capsule experience - MG Lorenzatto

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Wireless transmission of a color television moving image from the stomach using a miniature CCD camera, light source and microwave transmitter. Swain CP, Gong F, Mills TN. Gastrointest Endosc 1997;45:AB40. Meanwhile, back in Israel, Dr. Iddan knew that if there was to be a future for the capsule for small intestine imaging, it would have to be championed by a commercial organization. He began to arrange meetings with different organizations in the hope that they would take the challenge and invest in the business. It was one of these meetings that brought Dr. Iddan to me. We had first met in 1995 when I was CEO of Applitec Ltd., an Israeli company that had developed and was selling video cameras for endoscopy. In 1997, the patent in the US was approved, and the available technologies needed for the capsule's development had moved in the right direction. It was at this time that I approached the Rafael Development Corporation (RDC), who has the right of first refusal to commercialize technologies coming out of Rafael, in order to found together a start-up that would develop the capsule and bring it to market. I left my position at Applitec and set out to raise funds and develop a business model and strategy for the new company, which was named Given (GastroIntestinal Video Endoscopy) Imaging Ltd., and established in January 1998. At that time, I defined the fledgling company's mission as "to develop, produce, and achieve worldwide leadership in the marketing and sales of swallowable disposable electronic capsules, for diagnostics and therapy of the gastrointestinal (GI) tract". This was clearly a much wider mandate than the Development of the Swallowable Video Capsule initial small intestine capsule, and was based on the development of a technological platform that would then be further developed by listening to gastroenterologists, understanding the barriers in small intestine imaging, and implementing solutions to overcome them. By the end of 1998, the initial team, that included Dr. Gavriel Iddan, Dr. Paul Swain, and Dr. Arkady Glukhovsky, was in place and serious research & development went underway to transform the idea into reality. Successfully overcoming the enormous obstacles of size, transmission strength, battery power and image resolution, among many others, working prototypes were produced in January 1999. In May 2000, at the DDW 2000 meeting, Dr. Swain, together with Given Imaging, presented the results of the animal trials performed with the prototype system that was developed. [Wireless Capsule Endoscopy, Nature, Vol. 405, 25 May 2000]. During 2001, Given achieved major milestones with the completion of successful clinical trials, receipt of FDA clearance, CE Mark certification, and launch of the Given ® Diagnostic Imaging System worldwide. The initial clinical results have been excellent, and the feedback from patients and physicians has been remarkable. The idea of publishing this Atlas of Capsule Endoscopy came in recognition of the need that was expressed by many physicians to see with their own eyes specific pathologies and findings, and compare the images between the different available modalities. We hope the content of this Atlas assists in educating gastroenterologists and furthers the understanding and acceptance of the M2A ® as a standard tool of GI diagnostics in the clinical path. 5
Notes From the Inventor Gavriel J. Iddan, D.Sc. Approximately 20 years ago, I took a sabbatical from my position as an electro-optical systems engineer at Rafael, the Armaments Development division of the Israeli Ministry of Defense, and went to work for a medical instrument manufacturer in Boston, Mass. Coincidentally, I discovered that my next-door neighbor was a gastroenterologist, Prof. Eitan Scapa, who was also on sabbatical and working at a local hospital. After getting to know each other, we would spend time discussing our respective professions. Among other things, I learned about the field of endoscopy and was exposed to some of its challenges. After returning to my work at Rafael, I became deeply interested in medical devices and did some design work in this area. During my next sabbatical, and after further discussions with Professor Scapa, I decided to focus on the specific problems of imaging of the small intestine. After consulting with a number of gastroenterologists, I finally decided to attempt the development of a wireless camera. The major obstacles that I encountered and needed to overcome included: attaining an adequate field of view, achieving power requirements for the CCD, and the challenge of performing a diagnostic study that required close contact with the patient for many hours. A major breakthrough came in 1993 when I realized that the system