Capsule endoscopy of the future: What’s on the horizon?

Design and Evaluation of ScanCap: A Low-Cost, Reusable Tethered Capsule Endoscope with Blue-Green Illumination Imaging for Unsedated Screening and Early Detection of Barrett's Esophagus

Esophageal carcinoma is the sixth-leading cause of cancer death worldwide. A precursor to esophageal adenocarcinoma (EAC) is Barrett's Esophagus (BE). Early-stage diagnosis and treatment of esophageal neoplasia (Barrett's with high-grade dysplasia/intramucosal cancer) increase the five-year survival rate from 10% to 98%. BE is a global challenge; however, current endoscopes for early BE detection are costly and require extensive infrastructure for patient examination and sedation. We describe the design and evaluation of the first prototype of ScanCap, a high-resolution optical endoscopy system with a reusable, low-cost tethered capsule, designed to provide high-definition, blue-green illumination imaging for the early detection of BE in unsedated patients. The tethered capsule (12.8 mm diameter, 35.5 mm length) contains a color camera and rotating mirror and is designed to be swallowed; images are collected as the capsule is retracted manually via the tether. The tether provides electrical power and illumination at wavelengths of 415 nm and 565 nm and transmits data from the camera to a tablet. The ScanCap prototype capsule was used to image the oral mucosa in normal volunteers and ex vivo esophageal resections; images were compared to those obtained using an Olympus CV-180 endoscope. Images of superficial capillaries in intact oral mucosa were clearly visible in ScanCap images. Diagnostically relevant features of BE, including irregular Z-lines, distorted mucosa, and dilated vasculature, were clearly visible in ScanCap images of ex vivo esophageal specimens.

In vivo animal study of the magnetic navigation system for capsule endoscope manipulation within the esophagus, stomach, and colorectum

BACKGROUND/PURPOSES

Magnetic navigation capsule endoscopy (MNCE) is considered to be an important means to realize the controllable and precise examination of capsule endoscopy (CE) in the unstructured gastrointestinal (GI) tract. For the current magnetic navigation system (MNS), due to the limitation of workspace, driving force, and control method of the CE, only clinical application in the stomach has been realized, whereas the examination of other parts of the GI tract is still in the experimental stage. More preclinical studies are needed to achieve the multisite examination of the GI tract.

METHODS

Based on the MNS (Supiee) developed in the laboratory, an X-ray imaging system with magnetic shielding and a commercial CE are integrated to form the MNCE system. Then, in vivo GI tract experiments with a porcine model are performed to verify the clinical feasibility and safety of this system. Moreover, the effects of different control modes on the efficiency and effect of GI tract examination are studied.

RESULTS

Animal experiments demonstrate that with the MNCE system, it is convenient to achieve steering control in any direction and multiple reciprocating movements of CE in the GI tract. Benefiting from the flexibility of the three basic control modes, the achieved swing movement pattern of CE can effectively reduce the inspection time. It is demonstrated that the esophageal examination time can be reduced from 13.2 to 9.2 min with a maximum movement speed of 5 mm/s.

CONCLUSION

In this paper, the feasibility, safety, and efficacy of the MNCE system for a one-stop examination of the in vivo GI tract (esophagus, stomach, and colorectum) is first demonstrated. In addition, complex movement patterns of CE such as the swinging are proved to effectively improve examination efficiency and disease detection rates. This study is crucial for the clinical application of the MNCE system.

Feasibility and safety of a novel string magnetically controlled capsule endoscopy for esophageal and gastric examination in a porcine model

BACKGROUND

Currently used magnetically controlled capsule gastroscope has many shortcomings, such as low resolution and frame rate, incomplete examination of the esophagus due to rapid passage, and risk of capsule retention. A novel string magnetically controlled capsule endoscopy with high frame rate and resolution can examine the esophagus comprehensively, and has no risk of capsule retention.

AIM

To verify the feasibility and safety of a novel string magnetically controlled capsule endoscopy for esophageal and gastric examination by animal experiments.

METHODS

Magnetically controlled capsule endoscopy (MCE) and traditional gastroscopy were performed on three Bama minipigs successively. The examination time for the esophagus and stomach was recorded. The MCE maneuverability and mucosal visualization in each part of the esophagus and stomach (upper, middle, and lower part of the esophagus, Z-line, and gastric cardia, fundus, body, angulus, antrum, and pylorus). Routine blood and biochemistry parameters of experimental animals before and after examination were analyzed, and adverse reactions occurring during the experiment were recorded.

