Byintroducing better diagnostics and therapeutics in various branches of medicine, the endoscopy equipment market is set to scale new heights in the immediate future.

Throughout the last couple of decades there have been minimal changes to the overall design and functionality of endoscopes. Most of the design changes over the years have helped reduce the size of the scopes, while more recent developments offer scopes with rotation and steering, design changesaid in easier cleaning, and more options for sterilization compatibility. The most significant advancements have come in the form of image technology. High definition has turned into ultra-high definition and advanced imaging modalities within the camera system enhance the view of anatomy including fine detail, contrast, and improved clarity of tissue structures.

The use of endoscopic equipment in the diagnosis of major infections and diseases has become a staple for surgeons and doctors. The traditional endoscopic equipment tends to be cumbersome and gives discomfort to the patient for prolonged periods of time, as the device is plunged into the digestive tract and scans the entire gastrointestinal tract. Capsule endoscopy has opened new avenues for the field of endoscopy with its revolutionary small, capsule-sized device that can be ingested by the patient and travels all along the tract. The capsule is fitted with a minuscule camera that can capture high-precision images of the small intestine with minimal invasiveness. The technology enables better navigation through the tract and shows up bleeding, cancerous growths within the intestine, or even detects ulcers. Product developers of capsule endoscopy systems have made remarkable progress in terms of innovative hardware and software technologies. Over the next few years, capsule endoscopy is expected to replace diagnostic standard endoscopy and take over most therapeutic procedures giving no pain and no need for sedation.

Flexible endoscopes for gastroenterology and pulmonology continue to evolve along multiple vectors in order to meet the simultaneous needs of doctors for better access to hard-to-reach parts of the anatomy, better image quality and advanced modes of visualization, more ergonomic handling, and durability that hold up under heavy daily use. Specialized endoscopes with larger channels, smaller diameters, enhanced imaging capabilities, and other unique differences are becoming available to help doctors choose exactly the right tool for each patient's care. FDA clearance of disposable endoscopes in the past years is gaining momentum as newly approved products enter the market. These technologies address the significant challenges associated with the cleaning and disinfecting of traditional reusable endoscopes by providing an ergonomically advanced endoscope that offers both sterility and single use.

With such advancements, the endoscopic device market is set to witness greater progress as more and more medical companies set to expand the scope of their operations by including more innovative products in their offerings.

Indian Market Dynamics

The Indian endoscopy equipment in 2016 is estimated at 835 crore, with the rigid endoscopes segment valued at 580 crore and the flexible endoscopes segment at 245 crore. Capsules contributed a miniscule 10 crore in 2016.

The flexible segment is dominated by Olympus, with Karl Storz, Fujifilm, and Pentax being aggressive players. Karl Storz is the clear leader in the rigid segment. Olympus and Stryker are also aggressive players. Other brands which are present are Richard Wolf and Surgdent. Capsule endoscopes are dominated by Medtronics, with some presence from J Mitra and SISCO (representing Omom, China) also.

Vendors are adopting various strategies and competitive pricing to sustain themselves in the market and increase their shares. In January 2017, Pentax Medical acquired C2 Therapeutics. This acquisition strengthened the company's therapeutic endoscopy portfolio, including the role in gastroenterology suites. Subsequently in July 2017, Pentax and Aohua (Shanghai Aohua Photoelectricity Endoscope Co., Ltd.), China announced the creation of a joint venture to develop products in the field of flexible medical endoscopy. The new company offers global endoscopy solutions and is initially focusing on the emerging markets. The company has also launched a high-definition (HD) pulmonology endoscopy system in the European, Middle Eastern, & African (EMEA) markets. Defina system in pulmonology combines a state-of-the-art HD processor with i-scan imaging technology and two highly maneuverable HD bronchoscopes.

In September 2016, Olympus launched the Visera 4K UHD system for ear, nose, and throat procedures allowing big-screen surgery with ultra-high definition endoscopy.

The major factor driving the endoscopy market in India is the patient preference for minimally invasive surgeries and procedures that are increasingly being covered by insurance. Due to the rising middle align population that is now armed with higher spending power, a lot of people are opting for health insurance. The upcoming state-of-the-art private hospitals, diagnostic facilities, and relatively low cost are other factors that are driving the endoscopy market in India.

Global Market Dynamics

The global endoscopy equipment market is projected to reach USD 35.36 billion by 2021, growing at a CAGR of 6.2 percent, states MarketsandMarkets. The global flexible endoscopes market is expected to grow at a CAGR of 6.12 percent in the next four years while the capsule endoscopes market is expected to grow at a CAGR of 10.85 percent, with remarkable innovations in hardware and software technologies.

The use of endoscopy devices has gained swift popularity in diagnosis and therapies of several diseases. While some new products await clearance from regional drug and device regulating authorities, most of them have already had a positive influence on millions of lives and resulted in better patient outcomes. The competitive landscape of the industry is extremely promising with the leading market players investing in different R&D projects for the development of more minimally invasive and innovative endoscopic equipment. These strategies will ensure a dynamic competition in the market and promise major potential for growth in various regions of the world. By bringing out better diagnosticsResearch Updates

The technology in the endoscopy equipment has reached milestones over the past few years, opening a new era in endoscopic diagnosis. With research groups focusing on the development of miniaturized, high-definition systems, these advances in endoscopy equipment have extended the realm of applicability of these systems. Research focusing on the development of new multifunctional endoscopes that will bring endoscopic diagnosis of diseases closer to the clinic are next on the horizons.

