Most current endoscopes are ‘push’ endoscopes that provide suffic

Most current endoscopes are ‘push’ endoscopes that provide sufficient stiffness for advancement and sufficient flexibility for negotiating curves and corners. ‘Push’ endoscopes are almost always adequate for the upper gastrointestinal tract but colonoscopy can be technically demanding and there may be merit in alternative designs. The image of a colonoscope that ‘walks’ up the colon is attractive but may be some decades away. Such an instrument would need to be able to ‘sense’ the position of the lumen and differentiate it from

similar structures such as diverticula. However, variant colonoscopes that may facilitate C59 wnt chemical structure passage rather than ‘walking’ have already been described and include the ShapeLock endoscopic guide, the NeoGuide endoscopy system, the Aer-O-Scope and the Invendo colonoscope.14 Difficult procedures may also be facilitated by the use of enteroscopes, with or without balloons.15 Yet

another potential development is therapeutic colonoscopy using robotic platforms16 although this may well be restricted by cost. An important issue for endoscopy is the sterilization of equipment. Although the use of disposable endoscopes has been considered, it seems most unlikely that endoscopes of high Fulvestrant cell line resolution can be manufactured at a cost of $100 US or less. Furthermore, the disposal of endoscopic and other medical equipment not only involves additional costs but may be unacceptable to those concerned about the environment. The recent description of an endoscope that does not require sterilization but has both

上海皓元 disposable and non-disposable components deserves further study,17 particularly if the disposable components can be recycled. It seems likely that the major developments in endoscopy over the next 10–20 years will center on capsule endoscopy.18,19 Although capsules were initially developed to examine the small bowel, prototype capsules are now being evaluated for the esophagus, stomach and colon. Recent technical improvements include more frequent images (frames per second) of higher resolution and with a wider field of view. In addition, more prolonged studies are now possible because of an improved battery life. An innovative feature that has been incorporated in a second generation colon capsule (PillCam Colon 2) is variation in frame rates with movement of the capsule. For example, the frame rate when the capsule is in motion is 35 per second but this decreases to 2 per second when the capsule is stationary. An alternative solution to battery life is recharging of batteries from an extracorporeal power supply. One issue for capsule enthusiasts is the time required to analyze capsule studies of the small bowel. This is usually 30–60 min although some reduction has been achieved with improvements in software and there may be additional time-savings with experience.

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