RESULTS

Compared with traditional gastroscopy, MCE showed no significant difference in esophageal examination time (104.67 s ± 7.02 s vs 88.33 s ± 3.51 s, P = 0.093). The gastric examination time of MCE was longer than that of traditional gastroscopy (25.67 min ± 5.69 min vs 6.00 min ± 1.00 min, P = 0.019). The MCE maneuverability and mucosal visualization were better in the esophagus, Z-line, and gastric body, antrum, and pylorus than in the gastric cardia and fundus. No obvious adverse reactions occurred in experimental animals.

CONCLUSION

The novel string magnetically controlled capsule endoscopy has satisfactory feasibility and safety for esophageal and gastric examination in the porcine model.

Robotic, self-propelled, self-steerable, and disposable colonoscopes: Reality or pipe dream? A state of the art review

Robotic colonoscopes could potentially provide a comfortable, less painful and safer alternative to standard colonoscopy. Recent exciting developments in this field are pushing the boundaries to what is possible in the future. This article provides a comprehensive review of the current work in robotic colonoscopes including self-propelled, steerable and disposable endoscopes that could be alternatives to standard colonoscopy. We discuss the advantages and disadvantages of these systems currently in development and highlight the technical readiness of each system to help the reader understand where and when such systems may be available for routine clinical use and get an idea of where and in which situation they can best be deployed.

Endoscopic capsule robot-based diagnosis, navigation and localization in the gastrointestinal tract

The proliferation of video capsule endoscopy (VCE) would not have been possible without continued technological improvements in imaging and locomotion. Advancements in imaging include both software and hardware improvements but perhaps the greatest software advancement in imaging comes in the form of artificial intelligence (AI). Current research into AI in VCE includes the diagnosis of tumors, gastrointestinal bleeding, Crohn’s disease, and celiac disease. Other advancements have focused on the improvement of both camera technologies and alternative forms of imaging. Comparatively, advancements in locomotion have just started to approach clinical use and include onboard controlled locomotion, which involves miniaturizing a motor to incorporate into the video capsule, and externally controlled locomotion, which involves using an outside power source to maneuver the capsule itself. Advancements in locomotion hold promise to remove one of the major disadvantages of VCE, namely, its inability to obtain targeted diagnoses. Active capsule control could in turn unlock additional diagnostic and therapeutic potential, such as the ability to obtain targeted tissue biopsies or drug delivery. With both advancements in imaging and locomotion has come a corresponding need to be better able to process generated images and localize the capsule’s position within the gastrointestinal tract. Technological advancements in computation performance have led to improvements in image compression and transfer, as well as advancements in sensor detection and alternative methods of capsule localization. Together, these advancements have led to the expansion of VCE across a number of indications, including the evaluation of esophageal and colon pathologies including esophagitis, esophageal varices, Crohn’s disease, and polyps after incomplete colonoscopy. Current research has also suggested a role for VCE in acute gastrointestinal bleeding throughout the gastrointestinal tract, as well as in urgent settings such as the emergency department, and in resource-constrained settings, such as during the COVID-19 pandemic. VCE has solidified its role in the evaluation of small bowel bleeding and earned an important place in the practicing gastroenterologist’s armamentarium. In the next few decades, further improvements in imaging and locomotion promise to open up even more clinical roles for the video capsule as a tool for non-invasive diagnosis of lumenal gastrointestinal pathologies.

Efficacy and safety of vibrating capsule for functional constipation (VICONS): A randomised, double-blind, placebo-controlled, multicenter trial

BACKGROUND

Functional constipation (FC) is an intractable disease that carries large financial burden as well as emotional and physical stress. We aimed to assess the efficacy and safety of the newly developed smartphone-controlled vibrating capsule (VC) in patients with FC.

METHODS

From December 2018 to February 2020, we did a multicenter, blinded, placebo-controlled randomised trial in six top general hospitals in China focusing on patients aged 18 to 80 with FC. Patients were randomly assigned in a 1:1 ratio to receive VCs or placebo treatment for six weeks (two capsules per week) after a two-week baseline period. The primary outcome was the responder rate, defined as the proportion of patients with an increase of at least one complete spontaneous bowel movement (CSBM) per week during treatment compared to baseline in the full analysis set. This trial is registered with ClinicalTrials.gov, number NCT04671264, and is completed.

