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Abstract

The video capsule is specifically designed to view the inner lining of the
Esophagus. The capsule is equipped with miniature cameras on both ends and is about
the size of a multi-vitamin, which can be swallowed easily. Three sensor arrays are
strategically placed on the patient’s chest and connected to a data recorder, worn on a
belt around the waist.

The patient swallows the capsule lying down, and is then raised in a series of
inclinations over a total of 5 minutes. The PillCam™ ESO travels through the esophagus
by normal peristaltic waves, flashing 14 times per second, each time capturing images of
the inner lining of the esophagus.

As it continues down the esophagus, the images captured may identify potential
abnormalities, such as Esophagitis – which is inflammation of the lining of the esophagus
often caused by Gastroesophageal Reflux Disease or GERD. Severity of symptoms is
measured by a Grading system, and in severe cases, esophageal ulcers can appear.

Images captured by the PillCam™ ESO may also identify symptoms of Barrett's
Esophagus, which occurs as a result of abnormal cell growth in the lower esophagus.

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Columnar cells, typically found in the lining of the stomach, replace the squamous cells
in the lining of the esophagus, which can lead to a cancerous condition.

During this five-minute procedure, the PillCam™ ESO captures images, which
are transmitted to the sensor arrays. These images then travel from the sensors, along the
wires to the DataRecorder™. At this point, the patient is permitted to get up and walk or
remain seated for an additional 15 minutes to ensure the capsule has traveled the entire
length of the esophagus. After dropping into the stomach, the pill is later excreted
naturally.

Once all equipment is removed from the patient, the portable DataRecorder™
downloads the video images to a designated workstation, from which the physician views
and assesses the results in order to recommend next steps in the patient’s treatment

INTRODUCTION

An embedded system is some combination of computer hardware and software;


either fixed in capability or programmable that is specifically designed for a particular kind
of application device. Industrial machines, automobiles, medical equipment, cameras, as
well as the more obvious cellular phone are among the myriad possible hosts of an
embedded system. Embedded systems that are programmable are provided with a
programming interface

In the past, doctors who needed to diagnose digestive problems would either
use X-rays or endoscopy, which involves sedating a person and guiding a narrow tube
with a camera attached down the throat and into the stomach and upper intestinal tract.
Before endoscopy, doctors would have to perform surgery to assess some problems.
Capsule endoscopy allows us to see places inside the small bowel where other methods
cannot reach.

Endoscopy is the examination of the inside of the body using a lighted,


flexible instrument called an endoscope. In general, an endoscope is placed into the body
through a natural opening like the mouth or anus. The most common endoscopic
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procedures evaluate the esophagus (swallowing tube), stomach, and portions of the
intestine, colon.

Capsule camera, endoscopic capsule or video pill is a camera with the size and
shape of pill. The Imaging Capsule contains a miniature camera, battery, light, computer
chip and wireless transmitter. The target destination for the device is the small bowel,
where the miniature camera may help physicians detect sources of bleeding or diagnose
disease.

DESCRIPTION

The capsule itself is larger than an aspirin, about 11 mm x 26 mm in size and


about 4grams in weight. Called the M2A, it is not a medication, but rather a single-use
video color-imaging capsule. Besides the miniature color video camera, the capsule
contains a light source, batteries, a transmitter, and an antenna.

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Once swallowed this capsule/camera travels easily through the digestive tract and
is naturally excreted. It is never absorbed in the body. The patient wears a wireless Given
Data Recorder on a belt around his or her waist, much like a portable “Walkman.” This
device receives and records signals transmitted by the camera to an array of sensors
placed on the patient’s body. These signals can also track the physical course of the
capsule’s progress. During this procedure, users feel no pain or discomfort and are able to
continue their regular activities as the camera works inside the body and the sensors and
belt work outside. The entire process takes about eight hours.

Once all equipment is removed from the patient, the portable DataRecorder™
downloads the video images to a designated workstation, from which the physician views
and assesses the results in order to recommend next steps in the patient’s treatment.

A computer workstation using Given’s Imaging propriety software processes the


data and produces a video of the images together with additional relevant information
from the digestive tract. Doctors can then view, edit, and save both individual images and
the streaming video. The images produced are of an especially high quality.

PillCam™ ESO Capsule Images

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General Suspected Barret

Esophagitis Varices

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Doctor Sitting in front ES

How it Works

• PillCam™ ESO is equipped with two miniature color video cameras (one on each
end), battery and flashing light source
• Cameras transmit 14 color images per second as capsule moves through the
esophagus
• Transmits about 2,600 images of the esophagus to a recording device worn by the
patient
• Data is transferred from the recorder belt to the RAPID® Workstation (used for
viewing, editing, archiving and e-mailing video images. Saves individual images
and short video clips)

Procedure

• Patients fast for two hours before swallowing the PillCam™ ESO
• Smooth plastic capsule is easily swallowed with water while patient lies on
his/her back
• After swallowing PillCam™ ESO, patients are raised by 30 degree angles every
two minutes over a six minute ingestion period until they are sitting upright
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• PillCam™ ESO makes its way through the esophagus in about three minutes
• Transmits images to recorder belt worn around the patient’s waist
• Total procedure takes approximately 20 minutes in the doctor’s office, hospital or
clinic
• Natural digestive contractions help propel the disposable PillCam™ ESO through
the gastrointestinal (GI) tract, and is passed naturally and painlessly from the
body, usually within 24 hours