MEMS sensors and actuators. Over the last decade, optical fiber-based forms of microscopy and endoscopy have extended the realm of applicability for many imaging modalities. Optical fiber-based imaging modalities permit the use of remote illumination sources and enable flexible forms supporting the creation of portable and hand-held imaging instrumentations to interrogate within hollow tissue cavities. Microelectromechanical systems (MEMS) sensors and actuators have been playing a key role in shaping the miniaturization of optical and mechanical components.

Many promising results from MEMS-based optical fiber endoscopy have demonstrated great potential for clinical translation. Advanced MEMS-based optical fiber endoscopy can provide cellular and molecular features with deep tissue penetration enabling guided resections and early cancer assessment to better treatment outcomes. The precise dimensions and alignment of MEMS devices, combined with the mechanical stability that comes with miniaturization, make MEMS components well-suited to incorporate into these various endoscopy techniques.

Disposable endoscopes. With a sharp increase in the healthcare-associated infection outbreaks linked to contaminated endoscopes, the vendors have introduced single-use, disposable endoscopes providing endoscopists with a more advanced technology to perform colonoscopy and a system that enhances patient safety over current devices. Fully complying with increasing hygiene requirements, these new systems use disposable accessories to reduce the risk of cross-contamination.

Handheld fiber optic probes. In an important step toward endoscopic diagnosis of cancer, researchers have developed a handheld fiber optic probe that can be used to perform multiple nonlinear imaging techniques without the need for tissue staining. The new multimodal imaging probe uses an ultrafast laser to create nonlinear optical effects in tissues that can reveal cancer and other diseases. The ability for doctors to skip the biopsy and use a multimodal imaging endoscope to diagnose cancer on the spot would save valuable time and could also allow surgeons to more easily differentiate between cancerous and healthy tissue during surgery.

Hybrid endoscopes. In an ongoing research project Hybrid Optical and Optoacoustic Endoscope for Esophageal Tracking (ESOTRAC), engineers and physicians have been aiming to develop a novel hybrid endoscopic instrument for early diagnosis and staging of esophageal cancer. The device developed by ESOTRAC promises to change the landscape of gastroenterological endoscopy beyond diagnosis of esophageal cancer, by allowing rapid three-dimensional imaging of the entire esophageal wall as well as quantitation of disease biomarkers.The hybrid endoscope combines sensing of pathophysiological tissue signatures resolved by multispectral optoacoustic (photoacoustic) tomography (MSOT) with morphological disease signatures provided by optical coherence tomography (OCT).

Outlook

As the market progresses, there will be a clear differentiation of endoscopic systems due to the requirements of reprocessing and image-quality procedures. Trends are already visible from expensive optical high-end endoscopes toward optimized visualization systems that integrate endoscope and camera. Such significant changes in many minimally invasive applications continue to provide new opportunities for all system providers and require competent partners to develop new products.

System providers will ask for optimized solutions including instruments, lasers, or other medical devices. For such customized solutions, medical device manufacturers will continue to cooperate with companies that have expertise in the development and manufacture of endoscopes and camera technologies, as well as in image processing.

One strategy of manufacturers is to combine standard and private-label products. This allows them to immediately start with endoscopic products using their logo and brand without investing heavily in R&D, thereby avoiding long development times and costs. Furthermore, if manufacturers respond promptly to market feedback on first-generation products, they can start on a customized second generation of OEM products within a very short time, forging the path for significant advances in endoscopy.

Vijay Kumar Verma

Industry Speak

Endoscopy advancement - Early Detection of GI Cancer and Treatment

As per current year report by NDTV and Zee News etc., India is world's largest contributor to cancer deaths; doctors say 70 percent patients avoid consultation till terminal stage. Reason off course awareness, who are aware do have fear about the areas we really need to put more focus, cleaning, disinfection, sterilization, and mainly patient awareness about endoscopy.

Endoscopy technique predominantly can categories in two verticals – Rigid and flexible.

In both – various multinationals involved in advancement, many innovations need to be appreciated, brings quality healthcare, benefit to patient.

Latest dynamics applauds advance diagnosis by using combination of high definition sensors and different narrow wave length light with certain intensity to get the vascular pattern of lumen mucosa, it allows Advancement of Diagnosis – Early detection of cancer,(irrespective to GI-Eesopahgus, stomach, colon, and small bowel and pulmonology-lungs and up to certain peripherals), beyond that there is a technology where in endoscopy is incorporated with ultrasound transducer helps to get nonmalignant growth or cancer with staging in GI, pulmonology tract till lung, and even mediastinal nodes, it allows medical practitioners to treat patients also.

Advancement of therapy – ESD/EMR to remove early stage growth or cancer without open surgery, not only this – many of EUS guided ERCP, pseudo cyst drainage, pancreatic fluid collection, biliary ductal drainage, ablation of pancreatic cyst neoplasm, drainage of pelvic abscess, celiac plexus neurolysis, duodeno cystogastrostomy, tuberculosis diagnosis, sarcoidosis.

Cannot say if in future AI takes place, where in one software could support to interpret the pattern and help physician to rule out disease faster, by tat present time flexible video endoscopic ultrasound, which has restricted and limited access in GI and pulomonology is one of main support for early cancer diagnosis - provide many reference stream as per below chart.

Vijay Kumar Verma

Senior Product Marketing Manager,Fujifilm India Pvt. Ltd.


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