FINDINGS

107 patients aged from 18 to 74 were randomly assigned to receive VC (n = 53) or placebo treatment (n = 54). The responder rate in the VC group was significantly higher than that in the placebo group (64·2% vs. 35·8%; difference, 27·7% [95% CI, 10·4-45·1]; P = 0·005). More patients in the VC group reported weekly CSBMs ≥ 1 for at least four weeks during treatment (difference, 22·7% [95% CI, 8-46]; P = 0·022) and follow-up period (difference, 17.3% [95% CI, 0-35]; P = 0·048). The mean Patient Assessment of Constipation-Symptoms score and Patient Assessment of Constipation-Quality of Life score differed significantly from the baseline in both groups (all P < 0·0001). The most common adverse event associated with VC was abdominal discomfort (3·7%).

INTERPRETATION

VCs can promote defecation, as well as ameliorating symptoms and improving the quality of life in patients with FC with sustained efficacy. VC appears to be a potential alternative physical treatment for FC with the exact mechanism and parameters warranting further investigation.

FUNDING

The study was supported by "One hundred leading scientists for 21st century" of Health Department of Shanghai Municipal Government (to ZL, No.2017BR005).

Active Stabilization of Interventional Tasks Utilizing a Magnetically Manipulated Endoscope

Magnetically actuated robots have become increasingly popular in medical endoscopy over the past decade. Despite the significant improvements in autonomy and control methods, progress within the field of medical magnetic endoscopes has mainly been in the domain of enhanced navigation. Interventional tasks such as biopsy, polyp removal, and clip placement are a major procedural component of endoscopy. Little advancement has been done in this area due to the problem of adequately controlling and stabilizing magnetically actuated endoscopes for interventional tasks. In the present paper we discuss a novel model-based Linear Parameter Varying (LPV) control approach to provide stability during interventional maneuvers. This method linearizes the non-linear dynamic interaction between the external actuation system and the endoscope in a set of equilibria, associated to different distances between the magnetic source and the endoscope, and computes different controllers for each equilibrium. This approach provides the global stability of the overall system and robustness against external disturbances. The performance of the LPV approach is compared to an intelligent teleoperation control method (based on a Proportional Integral Derivative (PID) controller), on the Magnetic Flexible Endoscope (MFE) platform. Four biopsies in different regions of the colon and at two different system equilibria are performed. Both controllers are asked to stabilize the endoscope in the presence of external disturbances (i.e. the introduction of the biopsy forceps through the working channel of the endoscope). The experiments, performed in a benchtop colon simulator, show a maximum reduction of the mean orientation error of the endoscope of 45.8% with the LPV control compared to the PID controller.

Capsule Endoscopy for Gastric Evaluation

Wireless capsule endoscopy was first developed to observe the small intestine. A small capsule can be swallowed and images of gastrointestinal tract are taken with natural movement of peristalsis. Application of capsule endoscopy for observing the stomach has also received much attention as a useful alternative to esophagogastroduodenoscopy, but anatomical characteristics of the stomach have demanded technical obstacles that need to be tackled: clear visualization and active movements that could be controlled. Different methods of controlling the capsule within stomach have been studied and magnetic manipulation is the only system that is currently used in clinical settings. Magnets within the capsule can be controlled with a hand-held magnet paddle, robotic arm, and electromagnetic coil system. Studies on healthy volunteers and patients with upper gastrointestinal symptoms have shown that it is a safe and effective alternative method of observing the stomach. This work reviews different magnetic locomotion systems that have been used for observation of the stomach as an emerging new application of wireless capsule endoscopy.

Role of Artificial Intelligence in Video Capsule Endoscopy

Capsule endoscopy (CE) has been increasingly utilised in recent years as a minimally invasive tool to investigate the whole gastrointestinal (GI) tract and a range of capsules are currently available for evaluation of upper GI, small bowel, and lower GI pathology. Although CE is undoubtedly an invaluable test for the investigation of small bowel pathology, it presents considerable challenges and limitations, such as long and laborious reading times, risk of missing lesions, lack of bowel cleansing score and lack of locomotion. Artificial intelligence (AI) seems to be a promising tool that may help improve the performance metrics of CE, and consequently translate to better patient care. In the last decade, significant progress has been made to apply AI in the field of endoscopy, including CE. Although it is certain that AI will find soon its place in day-to-day endoscopy clinical practice, there are still some open questions and barriers limiting its widespread application. In this review, we provide some general information about AI, and outline recent advances in AI and CE, issues around implementation of AI in medical practice and potential future applications of AI-aided CE.

