Capsule endoscopy.pdf

CAPSULE
CAMERA

A
PILL
WIT
H
A
VIE
W

What is capsule endoscopy?
•Capsule endoscopy is a novel
noninvasive technology designed
primarily to provide diagnostic
imaging .

HISTORY
This Miniature Ingestible
Camera was conceived by
Tarun Mullick developed in
late 1980's with the help of
gastroenterologist, Dr. Sudhir
Dutta.

The Camera Pill
Swallowable Camera Capsule,
from Given Imaging, including
Zarlink’s ULP RF Transmitter

Specifications
§ Diameter of 10 mm and a Length of 20 mm.
§
§ Bullet shape - This shape and its diameter are critical for
mapping the small intestine.
§ Uses Silver oxide button batteries - high energy density &
disposable.
§ Made up of biocompatible material.

Features of the Capsule
•Capsule takes two images per second
•On average, 50,000 images are obtained during an
8 hour exam
•Magnification: 8x
•Capsule coating: non-adherant
•Disposable

CONSTRUCTION OF CAPSULE
CAMERA
-
HAS 8 PARTS

CAPSULE
CAMERA(Internal view)
Capsule
Electronics
1.Optical dome
2. Lens holder
3. Lens
4.Illuminating
LEDs
5. CMOS imager
6 .Battery
7. ASIC transmitter
8. Antenna

1.Optical Dome
Front part of capsule Bullet shaped
Easy orientation Easy propelling

2.Lens Holder
Lens Holder holds lens tightly & avoids its dislocation.

3.Lens
Arranged behind Light Receiving Window
Focuses light on the CMOS Image Sensor behind it.

PIXEL
ARRAY
4.CMOS Image Sensor
READ
CIRCUIT
OSCILLATI
NG
CIRCUIT
CODING
CIRCUIT
CONTROL
CIRCUIT
SWITCHING
CIRCUIT
CURRENT
LIMITING
CIRCUIT

5.Battery
Button shaped & two in number
Made of Zinc/Alkaline Electrolyte/Silver Oxide
Has discharge voltage, disposable and doesn’t cause harm to the
body.

6.ASIC Transmitter
The ASIC (Application Specific Integrated Circuit) Transmitter
Two Transmitting Electrodes are connected to the outlines of the
ASIC Transmitter.
These electrodes are electrically isolated from each other.

7.Antennae
The dome containing the Antennae is made of non conducting
material which is harmless to the human body.
Parylene coated onto polyethylene or polypropylene is used.
As shown, the Antennae is arranged at the end of the capsule. It
is enclosed in a dome shaped chamber.
The Antennae receives the data from the ASIC Transmitter and sends
it to the Data Recorder tied to the patient’s waist.

PillCam Platform
Components
• PillCam ESO or
SB
• Data Recorder
• Given
Workstation
• RAPID
Software

A view of Data Recorder being
mounted on a belt pack tied
to the patient’s waist.
Data Recorder with pick up
antennae & a Computer.

SB 2 with RAPID 4 SB 2 with RAPID 5

Improved Diagnostic Confidence:
RAPID Atlas
• All images reviewed
and labeled by
physician advisory
panel.
• Enables side-by-side
comparison of case
image to known
pathology.
• Searchable by Capsule
Endoscopy Structured
Terminology (CEST),
findings, and diseases.

TYPES AND
APPLICATION
-4 TYPES

PillcamSB
•Approved by FDA in 2001
•Size-11mm x 26 mm
•Weight-3.7 grams
•One-sided imaging
•Two pictures per second
•1:8 magnification
•140 degree field of view
•Over 50,000 images in 8
hours
•PillcamSB 2-cleared by FDA
May 2007-offers wider field
of view and improved optics

PillcamESO
•Approved by the FDA in
2004
•Size 11mm x 26mm
•Weight-3.7 grams
•Two sided photography
•14 images per second
•2,600 pictures in 20 minutes
•PillcamESO 2-cleared by
FDA May 2007-offers wider
field of view and 18 images
per second

Agile Patency Capsule
•Same size as actual video capsule
•Composed of lactose
•Contains a timer, radiofrequency
identification tag, and radio-opaque material
•Can be seen by plain abdominal film or by
special handheld radiofrequency detector
•Designed to progressively dissolve after 40
hours of contact with digestive secretions
•Disintegrates completely between 80 and 100
hours
•Allows localization of site of stenosis before
video capsule
•Not considered standard of practice

Uses
PillCam SB- Crohn's Disease, Small bowel
tumors, Small bowel injury, Celiac Disease, Mal-
Absorption Disorders, Vascular Disorders,
Ulcerative Colitis
PillCam ESO -esophageal diseases, gastro esophageal
reflux disease, Barrett's esophagus PillCam COLON-
colon
Agile patency capsule- intestinal patency

