Emergence of new technologies promises improved visualization and diagnostic efficiency.

Extraordinary developments have occurred in the field of endoscopy over the past 40 years. The era that began with the fiber-optic endoscopes (fiberscopes) has now moved to videoscopes. Current endoscopes with only minor modifications will continue to be widely used for at least another 5 years. The incorporation of multimodal features is already under way and the ideal endoscope of the future may permit rapid switching from white-light endoscopy to magnification endoscopy, multi-band imaging, and perhaps electronic microscopy and endoscopic ultrasound.

Indian Market Dynamics

The endoscopy market may be segmented into products and applications. Products may be further classified as endoscopes, visualization equipment, and other instruments and accessories, and endoscopes further as rigid, flexible, surgical, and capsule. The visualization equipment includes endoscopy cameras, video processors, video converters, camera heads, light sources, wireless displays, and transmitters and receivers.

However, it is difficult to obtain sales data in such detail. The Indian vendors broadly include the visualization equipment as part of endoscopes. ensocopes

Olympus is the leader in the endoscopy market with presence in rigid, flexible, balloon endoscopes, and accessories. In the flexible segment, it has an estimated
58 percent market share. Pentax commands an estimated 23 percent market share. Fujifilm and Karl Storz along with local, refurbished, and Chinese brands are aggressive.

In the rigid segment, Karl Storz and Stryker have a combined market share of almost 50 percent. Olympus, Richard Wolf, Escolab, and Surgdent are aggressive. The local, Chinese and refurbished players have a significant combined share in this segment.

Technology Update

The well-recognized rapid advances in television technology that provide the viewer with a more engaging, immersive experience have also occurred in endoscopic imaging. Endoscopists are becoming increasingly able to detect subtle, minute mucosal changes that were previously indistinguishable from normal tissue. This is due to improved standards in resolution and magnification, combined with image enhancement techniques available to the endoscopist at the touch of a button.

The endoscope has switched from standard definition to digital, high-definition white-light imaging. Standard definition endoscopes offered images of approximately 300,000 pixels whereas the new high-definition endoscopes, when combined with the latest processors, can achieve image quality of over 2 million pixels. Furthermore, all three of these companies offer endoscopes with high magnification to further enhance imaging. ensocopesA standard endoscope magnifies an image by 30–35 times normal. However, these companies produce high-definition endoscopes that can optically magnify images by up to 150 times.

In addition to high-definition white-light imaging, current market-leading endoscopes also provide further image enhancement by offering the endoscopist the ability to filter certain wavelengths of light. iScan, OE, narrow-band imaging (NBI), and intelligent chromo endoscopy are all post-processing optical technologies that are designed to enhance subtle architectural or vascular patterns on the mucosal surface and, therefore, enhance an endoscopist's ability to detect subtle lesions within the gastrointestinal tract.

Molecular imaging is a rapidly growing discipline in medical imaging, utilizing unique molecular signatures for targeted imaging of pathology. This technique relies upon the development of exogenous molecular probes that specifically locate and highlight desired pathology. The potential for molecular imaging goes beyond that of just aiding in the detection of lesions. Other possible applications of this technology are within the field of therapy, where molecular imaging could enhance drug delivery and monitor drug response. Autofluorescence is an area of molecular imaging that is based upon the detection of natural tissue fluorescence emitted by endogenous molecules (fluorophores), such as collagen, flavins, and porphyrins. Studies have demonstrated that dysplastic or cancerous tissues emit a different autofluorescence spectrum compared to normal tissues.

Consequently, wide-field autofluorescence imaging was integrated with high-definition white-light endoscopy and NBI to produce trimodal endoscopic imaging. This technique is not yet in clinical use and there is little data from large-scale clinical trials, although the data from smaller studies appears promising. Similarly, the use of near-infrared endoscopy and fluorescent activatable probes has limited clinical data, but early work demonstrates promise.

Device-assisted enteroscopy includes double balloon enteroscopy, single balloon enteroscopy, and spiral enteroscopy. The other method of visualizing the small bowel was capsule enteroscopy. Capsule enteroscopy too revolutionized endoscopy as it gave patients a degree of freedom never before enjoyed and would be the best screening tool available. However, its main disadvantage remains the inability to obtain biopsies.

Way Ahead

As the science behind endoscopy technologies improves, so does the ability of the endoscopist to visualize and treat lesions. It is without doubt that the improved ability to identify pre-cancerous or early cancerous lesions that have previously evaded even the most diligent endoscopist will have a significant impact on prognosis.

Alongside this, the impact these technologies could have in reducing the need for biopsies and,z therefore, the number of procedures will significantly alter the management of strained healthcare resources. However, one must acknowledge that much of this technology is still in its early stages and is yet to be fully tested in clinical practice. Similarly, although these technologies provide an exciting platform for the endoscopist, they are still reliant on the diligence and expertise of their user.

These techniques are only as good as the quality of training and the acquisition of knowledge that precedes their use. One can believe, however, that as with high-definition endoscopy, some of these technologies will emerge into mainstream use providing significant benefit to patient outcomes.

Indian Market Dynamics is based on market research conducted by Medical Buyer in September 2016.

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