From the scalpel to the scope

Advancements in technology are set to transform endoscopy, making procedures safer, more precise, and less invasive. Emerging innovations promise to improve patient comfort and expand the scope of endoscopy.

In the ever-evolving landscape of medical technology, endoscopy stands out as a groundbreaking field that continues to redefine diagnostics and therapeutics. With the rising prevalence of chronic conditions, such as pancreatitis, inflammatory bowel diseases, stomach ulcers, and chronic constipation, the demand for advanced endoscopic devices has surged globally.

Far from being a mere medical procedure, endoscopy has transformed how healthcare professionals interact with the human body. Its minimally invasive nature enables detailed examination of the gastrointestinal tract and other internal organs without the need for traditional surgeries, offering patients a safer and more comfortable experience.

Endoscopy not only addresses current challenges, it also paves the way for a future where internal medical conditions are diagnosed and treated with unparalleled precision. Enhanced imaging technologies, robotic assistance, and patient-centric innovations are revolutionizing this domain, making procedures more accurate, less invasive, and significantly more efficient. This leap forward signifies a new era of possibilities, bringing hope and improved outcomes to patients worldwide while reshaping modern medicine’s approach to care.

Indian market dynamics
The Indian endoscopy devices market is fragmented and consists of several major players. A few of the major players currently dominate the market in terms of share. Most of the global players have their presence in India in the form of branches, partnerships, subsidiaries, or third-party distribution. As the Indian market becomes more lucrative, due to the increased population and augmented standard of living, more companies are expected to invest and operate in India.

The Indian endoscopy devices market size in 2024 is estimated at ₹1445 crore and 8335 units. The rigid endoscopes, excluding imaging, contributed ₹915 crore, at 6000 units and the flexible ₹522 crore at 2300 units. The balloon endoscopic devices segment, dominated by double balloons, is estimated at ₹8 crore at 35 units. The motorized spiral enteroscopes (MSE), manufactured solely by Olympus but discontinued in September 2023, resulted in a decline in balloon endoscopes.

The EUS, which combines endoscopy and ultrasound to create images of the digestive tract and nearby organs and tissues, are becoming popular. From an average of 35–40 units of EUS procured before 2022, the market size has increased to 130 units in 2023 and 145 units in 2024. Olympus and Fujifilm offer EUS.

There is an increasing preference for high-end endoscopes, as 4K ultra-HD endoscopes that enhance surgical precision and diagnostic accuracy and can also remove specific tissues for a biopsy. The buyer is reconciled to a unit price of ₹3–4 crore, compared to a ₹400,000 camera a few years before. In May 2021, UnivLabs Technologies became India’s first company to indigenously design and manufacture a full-fledged 4K endoscope tower.

Near-infrared imaging endoscopy is also preferred in predicting viability of local, pedicled intranasal flaps during endoscopic endonasal surgery of the skull base. The technology has been found to also offer other key benefits in clinical use. It has the potential to significantly reduce errors by facilitating identification of critical vascular structures, and can be a useful auxiliary tool in differentiating tumors from adjacent structures. And using video angiography during microsurgical clipping of an intracranial aneurysm has been found to provide additional information in 42 percent cases that could not otherwise be obtained via microscopic video angiography. Because of endoscopic direct continuous visualization, this method increases the safety and durability of the aneurysmal clipping.

The refurbished endoscopes, albeit on a decline, cater to a selected buyer segment in Tier-II and Tier-III cities, and are offered largely by local players. Some brands offer buyback schemes too.

The Covid-19 outbreak had negatively impacted the Indian healthcare sector as it decreased the number of surgeries performed, international patient visits, and outpatient department (OPD) footfall. The country’s imported consumables, disposables, and capital equipment, including endoscopy devices, were negatively affected due to supply chain issues. Additionally, the devices were not used at their 100-percent capacity.

However, that is all in the past now. The increasing prevalence of endoscopy surgeries for treatment and diagnosis and technological advancements is leading to enhanced applications, augmenting the market’s growth. Also, the growing awareness among the elderly population about minimally invasive procedures, and the rising prevalence of chronic diseases and cancer, boost the demand for endoscopy devices further. As India’s population grows, the growing prevalence of gastrointestinal diseases is propelling this industry forward. Increasing investments and launches of better care facilities are driving the market’s growth.

The inherent nature of the treatment makes it popular. Endoscopy allows surgeons to operate on more fragile patients, such as the elderly, and treat more complex conditions like cancer. Endoscopy has several advantages, including less postoperative discomfort and difficulties, faster recovery, less sedation, and a shorter hospital stay. In surgery, interventional radiology, and advanced endoscopy, minimally invasive techniques have been developed to effectively treat various diseases and enhance patients’ postoperative outcomes.

