Wireless Video Capsule Endoscopy

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Presentation transcript:

Wireless Video Capsule Endoscopy 1st Invitational Workshop on Body Area Network Technology and Applications Wireless Video Capsule Endoscopy David Cave MD PhD Professor of Medicine University of Massachusetts Medical School

Disclosures David Cave Recipient of research funds from and consultant for Given Imaging Recipient of research funds from Intromedic Consultant for Olympus Corp

Anatomy of the small intestine Tools available Esophago-gastro-duodenoscopy Push enteroscopy Deep enteroscopy Colonoscopy

What is Capsule Endoscopy? Capsule endoscopy (CE) allows for direct, non-invasive visual examination of the gastrointestinal tract Images are transmitted from a disposable, ingestible wireless video capsule and are downloaded for clinical review CE has become the gold standard in evaluating suspected disease of the small bowel

Evolution of Capsule Endoscopy 1999 2000 2003 2007 Hardware Software Capsule OMOM Mirocam Capsocam

Capsule Endoscopy Systems Given PillCam SB2 Olympus EndoCapsule

Capsule Endoscopes  Size  Weight Resolution Rate Time Field of View IntroMedic MiroCam Given Imaging SB / SB2 Olympus EndoCapsule  Size 11x24mm 11x26mm  Weight 3.4g 3.45g -- Resolution 320 x 320 256 x 256 Rate 3 fps 2 fps Time 11 hours 8 hours Field of View 150° 140° / 156° 145° Communication HBC RF Real Time Viewer Yes Should also speak about quick view mode.

Gastrointestinal Endoscopy 2006;63(4):539-545 Clinical Applications for CE (ASGE Technology Status Evaluation Report) Small Bowel Capsule Endoscopy: Obscure GI bleeding including iron deficiency anemia (IDA) Suspected Crohn’s disease Suspected small intestinal tumors and surveillance in patients with polyposis syndromes Suspected or refractory malabsorptive syndromes (celiac disease) Gastrointestinal Endoscopy 2006;63(4):539-545 9

Clinical Applications for CE [Other] Chronic diarrhea Assessment of disease activity of Crohn’s disease. Detection of strictures Abdominal pain?????

The Problem Where is the lesion/capsule? Current localization algorithms are not useful

Anatomy of the small intestine

Video capsule desktop

What do we use to assess position of the VCE? Time Assumption: motion is linear between pylorus and ileo-cecal valve Factors that alter motility Disease process Adhesions Blood stimulates gut motility Transit incomplete 15-25% of the time

Assessment of motor function New insight into intestinal motor function via noninvasive endoluminal image analysis Malagelada C et al; Gastroenterology 2008 Oct;135(4):1155-62

Conclusions Is there a methodology that could improve location of a VCE? 1- longitudinally 2- in 3 D with reference to fixed points

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