The large number of medical centers in the country along with the ever-increasing number of new centers being set up will ensure that the demand never fades.

Endoscopy is a fast-moving field, and new techniques are continuously emerging. In recent decades, endoscopy has evolved and branched out from a diagnostic modality to enhanced video and computer-assisted imaging with impressive interventional capabilities. Modern endoscopy has seen advances not only in types of endoscopes available, but also in types of interventions amenable to the endoscopic approach. To date, there are a lot more developments that are being trialed.

Advancements in technology have resulted in several improvisations, including increased angles in the field of view in endoscopes, reduced outer diameters of scopes, endoscopy systems that are integrated with high-resolution technologies such as 3-D systems that have reduced the errors and improved depth-perception during surgical procedures, hence reducing the overall surgery time. Owing to the increasing number of endoscopic surgeries and improving endoscopy infrastructure in India, the endoscopy equipment market is expected to witness high growth in coming years.

Technology Trends

Between 2015 and 2020, diagnostic endoscopy is slated to be replaced gradually by capsule endoscopy including capsule colonoscopy. This change in approach will be largely driven by patient preference rather than results from capsule technology that are superior to those of conventional endoscopy. The capsules of 2020 will be smaller than those at present and will have lenses at both ends that will provide frequent images of high resolution and with a wide field of view. They may also incorporate diagnostic aids such as narrow-band imaging (NBI) and perhaps biosensors capable of detecting genetic mutations or protein markers associated with neoplasia. The analysis of capsule studies will be relatively rapid as software development includes technologies that highlight abnormal areas for further evaluation. Subsequent developments will result in automated computer readings, perhaps by 2025.

Advances in capsule endoscopes. Developments in capsule mobility with magnetic actuation being the most promising endeavor, integration of sensor data and fusing it with robotic control to outperform the standard invasive procedures, in a less intrusive manner is gaining momentum. The various advances in capsule mobility, in vivo position and orientation tracking, drug delivery, and characterization of capsule-bowel interaction may aid in device development and translation of interventional capsule technology from the bench-top to the clinical setting. Capsule endoscopy is currently employed in the detection of tumors in the small bowel, gluten enteropathy evaluation, and diagnosis of Crohn's disease and is expected to witness strong demand in the coming years owing to its effectiveness in detecting pathologies such as tumors and lesions that usually lie underneath the mucosal layers. The near-future direction of the field is to utilize proprioceptive capsule data to assist the user in driving capsules in an intuitive manner.

Robot-assisted endoscopes for surgery. Surgical robots are an important component for delivering advanced paradigm-shifting technology such as image-guided surgery and navigation. Robotic or robot-assisted surgery integrates advanced computer technology with the experience of the skilled surgeons. This technology provides the surgeon with a 10× magnified, high-definition 3-D-image of the body's intricate anatomy. However, for robotic systems to be readily adopted into the operating room they must be easy and convenient to control and facilitate a smooth surgical workflow. Thus, removing human contact during surgery may be taken to the next level with robotic surgery systems capable of functioning at greater distances between surgeon's control console and the patient-side table robotics. Many hospitals in India are adopting robot-assisted minimally invasive surgeries in various specialties.

High-definition camera endoscope. The flexible high-definition camera endoscope has emerged as a potential solution to the shortcomings of available instruments by combining superior flexibility and image quality. Forward-and-backward compatibility of the components may help to reduce or distribute the cost of upgrading over a longer time period. The reprocessing requirements such as autoclavability and interoperability of the video system with facility's PACS (picture archiving and communication systems), and OR integration systems are also continuously reducing the cost constraints.