However, the lack of skilled technicians in the country is likely to hinder the market’s growth. The high cost of medical devices and the high cost of diagnostics are stifling the endoscope market. In addition, the market’s growth has been hindered by rigorous regulatory standards for new technical items. Infections contracted through non-sterilized endoscopes also pose a threat to the market’s expansion.

Recent developments
In collaboration with Cybernet Systems Co. Ltd., Olympus has established an artificial intelligence (AI) diagnostic support system at a major medical institution, the Asian Institute of Gastroenterology (AIG), based in Hyderabad, India.

While AI is rapidly developing in various medical fields, in endoscopy, AI started in colonoscopy to help improve polyp and adenoma detection and interpret the lesion patterns, differentiating between benign and precancerous polyps. Omega Healthcare and Sanjivani Gastro Liver Clinic have brought AI-enabled endoscopy to Odisha. This advanced facility aids in diagnosing and treating gastrointestinal (GI) disorders.

According to the senior consultant and head of gastroenterology and hepatology at Omega Healthcare, Dr Sushant Kumar Sethi, patients will immensely benefit from the identification and treatment of cancerous, precancerous, and even non-cancerous lesions with the help of the advanced technology-assisted endoscopy procedure.

The success rate is very high as it detects and rectifies human errors. Suppose an endoscopist misses something during a procedure. In that case, the machine picks it up with its deep learning mechanism and computer-assisted detection (CAD) technology to minimize and correct the error. This technology aids in diagnosing and treating many complex GI disorders with absolute ease and precision. This technology was primarily limited to Japan and the US. Now, it is available in India as well.

Owing to their rapid development, AI technologies offer an excellent promise for gastroenterology practice and research. At present, AI-guided image interpretation has already been used with success for endoscopic detection of early malignant lesions.

The usage of AI algorithms for polyp detection in screening colonoscopy results in a significant increase in the adenoma detection rate, mainly attributed to the identification of diminutive polyps. Computer-aided characterization of colorectal polyps accompanies the detection, but further studies are needed to evaluate the clinical benefit. In contrast to colonoscopy, the usage of AI in gastroscopy is currently somewhat limited. Regarding other fields of endoscopic imaging, capsule endoscopy is the ideal imaging platform for AI due to the potential to save time in video analysis.

The Institute of Liver & Digestive Sciences (ILDS) Hospital, Manipur, has announced the establishment of the first Advanced Endoscopy Center in the entire North-East region, following a successful inspection by the Society of Gastrointestinal Endoscopy of India (SGEI), which is the highest endoscopic body in India. This state-of-the-art center is equipped with the latest technology, including ERCP, endoscopic ultrasound, cholangioscopy with electrohydro lithotripsy, single-balloon enteroscopy, AI-supported endoscopy, and advanced therapeutic procedures to address gastrointestinal, liver, pancreatic, and biliary diseases.

The 20^th World Congress of Endoscopic Surgery (WCES 2024), the flagship event of the International Federation of Societies of Endoscopic Surgeons (IFSES), was held in conjunction with the 22^nd Annual Conference of the Indian Association of Gastrointestinal Endo Surgeons (IAGES), bringing together over 2000 delegates, including more than 200 international faculties and 1000 trainees from around the world at Kolkata from October 23–26, 2024.

The conference attracted participation from multiple global societies, including the Society of Endo-Laparoscopic Surgeons of Bangladesh, the Society of Surgeons of Pakistan, the Association of Laparoscopic Surgeons of Great Britain and Ireland, and others from across Asia, Europe, and the Americas.

Global market dynamics
The global market for endoscopy devices is valued at USD 38.12 billion in 2024, and is projected to reach USD 63.54 billion by 2031, growing at a CAGR of 7.6 percent from 2024 to 2031, according to Coherent Market Insights.

The less invasive properties and affordable post- and pre-procedure cost of endoscopy devices are the major factors anticipated to boost the market growth. Furthermore, a shift in trend to use disposable endoscopic components to minimize the procedure cost, as well as the chance of cross-contamination, is also expected to accelerate market growth over the years.

The rising global burden of chronic diseases and an aging population are expected to drive the adoption of advanced endoscopic devices, such as wireless capsule endoscopy and high-definition camera systems. As age-related conditions like liver abscess, gallstones, endometriosis, and intestinal perforation require endoscopic interventions, the demand for endoscopy devices is set to increase in the coming years.

