Interventional gastroenterology

Call for a paradigm shift in endoscope design

Australian clinicians have suggested there is considerable room for improvement in the design of endoscopes for diagnostic and therapeutic procedures into the future.

Professor Gerald Holtmann and colleagues, from the Princess Alexandra Hospital in Brisbane, wrote in the Journal of Clinical Gastroenterology that current mainstream endoscopes were not fundamentally different from the initial fiberoptic versions of 50 years ago.

And they had limitations including:

  • The quality and outcomes of endoscopic procedures is operator dependent
  • Endoscopes are manually controlled
  • The need for anaesthesia/sedation
  • The risk of procedure-related complications
  • Risk of transmission of infection

“Artificial intelligence and pattern recognition should eliminate interindividual variability including polyp detection rates, self-propelled, and (potentially remotely controlled) scopes with a soft shaft could reduce the discomfort during procedures and abolish the need for sedation and anesthesia altogether and single-use designs should eliminate the risk of patient-to-patient transmission of infections,” they said.

And there was, for example, “a promising and refreshingly different alternative” developed and marketed in Italy.

“The endoscope itself is made of polyurethane, the tip of the scope and the propulsion are driven by a separate innovative pneumatic controller system that allows the instrument to navigate through the intestine while the endoscopist controls the system via a “PlayStation-type” console that is connected to the controller system directly or alternatively wireless via Bluetooth.”

“Instead of expensive special camera chips, more affordable sensors manufactured originally for smartphones are used. A sufficiently sized working channel still allows the usual therapeutic and diagnostic interventions.”

They said the next generation of medical professionals that have grown up using PlayStation were likely to be able to rapidly adapt their skills to the new technology.

“In addition, such a design would allow an extended integration of AI for pattern recognition and the semiautomated inspection of, for example, the colon as well as assist in advancing or even autopiloting such devices through all regions of our GI tract.”

They said innovation now required a shift in focus from the refinement of optical capabilities towards the overall performance of the endoscopic system.

“The required design changes are more than small refinements but represent a paradigm shift of the current design of endoscopes.”

“This will present a challenge for all relevant stakeholders not only because of cost implications due to the need to fund the development, the training, and clinical use of the new equipment; it equally will be important to convince all relevant stakeholders including gastroenterologists who have trained to become competent endoscopists with the conventional equipment,” they concluded.

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