Narrow-band imaging (NBI). It is a digitally enhanced endoscopic imaging technique which has the potential to improve the diagnostic capability of standard white-light endoscopy. It applies narrow-band spectrum filters to enhance the visualization of mucosal and submucosal wavelength. The blue filter is designed to correspond to the peak absorption spectrum of hemoglobin to enhance the image of capillary vessels on mucosal surface. The green filter penetrates deeper and highlights the submucosal vascular plexus. The reflection is captured by a CCD chip, and an image processor creates a composite pseudocolor image, which is displayed on a monitor, enabling NBI to enhance mucosal contrast. NBI increases tissue contrast by specifically identifying superficial capillaries and neo-angiogenesis in abnormal mucosa. It requires no special dyes and allows for easy inspection of the superficial vascular bed. A combination of the mucosal abnormalities detectable by NBI may result in an accurate endoscopic tool that will help to target biopsy examination to areas with suspicious superficial vascular morphology or enable excision biopsies to be more accurate.

Confocal laser endomicroscopy (CLE). It represents a revolutionary technology that enables endoscopists to collect real-time in vivo histological images or virtual biopsies of the gastrointestinal mucosa during endoscopy, and has raised significant interest for the potential clinical applications and numerous research possibilities. After intravenous administration of fluorescein as a contrast agent, CLE enables real-time visualization of the tumor vasculature, which is structurally and functionally altered compared to the normal vascular networks. By providing in vivo microscopic-resolution images of mucosal glands, goblet cells, and capillary patterns that may highlight dysplastic changes, CLE has the potential to replace the role of biopsies in specimen acquisition.

Endoscopic ultrasonography (EUS). EUS has evolved from a diagnostic imaging modality to one that can also be used for invasive diagnostic and therapeutic procedures. The progressive diffusion of ultrasound endoscopy had a tremendous impact in the clinical management of gastrointestinal neoplasia, allowing a proper selection of patients suitable for curative endoscopic resection, or bypass procedures not feasible by standard endoscopy. These advances are largely due to the introduction of linear scanning instruments that can be used to place equipment into the ultrasound plane of view, permitting various interventions to be performed. Until recently, electronic (linear) and mechanical (radial) EUS instruments required separate processors, adding significantly to the cost of providing a comprehensive EUS service. However, 360-degree electronic radial echoendoscopes have been developed, allowing for use of a curvilinear array and a radial echoendoscope by a single processor, thus economizing EUS service. The ability of EUS to guide a biopsy needle into lesions that are too small to be identified by computed tomography or magnetic resonance imaging, or too well encased by surrounding vascular structures to allow percutaneous biopsy, secures its role in a variety of clinical settings.

There has been a continuous advancement in technology to make endoscopic procedures more comfortable for patients and also to make it easier for doctors. Recent advancements prove that endoscopic procedures have been developed to diagnose a wide range of abnormalities and diseases occurring in the interior of a body system. Newer approach to provide treatment with these endoscopic techniques is a challenge for the experts and hence various clinical trials are in process to confirm the satisfactory outcomes from this.

Future Outlook

In the coming decade, more complex therapeutic procedures are expected to be performed by a new group of therapeutic endoscopists using advanced videoscopes. Several new therapeutic procedures are likely to emerge but natural orifice transluminal approaches will need to compete with advances in laparoscopic techniques. With escalating medical costs, healthcare administrators may demand more expensive procedures that not only facilitate enhanced patient care but also result in superior health outcomes.

Advanced technologies such as confocal microendoscopy and HD cameras have led to the generation of high-quality images, which in turn have increased the rate of detection and accuracy of diagnosis. Visualization systems for endoscopy, in particular, are expected to witness demand surge due to the advent of HD cameras, 3-DHD systems, and growing usage of HDTV three-chip systems in hospitals. Increasing complexities, such as new imaging tools and NOTES while evolving rapidly, shall continue to present seemingly limitless possibilities for innovation, technique, and device development.

The emergence of new technologies that promise to improve visualization and diagnostic efficiency is, therefore, expected to positively benefit the market for endoscopes and related equipment. The large number of medical centers in the country along with the ever-increasing number of new centers being set up will ensure that the demand never fades. As more and more medical centers opt for the instrument, the market will be benefited and players will be able to earn higher profits.

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