In addition, the growing preference for advanced endoscopy devices with high-definition cameras and light sources is driving market growth. The shift toward minimally invasive procedures, which reduce hospital stays and post-procedure complications, is fuelling demand for endoscopy devices, offering higher patient satisfaction, better economic viability, and improved outcomes.

Furthermore, the rising global cancer burden is driving the adoption of endoscopy devices for early diagnosis and treatment. In 2023, the US saw 2 million new cancer cases, with projections reaching 2.3 million by 2040. The growing preference for biopsies in cancer detection further boosts the demand for endoscopic devices, supporting market growth.

Technological advancement to develop innovative endoscopic devices is also anticipated to accelerate market growth. The key manufacturers are continuously looking forward to innovating advanced endoscopic solutions for better treatment and diagnosis of several chronic disorders.

Moreover, the Covid-19 pandemic significantly impacted the endoscopy devices market, with a reduction in elective surgeries and supply chain disruptions hindering growth. According to a 2020 study, over 50 percent of endoscopic procedures were reduced in 85 percent of responding countries during the pandemic.

The global endoscopy devices market is seeing rapid innovation, particularly with the widespread use of AI in endoscopic image processing, which is expected to drive market growth.

The market is witnessing significant advancements and changes, driven by stricter regulatory requirements and innovative technologies. Companies are allocating substantial resources to clinical trials and regulatory submissions to comply with stringent EU guidelines, which mandate rigorous testing for both new and existing endoscopic devices to ensure therapeutic benefits and minimize risks. This has increased the cost and complexity of developing novel technologies.

Capsule endoscopy is reshaping the field, offering a compelling alternative to traditional endoscopes. These devices leverage advanced technologies, including miniaturized, high-resolution cameras, wireless image transmission, and intuitive control systems, enabling precise diagnostics in a minimally invasive manner.

To enhance their market position, several companies are expanding into new geographical regions, supported by increased funding. This strategic expansion allows them to broaden their product portfolios, reach more patients, and tap into emerging markets, further fuelling growth in the endoscopy devices sector.

Product insights. Of the range, including endoscopes, visualization systems, components, and operative devices, in 2024, endoscopes led the market with a 41.1-percent revenue share and are expected to grow rapidly. Their widespread adoption in diagnosing and treating conditions like cancer, GI, urinary, and lung disorders drives this growth. Flexible endoscopes dominated due to their safety, efficiency, and ergonomic advantages over rigid endoscope options, making them highly preferred by medical professionals for procedures and biopsies.

End-use insights. In 2024, outpatient facilities led the market with a 53.6-percent revenue share, and are expected to grow fastest. The rising preference for minimally invasive procedures, reduced hospital stays, faster recovery, and lower costs drive this growth. Ambulatory surgery centers and diagnostic clinics benefit from the increased adoption of keyhole endoscopic procedures, boosting segment expansion.

Regional insights. North America dominated the endoscopy devices market with a 39.8-percent revenue share in 2024. The high prevalence of diseases like GI disorders, cancer, and respiratory conditions drives demand for minimally invasive diagnostic tools. For instance, the US is expected to report 2.0 million new cancer cases and 611,720 deaths, highlighting the growing adoption of endoscopes in the region.

The Europe endoscopy devices market is set for significant growth, driven by advancements in technology and rising demand for minimally invasive procedures. Favorable conditions are prompting key players to expand through mergers, acquisitions, and collaborations.

Asia Pacific is the fastest-growing market, driven by improving healthcare infrastructure, economic growth, and foreign investments. Key players are expanding through training initiatives and R&D to develop advanced endoscopes.

Game-changing technologies on the horizon
Post-sleeve gastrectomy fistulas, though rare, are potentially severe and life-threatening complications. Treatment primarily involves early reoperation and drainage, with endoscopy playing a crucial role in management. Current endoscopic treatment options include stent or clip placement, while newer therapies, such as endoscopic vacuum therapy, VacStent therapy, pigtail stent internal drainage, endoscopic suturing, and stem cell injections, have shown promise. However, limited study sizes and a lack of comparative data between these novel and standard treatments prevent definitive treatment preferences. Similarly, intragastric band migration, another rare complication, can be effectively managed through endoscopic retrieval, offering a less invasive alternative to surgery.

The introduction of flexible fiber optic endoscopes by Basil Hirschowitz in the 1950s was a revolutionary leap, enabling detailed internal imaging and safer procedures. This innovation laid the foundation for today’s advanced endoscopic techniques.

