Disruptive solution of medical endoscopy in the diagnosis and treatment of gastrointestinal diseases

1、 Disruptive breakthroughs in the field of diagnosis

1. Wireless Capsule Endoscopy (WCE)

Disruptive: Completely solve the "blind spot" of small intestine examination and replace the painful traditional push type small intestine endoscope.

Technical upgrade:

AI assisted diagnosis: such as Given Imaging's PillCam SB3, equipped with adaptive frame rate technology, AI automatically marks bleeding points/ulcers (sensitivity>90%).

Magnetic controlled capsule gastroscopy (such as NaviCam from Anhan Technology): precise control of capsule rotation by external magnetic field enables comprehensive examination of the stomach, and the accuracy of early screening for gastric cancer is comparable to traditional gastroscopy (>92%).

Biopsy capsule (experimental stage): such as the micro clamp capsule developed by the South Korean research team, which can be remotely controlled for sampling.

2. Intelligent staining endoscopic technology

Narrowband Imaging (NBI):

Principle: 415nm/540nm narrow spectrum light enhances mucosal vascular contrast.

Disruptive effect: The detection rate of early gastric cancer has increased from 45% in conventional white light endoscopy to 89% (according to the Japanese JESDS standard).

Linkage Imaging (LCI):

Advantage: Fuji's patented algorithm has a 30% higher recognition rate for superficial gastritis and intestinal metaplasia compared to NBI.

3. Confocal Laser Endoscopy (pCLE)

Technical highlight: The probe diameter is only 1.4mm (such as the Cellvizio system), achieving real-time cell level observation at a magnification of 1000 times.

Clinical value:

Instant identification of Barrett's esophageal dysplasia to avoid repeated biopsies.

The negative predictive value for monitoring ulcerative colitis carcinogenesis is 98%.

2、 Revolutionary solutions in the field of treatment

1. Endoscopic mucosal dissection (ESD)

Technological breakthrough:

Bipolar electric knife (such as FlushKnife BT): saline infusion reduces the risk of perforation.

CO ₂ laser assisted: precise vaporization of submucosal layer, bleeding volume<5ml.

Clinical data:

The curative resection rate for early gastric cancer is over 95%, and the 5-year survival rate is comparable to traditional surgery (over 90%).

The DDW study in the United States shows that the overall resection rate of colon lateral developmental tumors (LST) larger than 3cm is 91%.

2. Endoscopic surgery via natural cavity (NOTES)

Representative surgical techniques:

Transgastric cholecystectomy: Olympus TriPort multi-channel endoscope is used, and food is consumed 24 hours after surgery.

Transrectal appendectomy: South Korean team reports the world's first successful case in 2023.

Core equipment: Full layer closed clamp (such as OTSC) ®） Resolve the biggest challenge of NOTES - cavity closure.

3. Endoscopic full-thickness resection (EFTR)

Indication breakthrough: Treatment of gastric stromal tumors (GIST) originating from the intrinsic muscle layer.

Technical key: Laparoscopic endoscopic combined surgery (LECS) ensures safety.

New suture instruments (such as OverStitch) ™） Realize full layer stitching.

3、 Integrated scheme for tumor diagnosis and treatment

1. Endoscopic guided radiofrequency ablation (EUS-RFA)

Treatment of pancreatic cancer: 19G puncture needle was introduced into the RF probe, and the local control rate was 73% (≤ 3cm tumor).

Compared to open surgery, the complication rate has decreased from 35% to 8%. Liver cancer application: Duodenal ablation of tumors in the caudate lobe of the liver.

2. Fluorescent navigation endoscopic surgery

ICG labeling technology: Preoperative intravenous injection, near-infrared endoscopy (such as Olympus OE-M) to display lymphatic drainage range. The completeness of lymph node dissection during gastric cancer surgery is improved by 27%.

Targeted fluorescent probes (experimental stage): such as MMP-2 enzyme responsive probes, specifically label small metastases.

4、 Innovation in Emergency and Critical Care Scenarios

1. Acute gastrointestinal bleeding

Hemospray hemostatic powder:

Under endoscopic spraying, a mechanical barrier is formed, with a hemostasis rate of 92% (Forrest Grade Ia bleeding).

Over The Scope Clip (OTSC):

O "Bear Claw" design, closing ulcer perforation with a diameter of up to 3cm.

2. Endoscopic decompression for intestinal obstruction

Self expanding metal bracket (SEMS):

Bridge therapy for malignant colon obstruction, with a relief rate of over 90% within 48 hours.

New laser cutting brackets (such as Niti-S) ™） Reduce the shift rate to 5%.

5、 Future technological directions

1. AI real-time decision-making system:

Like Cosmo AI ™ Automatically recognize the withdrawal speed during colonoscopy examination, reducing adenoma missed diagnosis (ADR increased by 12%).

2. Degradable capsule endoscope:

Magnesium alloy frame+polylactic acid shell, dissolved in the body within 72 hours after inspection.

3. Micro robot endoscope:

The "origami robot" from ETH Zurich can be developed into a surgical platform for sampling.

Clinical Effect Comparison Table

Implementation considerations

Grassroots hospitals: Priority should be given to equipping magnetic control capsule gastroscopy+OTSC hemostatic system.

Third class hospital: It is recommended to establish an ESD+EUS-RFA minimally invasive cancer treatment center.

Research direction: Focus on AI pathology real-time analysis+degradable robotic endoscopy.

These technologies are reconstructing the diagnosis and treatment paradigm of gastrointestinal diseases through three major paths: non-invasive, precise, and intelligent. Actual application needs to be combined with individual patient differences and accessibility of medical resources.