Novel Clinical Applications and Technical Developments in Video Capsule Endoscopy

Video capsule endoscopy is entering its third decade. After slow acceptance, it has become the gold standard in diagnosing small intestinal disorders. This article summarizes new practical applications for capsule endoscopy outside the small intestine. From 2 randomized controlled trials, it is becoming clear that it has a role in the management of patients with hematemesis and nonhematemesis bleeding. Under active investigation are novel applications of capsule technology, including the potential ability to sample luminal contents or tissue, self-propelled capsules, incorporation of other imaging techniques beyond white light, such as ultrasound and fluorescents, and the possibility of drug delivery.

Closed-loop control of soft continuum manipulators under tip follower actuation

Continuum manipulators, inspired by nature, have drawn significant interest within the robotics community. They can facilitate motion within complex environments where traditional rigid robots may be ineffective, while maintaining a reasonable degree of precision. Soft continuum manipulators have emerged as a growing subfield of continuum robotics, with promise for applications requiring high compliance, including certain medical procedures. This has driven demand for new control schemes designed to precisely control these highly flexible manipulators, whose kinematics may be sensitive to external loads, such as gravity. This article presents one such approach, utilizing a rapidly computed kinematic model based on Cosserat rod theory, coupled with sensor feedback to facilitate closed-loop control, for a soft continuum manipulator under tip follower actuation and external loading. This approach is suited to soft manipulators undergoing quasi-static deployment, where actuators apply a follower wrench (i.e., one that is in a constant body frame direction regardless of robot configuration) anywhere along the continuum structure, as can be done in water-jet propulsion. In this article we apply the framework specifically to a tip actuated soft continuum manipulator. The proposed control scheme employs both actuator feedback and pose feedback. The actuator feedback is utilized to both regulate the follower load and to compensate for non-linearities of the actuation system that can introduce kinematic model error. Pose feedback is required to maintain accurate path following. Experimental results demonstrate successful path following with the closed-loop control scheme, with significant performance improvements gained through the use of sensor feedback when compared with the open-loop case.

A Review on Lossless Compression Techniques for Wireless Capsule Endoscopic Data

BACKGROUND

The videos produced during wireless capsule endoscopy have larger data size causing difficulty in transmission with limited bandwidth. The constraint on wireless capsule endoscopy hinders the performance of the compression module.

OBJECTIVES

The objectives of this paper are as follows: (i) to conduct an extensive review of the lossless compression techniques and (ii) to find out the limitations of the existing system and the possibilities for improvement.

METHODS

The literature review was conducted with a focus on the compression schemes satisfying minimum computational complexity, less power dissipation and low memory requirements for hardware implementation. A thorough study of various lossless compression techniques was conducted under two perspectives, i.e., techniques applied to Bayer CFA and RGB images. The detail of the various stages of wireless capsule endoscopy compression was investigated to have a better understanding. The suitable performance metrics for evaluating the compression techniques were listed from various literature studies.

RESULTS

In addition to the Gastrolab database, WEO clinical endoscopy atlas and Gastrointestinal atlas were found to be better alternatives for experimentation. Pre-processing operations, especially new subsampling patterns need to be given more focus to exploit the redundancies in the images. Investigations showed that encoder module can be modified to bring more improvement towards compression. The real-time endoscopy still exists as a promising area for exploration.

CONCLUSION

This review presents a research update on the details of wireless capsule endoscopy compression together with the findings as an eye-opener and guidance for further research.

Photometric Stereo-Based Depth Map Reconstruction for Monocular Capsule Endoscopy

The capsule endoscopy robot can only use monocular vision due to the dimensional limit. To improve the depth perception of the monocular capsule endoscopy robot, this paper proposes a photometric stereo-based depth map reconstruction method. First, based on the characteristics of the capsule endoscopy robot system, a photometric stereo framework is established. Then, by combining the specular property and Lambertian property of the object surface, the depth of the specular highlight point is estimated, and the depth map of the whole object surface is reconstructed by a forward upwind scheme. To evaluate the precision of the depth estimation of the specular highlight region and the depth map reconstruction of the object surface, simulations and experiments are implemented with synthetic images and pig colon tissue, respectively. The results of the simulations and experiments show that the proposed method provides good precision for depth map reconstruction in monocular capsule endoscopy.