EXISTING PRODUCTS
1.OMOM 2.M2A
3.PILLCAM 4.NORIKA3
5.MTSI

Preparation
§Patient fasts overnight or for at least 12 hours
§No iron pills for 5 days or olestra
§Colyte prep: clear liquid diet at noon, 2/3 gallon
colyteat 6 PM, 4 hours prior to capsule take 1/3 gallon
colyteand 2 simethicone tablets
§Magnesium Citrate prep: clear liquid diet at noon, 1
bottle of magnesium citrate followed by 1 bottle of
gatoradeat 6 PM, 8 PM and 4 hours prior to capsule with
2 simethicone tablets 4 hours prior

Procedure for PillcamSB
Ø•Patient comes to endoscopy center
Ø•8-lead antenna placed on patient and battery pack placed
on patient
Ø•Patient swallows pill and leaves unit
Ø•Can ingest liquids 2 hours after capsule taken
Ø•Can eat food 4 hours after capsule taken
Ø•Patient brings back recorder approximately 8 hours after
ingestion
Ø•Patient does NOT recover capsule
Ø•Recorder then downloaded onto computer which can
take 2.5 to 3 hours
Ø•Capsule then read on computer

Procedure for PillcamESO
Ø•Patient swallows the pill while lying down
with little or no water
Ø•The patient is then slowly elevated
Ø•This allows for the capsule to spend a longer
time in the esophagus and therefore allow for
better visualization of the esophagus

Endoscopy Procedure
Ø Capsule is swallowed by the patient like a conventional pill.
Ø It takes images as it is propelled forward by peristalsis.
Ø A wireless recorder, worn on a belt, receives the images
transmitted by the pill.
Ø A computer workstation processes the data and produces a
short video clip or still images.

The Diagnostic Procedure

Capsule
Imaging
• Moved by
peristalsis
• 2Hz, 576 X576
color image
• Typical studies are
around 6-8
hours.
• 10,000s of images
from each
study
• Somewhat
cumbersome to

In approximately eight hours, the
patient will return to the clinic for
removal of equipment.
9:00 am 5:00 pm

Advantages
§ Painless, no side affects or complications.
§Miniature size, so can move easily through the digestive system.
§ Accurate, precise & low power consumption.
§Images taken are of very high quality which are sent almost
instantaneously to the data recorder for storage.
§
§Made of bio compatible material, doesn’t cause any harm to the body.
§
§The procedure is simple.

§Use of Suspected Blood Indicator (SBI)which add no cost.
§
§AdvanCE (Advance CE) for patients unable to swallow
§
§High sensitivity and specificity for detecting lesions.
§
§CE avoids the risks associated with sedation and radiation.
§
§It is noninvasive and may not require the patient to miss work.
§Reducing physician reading times and improving cost-effectiveness.
§
§More efficient than normal endoscopy,the X ray or the CT scan.
§Remote interpretation for rural settings

Image Spectrum: PillCam Capsule Endoscopy
Bleeding
Tumors
Suspected Crohn’s
Celiac Disease

Capsule Endoscopy Versus Other
Imaging Modalities
Study Yield
Capsule vs Ileoscopy 61% vs 46%
Capsule vsPush enterosc 51% vs 7%
Capsule vs CT enterography 75% vs 37%
Capsule vs Small bowel MRI 60% vs 40%

Disadvantages
Gastrointestinal obstructions and swallowing disorders prevent free flow of
capsule through the digestive system.
Patients with pacemakers, pregnant women and all pediatrics have to be
monitored continuously while taking the capsule.
The M2A procedure is not a replacement for Colonoscopy.
It is not reusable.
Capsule obstruction which necessitate surgical removal
More expensive than the other procedures
Batteries may not last long
Presence of cardiac pacemakers and cardiac defibrillators could lead to
corruption and loss of the transmitted data.
MRI not possible while the capsule inside the patient's body
v

CAPSULE ENDOSCOPY
RETENTION
• Capsule retained proximal to an intestinal narrowing for at
least TWO WEEKS.
• Untreated, may be permanent.
• Capsule removal requires medical endoscopic or surgical
intervention

Future Improvements
§Equipping the capsule with a LASER.
§ Adding additional features like Zooming & Auto
Focus.
§ Can be used in Restorative Surgery &
Pharmacological Intervention.
§ Further reduction in size using Nano Technology.
§Making it cost effective.
§

§SB2 with new features mm
§RAPID® REAL TIME VIEWER
§Labeling the bowel wall, sample luminal
contents, biopsy the mucosa, provide therapeutic
ablation of lesions, or control the movement of the
device.
§Evaluation of celiac sprue and chronic abdominal
pain.
§Longer battery half-life
§Humanoid robot
§Capsule camera with telemetric capacities
§Making it cost effective.

Conclusion
The Endoscopy capsule is a pioneering concept for Medical
Technology of the 21 st century.
The endoscopy system is the first of its kind to be able to provide noninvasive
imaging of the entire small intestine.
It has revolutionized the field of diagnostic imaging to a great extent
and has proved to be of great help to physicians all over the world.

THANK YOU