Endoworm: A new semi-autonomous enteroscopy device

Abstract

Using enteroscopes with therapeutic capacity to explore the small intestine entails certain limitations, including long exploration times, patient discomfort, the need for sedation, a high percentage of incomplete explorations and a long learning curve. This article describes the advances and setbacks encountered in designing the new Endoworm enteroscopy system, a semi-autonomous device consisting of a control unit and three cavities that inflate and deflate in such a way that the bowel retracts over the endoscope. The system can be adapted to any commercial enteroscope. Endoworm was tested in different intestine models: a polymethyl methacrylate rigid tube, an in vitro polyester urethane model, an ex vivo pig model and an in vivo animal model. The general behavior of the prototype was evaluated by experienced medical personnel. The mean distance covered through the lumen was measured in each cycle. The system was found to have excellent performance in the rigid tube and in the in vitro model. The ex vivo tests showed that the behavior depended largely on the mechanical properties of the lumen, while the in vivo experiments suggest that the device will require further modifications to improve its performance.

Analysis of the ‘Endoworm’ prototype’s ability to grip the bowel in in vitro and ex vivo models

“…This locomotion concept is similar to that used in double-balloon enteroscopy, 2 but in this case, the movement is automatic. In a previous work, 34 the prototype was described in detail. Briefly, an electronic microcontroller governs the pneumatic system.…”

“…It was conceived to combine robotic technology with the push-and-pull principle. 33,34 Although it was designed to achieve easier and faster explorations, certain problems related to its gripping capacity were found in its ability to advance. The aim of this work is to get a deeper knowledge of the different parameters that influence this new prototype’s gripping capacity.…”

Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

“…About this latter point, a novel motorized spiral enteroscope has been successfully used for the treatment of angiodysplasia . Another robotic system called ‘endoworm’ is in study . This semi‐autonomous device consists of an electronic control unit and a pneumatic system with two balloons that are inflated and deflated in such a way that the bowel retracts over the endoscope.…”

“…191 Another robotic system called 'endoworm' is in study. 192 This semi-autonomous device consists of an electronic control unit and a pneumatic system with two balloons that are inflated and deflated in such a way that the bowel retracts over the endoscope. Experiments have shown excellent performance in an in vitro model but a very poor performance in an in vivo animal model as a result of problems related to the bowel's characteristics, thus showing the need for improvement prior to human applications.…”

“…Experiments have shown excellent performance in an in vitro model but a very poor performance in an in vivo animal model as a result of problems related to the bowel's characteristics, thus showing the need for improvement prior to human applications. 192 In conclusion, there is an ideal enteroscopy system for each type of procedure (i.e. diagnostic or therapeutic), clinical setting (e.g.…”