Current Advances in Drug Delivery Systems for Capsule Endoscopy

BACKGROUND

Oral administration of medications and current oral modified-release systems are the most preferred drug delivery routes, but they provide efficacy up to 12-24 hours per administration and are not useful when the patient has short transit time. The once-daily administered formulations are the endpoint of many types of drug development, and some innovations in capsule endoscopy (CE) can solve this problem.

OBJECTIVE

This review aims to reveal recent advances in drug delivery systems (DDS) for CE as an essential field of research for more precise drug targeting at the gastrointestinal (GI) tract.

METHODS

We performed a narrative overview of the MEDLINE database from 1991-2020 using the keywords of DDS and CE with synthesizing the findings, hand searches, and authoritative articles.

RESULTS

There are microelectromechanical systems and non-mechanical patent technologies for DDS for CE, and the implementation of wireless-capsule medical devices into the human body will provide new diagnostic and therapeutic options. Integrating biomedical CE with DDS and the cloud technology will bring remote real-time feedbackbased automated treatment or responsive medication.

CONCLUSION

Swallowable drug delivery systems for capsule endoscopy brings an entirely new approach for diagnostic and therapeutic methods in digestive diseases.

Miniature gastrointestinal endoscopy: Now and the future

Since its original application, gastrointestinal (GI) endoscopy has undergone many innovative transformations aimed at expanding the scope, safety, accuracy, acceptability and cost-effectiveness of this area of clinical practice. One method of achieving this has been to reduce the caliber of endoscopic devices. We propose the collective term “Miniature GI Endoscopy”. In this Opinion Review, the innovations in this field are explored and discussed. The progress and clinical use of the three main areas of miniature GI endoscopy (ultrathin endoscopy, wireless endoscopy and scanning fiber endoscopy) are described. The opportunities presented by these technologies are set out in a clinical context, as are their current limitations. Many of the positive aspects of miniature endoscopy are clear, in that smaller devices provide access to potentially all of the alimentary canal, while conferring high patient acceptability. This must be balanced with the costs of new technologies and recognition of device specific challenges. Perspectives on future application are also considered and the efforts being made to bring new innovations to a clinical platform are outlined. Current devices demonstrate that miniature GI endoscopy has a valuable place in investigation of symptoms, therapeutic intervention and screening. Newer technologies give promise that the potential for enhancing the investigation and management of GI complaints is significant.

Sensitivity Ellipsoids for Force Control of Magnetic Robots with Localization Uncertainty

The navigation of magnetic medical robots typically relies on localizing an actuated, intracorporeal, ferromagnetic body and back-computing a necessary field and gradient that would result in a desired wrench on the device. Uncertainty in this localization degrades the precision of force transmission. Reducing applied force uncertainty may enhance tasks such as in-vivo navigation of miniature robots, actuation of magnetically guided catheters, tissue palpation, as well as simply ensuring a bound on forces applied on sensitive tissue. In this paper, we analyzed the effects of localization noise on force uncertainty by using sensitivity ellipsoids of the magnetic force Jacobian and introduced an algorithm for uncertainty reduction. We validated the algorithm in both a simulation study and in a physical experiment. In simulation, we observed reductions in estimated force uncertainty by factors of up to 2.8 and 3.1 when using one and two actuating magnets, respectively. On a physical platform, we demonstrated a force uncertainty reduction by a factor of up to 2.5 as measured using an external sensor. Being the first consideration of force uncertainty resulting from noisy localization, this work provides a strategy for investigators to minimize uncertainty in magnetic force transmission.

Current Status of Interpretation of Small Bowel Capsule Endoscopy

Capsule endoscopy (CE) has revolutionized direct small bowel imaging and is widely used in clinical practice. Remote visualization of bowel images enables painless, well-tolerated endoscopic examinations. Small bowel CE has a high diagnostic yield and the ability to examine the entire small bowel. The diagnostic yield of CE relies on lesion detection and interpretation. In this review, issues related to lesion detection and interpretation of CE have been addressed, and the current status of automated reading software development has been reviewed. Clinical significance of an external real-time image viewer has also been described.