could be separated into 3 major units: capsule/transmitter, receiver/recorder and a workstation. The separation of these components would allow the patient to be ambulatory without the need to be connected to a monitor. During this period, the scientific literature started to report a breakthrough in video imaging. This was the introduction of the CMOS imager which consumed only a fraction of the energy required by a CCD, had all the required circuits on the same chip, and was not expensive to manufacture. To complete the idea, a special self-cleaning optical configuration was added and detailed design and experiments commenced. (One of the first experiments was done on a frozen chicken purchased in the supermarket.) By the second half of 1993, I began writing a patent application, which was submitted in January 1994. While searching urgently for financing to create this device, I approached Dr Gavriel Meron, who at that time was the manager of a company specializing in small endoscopic cameras. Taking my invention and developing a viable business plan, Dr. Gavriel Meron established Given Imaging Ltd in 1998, thus launching the new field of capsule endoscopy and making the dream a reality. 7
Page 1 and 2: Atlas of Capsule Endoscopy Editors:
Page 3 and 4: Atlas of Capsule Endoscopy Marisa H
Page 5 and 6: Acknowledgments We would like to th
Page 7 and 8: Table of contents Development of th
Page 9: 4 Development of the Swallowable Vi
Page 13 and 14: 10 Chapter 1 THE OPTICAL DOME The o
Page 15 and 16: 12 Chapter 1 c. Conscious sedation
Page 17 and 18: 16 Chapter 2 Typical timing of a ca
Page 19 and 20: 18 Chapter 2 Figure 1. Intializing
Page 21 and 22: 20 Chapter 2 Figure 5. Time Capsule
Page 23 and 24: 24 Chapter 3 becomes very obvious.
Page 25 and 26: 26 Chapter 3 M2A ® M2A ® Figure 3
Page 27 and 28: 28 Chapter 3 M2A ® Figure 3.5b Nor
Page 29 and 30: 30 Chapter 3 M2A ® M2A ® Figure 3
Page 31 and 32: Chapter 4 Inflammatory Diseases of
Page 33 and 34: Chapter 4 6 Sayek I, Aran O, Uzunal
Page 35 and 36: Chapter 4 M2A ® M2A ® Figure 4.4a
Page 37 and 38: Chapter 4 M2A ® Figure 4.5f Pseudo
Page 39 and 40: Chapter 4 M2A ® Figure 4.6f Extens
Page 41 and 42: Chapter 4 M2A ® M2A ® Figure 4.10
Page 43 and 44: Chapter 4 M2A ® Figure 4.15a Jejun
Page 45 and 46: 48 Chapter 5 with small bowel tumor
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Page 53 and 54: 56 Chapter 5 Figure 5.12c Biopsy of
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Chapter 6 Iatrogenic Diseases M2A
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Chapter 7 Vascular Abnormalities Ma
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Chapter 7 References and Suggested
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Chapter 7 M2A ® Figure 7.2 74 year
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Chapter 7 M2A ® Figure 7.8a Small
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Chapter 8 Malabsorption Gerard Gay,
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Chapter 8 References and Suggested
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Chapter 8 Endoscopic management of
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Chapter 8 M2A ® M2A ® Figure 8.1e
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Chapter 8 Figure 8.3a Enteroscopy p
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Chapter 8 M2A ® M2A ® Figure 8.3i
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Chapter 8 M2A ® Figure 8.4a Celiac
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Chapter 8 Figure 8.6e Histological
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Chapter 8 Figure 8.7f Higher magnif
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Chapter 8 M2A ® Figure 8.9a 38 yea
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104 Chapter 9 Our preliminary data
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106 Chapter 9 M2A ® M2A ® Figure
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108 Chapter 9 M2A ® Figure 9.4a 11
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112 Chapter 10 transplant. Indicati
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114 Chapter 10 M2A ® Figure 10.2b
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116 Chapter 10 M2A ® Figure 10.4c
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120 Chapter 11 CONCLUSION During th
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122 Chapter 11 M2A ® Figure 11.4a
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Contributors Carla Abbiati, M.D. Un
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128 Contributors (continued) Sandor
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130 Contributors (continued) Ana Sa
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capsule experience - MG Lorenzatto

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