher patient satisfaction.
The image quality has been improved by the introduction of high definition (HD) imaging and advanced filter functions, where the light wavelength and their penetration depths were utilized. These improved images have radically changed the endoscopist’s opportunities to perform real-time macroscopic histological diagnoses, and thereby making safer and more efficient clinical decisions.
But recently, a new tool has emerged on the arena – artificial intelligence (AI). AI is already known in many other contexts. In endoscopy, the focus is on detection of neoplasia, and classification.
In the field of therapeutic endoscopy, the speed of development is breathtaking. In the endoscopy unit, in the recent years, market has introduced and established a wide variety of these new techniques.
A few examples are in the area of colonic neoplasia; full thickness resection using the techniques of endoscopic full thickness resection (e-FTR) and combined endoscopic and laparoscopic surgery (CELS), while in the area of bile drainage; lumen apposing metal stenting (LAMS).
In general, the aim of many new therapeutic endoscopic techniques has been toward replacing existing surgical techniques, examples of this have been – endoscopic fundoplication, endoscopic gastric sleeve, POEM to replace Hellers myotomy, gastroenteroanastomoses (GEA) with LAMS, just to name a few. The benefit being a lesser invasive procedure, often performed without general anesthesia, and thereby giving also more fragile patients a better option for treatment.
Looking into the crystal ball, on the future development within the fields of endoscopy, the vision on improving image quality is toward 3D virtual-reality imaging, and increasing wider field of vision, in order to visualize as much of a given intestinal surface as possible.
The Indian endoscopes market in 2020-21 received a minor setback with the COVID outbreak. Sales fell by about 10 percent, by value. The fall in sales in 2020 was compensated by a surge in demand in JFM 2021 quarter, and the momentum continues, with the government being a major contributor. The market in 2020-21 is estimated at ₹521.6 crore, at 3317 units; a new entry in the segment is the motorized spiral endoscope, the latest model launched in 2020.
The three leading brands in the rigid endoscopes segment, Olympus, Stryker, and Karl Storz, together constitute 90 percent of the market. The local players continue to have a 10-percent market share. While the imported segment commands a unit price in the range of ₹12–15 lakh, the local players have to make do with ₹7.5 lakh. Refurbished models are no longer preferred and the Chinese players too lost ground this year.
The flexible endoscopes segment is dominated by Olympus, with Fujifilm also aggressive in the market. Pentax is continuing to lose market share, especially with the private sector. Karl Storz is more of a regional player.
Indian endoscopy equipment market
Major players – 2020
and Karl Storz
|Refurbished, regional, and Chinese brands|
|Karl Storz, Richard Wolf,
and other regional brands
|Balloon||Olympus (single) and Fujifilm (double)|
|ADI Media Research|
Olympus has introduced the PowerSpiral Enteroscopy, a motorized type of endoscope that allows for fast and gentle access to reach deep into the gastrointestinal tract by pleating the small bowel onto the enteroscope using a spiral segment. This is achieved via an integrated motor, which rotates the single-use PowerSpiral cover tube that is equipped with soft spiral-shaped fins that gently follow the mucosa. The enhanced insertion speed, easy advancement, controlled withdrawal, and improved maneuverability can substantially reduce the overall procedure time and allow time for effective treatment. The company had sales of 12 units in 2020-21, installation base being 17 units. This technology is being preferred over the balloon endoscopes, with which the same procedure takes almost double the time.
As India continued to battle the COVID-19 pandemic, new deadly complications of the infection surfaced. Patients with suspected mucormycosis needed to undergo nasal endoscopy, an endoscope from the rigid segment. This segment is expected to clock ₹430 crore in 2021-22, from ₹380 crore in 2019-20 and ₹340 crore in 2020-21.
Thanks to new technologies, the world of classic endoscopy is seeing significant changes, opening the doors for related medical devices and system providers to step into the market.
Until a few years back, the majority of minimally invasive surgical procedures used rigid endoscopes, such as laparoscopes and arthroscopes, with a rod-lens-based optical system. These optical systems are usually expensive and fragile, which is why the users of such devices, reprocesses included, are trained to handle them with extreme care and caution. But a number of technological developments have significantly pushed forward improvements in endoscopy to the benefit of doctors and patients alike.
Trends, such as the combining and merging of different imaging and visualization methods – like MRI or CT with endoscopic images – or the connection and integration of medical devices in the operating theater, as well as combining endoscopic visualization with instruments, lasers, and other devices and technologies, will push further developments in this area.
Chip-in-scope and LED-in-scope, together with full-HD image sensors, offer new possibilities in the endoscopic field. In addition to making the instrument a lightweight hand-piece with a single cable, the system does not require any additional or separate light sources or cables.
One of the challenges of using the LED-in-tip system is the high temperature generated at the distal tip. However, such a system would have the distinctive advantage of avoiding any additional fibers for light transmission, such as from the hand piece.
As the market progresses, there will be a clear differentiation of endoscopic systems due to the requirements of reprocessing and image-quality procedures. Trends are already visible from expensive optical high-end endoscopes toward optimized visualization systems that integrate endoscope and camera. Such significant changes in many minimally invasive applications continue to provide new opportunities for all system providers, and require competent partners to develop new products.
System providers will ask for optimized solutions including instruments, lasers, or other medical devices. For such customized solutions, medical devices manufacturers will continue to cooperate with companies that have expertise in the development and manufacture of endoscopes and camera technologies, as well as in image processing.
One strategy for manufacturers is to combine standard and private-label products. This allows them to immediately start with endoscopic products, using their logo and brand, without investing heavily in R&D, thereby avoiding long development times and costs. Furthermore, if manufacturers respond promptly to market feedback on first-generation products, they can start on a customized second generation of OEM products within a very short time, forging the path for significant advances in endoscopy.