Benefits over Traditional Endoscopy

• Little discomfort
• Does not require sedation
• Eliminates potential sedation related cardiopulmonary complications
• Offers a simple, safe and less invasive alternative
• Patient satisfaction
• Ease of ingestion
• Comfort during procedure
• Convenience
• Immediate recovery
• Preferred by patient over traditional endoscopy

CONTROLABLE CAPSULE CAMERA WITH LEGS

Metin Sitti, director of the NanoRobotics Lab, is developing a set of legs that
could be incorporated into the swallowable camera-in-a-pill that has become available in
the past four years for diagnosing gastrointestinal disorders in the small intestine.The
capsule camera snaps thousands of pictures as it makes its way slowly through the narrow
tract, carried by the wave-like peristaltic motion that moves all contents through the
intestines.

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Metin Sitti, director of Carnegie Mellon University's Nanorobotics Lab, with his six-legged
intestinal robot.

But Sitti is hoping that adding legs to the capsule will give physicians a measure
of control. The work is supported by the Intelligent Microsystems Center in Seoul, Korea,
and sponsored by the Korean Ministry of Commerce, Industry and Energy.In the simplest
scheme, the capsule could deploy three legs, creating a tripod that could stop the capsule's
movement through the intestine, giving doctors a chance to take a closer look at
something.Polymer pads on the leg tips, mimicking the adhesive foot pads of the
palmetto beetle, would stick to the intestinal walls. The adhesive foot pads require very
little pressure, yet enable the beetle to withstand forces of more than 200 times its body
weight.

A more elaborate, telescoping capsule, featuring a set of three legs on either end,
would enable it to crawl as if it were inchworm. The capsule could thus go rapidly to a
point of interest or, if sufficient power was available, move upstream to give doctors a
second look at a suspicious lesion. If that proves possible, it will be a big step forward,
being able to take a prolonged look at a suspicious lesion, or a second look, would be
helpful in many cases..

This work is still in its early stages, however. Thus far, he has devised a simple,
three-footed apparatus less than two-thirds of an inch in diameter to test its stopping
power in flexible plastic tubes and, in preliminary testing in South Korea, in pig
intestines. A six-footed apparatus for testing the inchworm-like locomotion has been
assembled and will soon be ready for testing.

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Proponents of nanotechnology -- devices measured in billionths of a meter, or
nanometers -- have proposed the fantastic vision of whole swarms of tiny robots being
injected into a patient, where the robots would work together to deliver medication or
perform surgery.Those nanorobots are still far in the future, but Sitti said the technology
for his microcapsule robot could be achieved within two or three years.

Swallowable cameras, which were pioneered by Israel's Given Imaging but now
are being developed by several companies, already have changed the treatment of
gastrointestinal bleeding and inflammatory bowel disease.

The disposable camera is ingested by the patient and, as peristalsis carries the capsule
on an eight-hour journey through the small intestine, it snaps thousands of images that are
transmitted to a data recorder that the patient wears. Doctors review the images
afterward."But there are lots of times when you have these abnormalities [in an image]
and you're not really sure what you're seeing," Lebovitz said.

In one recent case, for instance, UPMC's Appasamy said the camera picked up
what might have been an early tumor in one elderly patient. But the findings weren't clear
and the patient ultimately decided against surgery to biopsy or remove the tumor.

In those cases, both doctors said, it would helpful to send down a swallowable
camera that could be controlled and have it go to areas that need further study.In addition
to equipping the robot with biopsy capability, it also might be used to deliver anti-
inflammatory or other medications. Lebovitz said that a robot equipped with a flashing
light might even help surgeons find a diseased area that needs to be excised.

A number of problems remain to be solved. For instance, the small intestine is typically
collapsed, so maneuvering through it might be difficult for a legged robot. And power
already is limited for the capsule cameras; precious little additional power may be
available for locomotion.

But if the gutbot proves feasible for the small intestine, other applications may
await it in the colon. Though the colon can be visualized with a long, flexible
colonoscope, the procedure is not a popular one. Sitti, Lebovitz and Appasamy suggested

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it may someday be possible to use a legged camera introduced through the anus as a
substitute for traditional colonoscopy.

They emphasized, however, that such an application is still years away.For that
matter, Sitti said, it may be possible to someday equip an intestinal robot to perform
surgeries beyond just biopsies. But for now, developing a robot that could improve
diagnosis of digestive tract disease is the immediate concern.

CONCLUSION

In clinical trials, the Given Imaging System seemed to be more effective than push
enteroscopy or surgical techniques in detecting suspected physical abnormalities in the
small intestines. To date, there have been no side effects associated with this procedure.
Given Imaging believes their system will be cost effective and is planning to work with
insurers to see that this procedure is included in reimbursement policies.

It looks like the Given ingestible video capsule is a win-win situation. With clinical trial
results showing the M2A capsule more effective than enteroscopy and this procedure
being, understandably, more popular, patients with suspected small intestine disorders
will be popping the M2A pill with a smile.

REFERENCES:

http://en.wikipedia.org/wiki/Wireless_capsule_endoscopy

http://rhizome.org/artbase/33353/host
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http://www.channel4.com/news/special-reports/special-reports-
storypage.jsp?id=1724

http://www.wired.com/news/business/0%2C1367%2C38515%2C00.h
tml

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