Fifty years of digestive endoscopy: Successes, setbacks, solutions and the future

Abstract

Flexible endoscopes became generally available 50 years ago and created a revolution in the practice of gastroenterology. They improved diagnosis enormously, enabled quicker, less invasive, and more cost‐effective surgical treatment, while endoscopic screening has prevented many cancer deaths. The new technology stimulated research leading to a better understanding of gastrointestinal pathology, identifying new diseases and clarifying the etiology of others. Better‐controlled clinical trials accelerated the use of newer and more effective drugs. National and international endoscopy societies supported nursing input, encouraged research, stimulated specialist journals, and devised guidelines that encouraged audit and quality assurance. Advances in instrument design and the manufacture of new accessories enhanced endoscopic technique, diagnostic ability, patient comfort, and safety. The risk of cross‐infection inherent in the use of complex labile equipment that cannot be autoclaved remains a challenge. Endoscopy societies working closely with industry have established rigid protocols for high‐level disinfection that minimize the risks, but strict adherence to guidelines and continued vigilance is essential, especially with the increasing prevalence of antibiotic‐resistant commensals that can give rise to opportunistic infection. Government health departments have a responsibility to encourage and support research in this area by endoscopists, instrument manufacturers, and the pharmaceutical industry. Current trends suggest that in the future, artificial intelligence will greatly improve endoscopic diagnosis, and that therapeutic endoscopy will expand, encouraging endoscopists to subspecialize.

Video Capsule Endoscopy and Ingestible Electronics: Emerging Trends in Sensors, Circuits, Materials, Telemetry, Optics, and Rapid Reading Software

“…With expanding knowledge of sacral and vagal nerve pathways and underlying mechanisms, the emerging technologies of bioelectric neuromodulation and gastric electrical stimulation (GES) could be tailored and optimized for the treatment of gut inflammation, obesity, gastroparesis, and fecal incontinence [11]. The rising rates of gastrointestinal diseases and cancers suggest that we will see further subspecializations in therapeutic and diagnostic endoscopy with emphasis on procedural training, computing skills, and service quality [10]. The performance measures for endoscopic procedures will evolve with time and affect the organization, leadership, staffing, quality and safety, and patient involvement [40].…”

“…Artificial intelligence and personalized treatments will play a greater role in endoscopic therapeutics and diagnosis. Lastly, video capsule endoscopy could effectively complement existing procedures in surgery and radiology by establishing safe and high-quality out-patient procedures, reduced medical complications, and quicker diagnostics at lower costs [10]. Advanced Devices & Instrumentation tabulation, and discussion.…”

“…This led to the invention of a fully flexible, digestive endoscope by Basil Hirschowitz in 1957. A collection of photographs of these pioneers and the endoscopic equipment from that particular era is nicely illustrated in a recent review article [10]. The same decade witnessed the invention of the first wireless, swallowable capsule (called the radio pill) to measure pH, core body temperature, and pressure of the gastrointestinal tract.…”

“…From the clinical perspective, emphasis started to be placed on improving the quality and safety of endoscopic service with a patient-centered approach [40]. As such, specialized nursing groups were created within gastroenterology and endoscopy societies to improve the safety and comfort of patients, monitor the purchase and maintenance of endoscopic equipment, and provide support during patient hospitalization, recovery, and discharge [10].…”

“…The assessment of capsule functions is done using key performance indicators (KPIs) of accuracy and resolution, repeatability and robustness, autonomous navigation, power consumption, form factor, and operational ease. Besides these KPIs, a central objective of capsule technologies lies in improving the safety and quality of procedures while prioritizing patient comfort and involvement [10]. However, capsule system manufacturers face multiple hurdles as they move up the technology readiness levels (TRLs).…”