Evaluation of Gastric Disease with Capsule Endoscopy

The clinical indication for capsule endoscopy has expanded from small bowel evaluation to include esophagus or colon evaluation.Nevertheless, the role of capsule endoscopy in evaluation of the stomach is very limited because of the large volume and surface.However, efforts to develop an active locomotion system for capsule manipulation in detailed gastric evaluation are ongoing, becausethe technique is non-invasive, convenient, and safe, and requires no sedation. Studies have successfully reported gastric evaluation usinga magnetic-controlled capsule endoscopy system. Advances in technology suggest that capsule endoscopy will have a major role notonly in the evaluation of gastric disorders but also in the pathologic diagnosis, intervention, and treatment of any gastrointestinal tractdisorder.

A magnetically actuated anchoring system for a wireless endoscopic capsule

In this study, we propose a new magnetically actuated anchoring system for wireless capsule endoscopes (WCE) by employing the principle of a switchable magnetic spring. A force model is derived to predict the magnetic force needed to support the interaction between the anchors and the intestinal lumen. The theoretical and experimental analysis conducted shows that the magnetic spring is capable of providing the force needed to activate the anchoring mechanism, which consists of four foldable legs. A prototype capsule with a size comparable with the size of a commercial WCE was designed, fabricated, and tested. The in-vitro tests with a real small intestine show that the proposed anchoring mechanism is able to raise the friction force between the anchoring legs and inner wall of the intestine by more than two times after its activation using an external magnetic field. Experimental results presented demonstrate that the proposed anchoring system, which has a low foot-print not taking up too much space on the capsule, can provide a reliable anchoring capability with the capsule inside the intestinal lumen.

Cholestyramine as a promising, strong anion exchange resin for direct capture of genetic biomarkers from raw pancreatic fluids

The ability to capture cell-free DNA from the gastrointestinal tract, in a minimally invasive manner, could enhance our ability to diagnose gastrointestinal disease, or gain a better understanding of the spatial mapping of the intestinal microbiota. We, therefore, sought to identify a class of capture agents that could directly and efficiently sequester genetic material from intestinal fluids. As a particular case study, we examined the ability to capture DNA from pancreatic secretions, for potential application in enabling the sequestration of early, genetic biomarkers of pancreatic disease. We hypothesized that the cholestyramine series of strong cation exchange resins, which are FDA approved for the treatment of high cholesterol, may be capable of capturing DNA from pancreatic secretions. We identified a particular cholestyramine resin, DOWEX 1 × 2 100-200 mesh, which is able to efficiently capture and purify DNA from pancreatic fluid. Using only 200 μL of pancreatic secretions, we are able to recover 247 ± 182 ng of amplifiable human DNA, giving an estimated pancreatic fluid DNA content of 1.23 ± 0.91 ng/μL. To our knowledge, this is the first demonstration of a material that can effectively capture and purify DNA directly from untreated pancreatic fluids. Thus, our approach could hold high utility for the in vivo capture of DNA and disease biomarkers if incorporated into an appropriate sampling device. Biotechnol. Bioeng. 2017;114: 934-938. © 2016 Wiley Periodicals, Inc.

Frontiers of robotic endoscopic capsules: a review

Digestive diseases are a major burden for society and healthcare systems, and with an aging population, the importance of their effective management will become critical. Healthcare systems worldwide already struggle to insure quality and affordability of healthcare delivery and this will be a significant challenge in the midterm future. Wireless capsule endoscopy (WCE), introduced in 2000 by Given Imaging Ltd., is an example of disruptive technology and represents an attractive alternative to traditional diagnostic techniques. WCE overcomes conventional endoscopy enabling inspection of the digestive system without discomfort or the need for sedation. Thus, it has the advantage of encouraging patients to undergo gastrointestinal (GI) tract examinations and of facilitating mass screening programmes. With the integration of further capabilities based on microrobotics, e.g. active locomotion and embedded therapeutic modules, WCE could become the key-technology for GI diagnosis and treatment. This review presents a research update on WCE and describes the state-of-the-art of current endoscopic devices with a focus on research-oriented robotic capsule endoscopes enabled by microsystem technologies. The article also presents a visionary perspective on WCE potential for screening, diagnostic and therapeutic endoscopic procedures.