Scoping into the future of endoscopy

Scoping into the future of endoscopy

by Lasse Bremholm, Head of Endoscopy, MD, Senior Consultant, PhD, Associate Professor

For years, the trend on improving the quality of endoscopy has been the launch of new models where the aim was: thinner and better looking.

These developments have given us scopes with an increasingly smaller diameter, thereby giving easier access and better patient satisfaction.

The image quality has been improved by the introduction of high definition (HD) imaging and advanced filter functions, where the light wavelength and their penetrations depths were utilized. These improved images have radically changed the endoscopist’s opportunities to perform “real-time” macroscopic “histological” diagnoses, and thereby making safer and more efficient clinical decisions.

But recently a new tool has emerged on the arena: Artificial Intelligence (AI). AI is already known in many other contexts. In endoscopy the focus is on detection of neoplasia, and classification. The systems for AI were introduced in 2019, preliminary testing has already been done, and we are planning for more extensive tests.

In the field of therapeutic endoscopy, the speed of development is breathtaking. In the endoscopy unit, in the recent years, we have introduced and established a wide variety of these new techniques.

A few examples are in the area of colonic neoplasia; full thickness resection using the techniques of endoscopic full thickness resection (e-FTR) and combined endoscopic and laparoscopic surgery (CELS), while in the area of bile drainage; lumen apposing metal stenting (LAMS).

In general, the aim of many new therapeutic endoscopic techniques have been towards replacing existing surgical techniques, examples of this have been; endoscopic fundoplication, endoscopic gastric sleeve, POEM to replace Hellers myotomy, gastroenteroanastomoses (GEA) with LAMS, just to name a few. The benefit being a lesser invasive procedure, often performed without general anesthesia, and thereby giving also more fragile patients a better option for treatment.

Looking into the crystal ball, on the future development within the fields of endoscopy, the vision on improving image quality is towards 3D virtual reality imaging, and increasing wider field of vision, in order to visualize as much of a given intestinal surface as possible.

The future vision of therapeutic endoscopy is aimed to remote controlled devices, by either wire or autonomous units, and thereby changing the classic capsule endoscopy, with only one imaging possibility, towards real therapeutics.