Modern endoscopy has seen significant transformations driven by miniaturization, precision, and technological integration. Ultra-thin endoscopes, with diameters as small as 80–250 micrometers, allow for minimally invasive procedures and access to hard-to-reach areas. Technologies like confocal laser endomicroscopy (CLE) enable real-time microscopic examination of tissues, reducing the need for biopsies. Similarly, capsule endoscopy, featuring pill-sized cameras, provides detailed imaging of the digestive tract, revolutionizing the examination of the small intestine.

AI is another game-changer, enhancing diagnostic accuracy and procedural efficiency. Devices like the GI genius intelligent endoscopy module detect colorectal polyps in real time, aiding early diagnosis. Similarly, systems like WavSTAT4 and CAD EYE utilize machine learning for real-time tissue differentiation, ensuring precise interventions. Wireless and remote-controlled instruments, such as capsule endoscopes and the NaviCam, enable less invasive procedures with enhanced flexibility, improving patient comfort and outcomes.

AI’s growing role is expected to improve diagnostic precision and procedural outcomes. Innovations like endoculus, a robotic endoscope with advanced navigation capabilities, signal a shift toward semi-autonomous procedures. Transoral incisionless surgery (TIS), which allows scarless appendix or gallbladder removal, showcases the potential for endoscopy to redefine surgical practices.

As endoscopic devices become smaller and more advanced, challenges like ensuring safety, cost accessibility, and training healthcare professionals remain pivotal.

Robotics and AI – The new surgeons’ assistants
The integration of robotics and AI is revolutionizing surgery, providing new opportunities for early detection and precise treatment. These advanced technologies enhance surgical capabilities by increasing accuracy and efficiency, particularly in identifying early-stage diseases.

AI-powered systems analyze large amounts of imaging data to detect subtle tissue changes, such as the initial stages of cancer, with exceptional accuracy. These tools are transforming endoscopic procedures and biopsies, enabling real-time identification of abnormalities and supporting timely interventions. Such advancements are especially critical in detecting diseases like gastrointestinal cancers, where early diagnosis can significantly improve patient outcomes.

Robotic systems have become indispensable in minimally invasive surgeries, offering enhanced precision, dexterity, and visualization. These systems allow for intricate procedures with minimal damage to surrounding tissues, reducing patient recovery times and improving overall outcomes.

AI further elevates the capabilities of robotic platforms, enabling semi-autonomous actions that enhance surgical precision. Integrated imaging technologies generate highly detailed reconstructions of patient anatomy, guiding surgeons through complex procedures with exceptional accuracy and efficiency.

Outside the operating room, AI supports predictive analytics to assess disease progression, identify high-risk patients, and personalize treatment plans. Additionally, robotics and AI streamline surgical workflows by automating repetitive tasks like preoperative planning and instrument handling, allowing surgeons to focus more on critical decision-making and patient care.

The collaboration between robotics and AI is shaping a future where surgical precision and patient care are taken to unprecedented levels. These technologies are not just tools – they are transformative partners in advancing healthcare and improving lives.

Green endoscopy and sustainability
The growing emphasis on sustainability has led to the adoption of eco-friendly practices in endoscopy. Recognizing the healthcare industry’s substantial carbon footprint, stakeholders are prioritizing greener alternatives in device manufacturing and procedural workflows. Efforts focus on reducing waste through optimized biopsy protocols, transitioning to digital systems for paperless operations, and recycling non-infectious plastic waste.

Reusable endoscopes with disposable components are gaining traction as a balanced solution to minimize environmental impact without compromising patient safety. Innovations in sterilization methods and the exploration of biodegradable materials further support sustainable practices. Policies encouraging responsible procurement, streamlined packaging, and reduced water and energy consumption within endoscopy units are paving the way for a greener future.

These eco-friendly initiatives underscore the healthcare sector’s commitment to combating climate change while maintaining high standards of care.

Beyond diagnostics – Therapeutic endoscopy
The evolution of endoscopic techniques has revolutionized the management of digestive tract lesions and IBD complications, reducing reliance on invasive surgeries. Methods like endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have transitioned from basic interventions to highly refined procedures. Advanced approaches, such as underwater EMR, traction-assisted methods, and optimized knife technology, now offer superior precision and improved outcomes, with organ preservation as a key benefit.

For IBD-related strictures, endoscopic balloon dilation (EBD) has emerged as a minimally invasive solution, effectively addressing fibrotic complications while preserving bowel integrity. Similarly, dysplastic lesions in IBD patients can now be managed with EMR and ESD, reducing colorectal cancer risks without the need for extensive surgeries.

These advancements ensure shorter recovery times, reduced morbidity, and repeatable treatments tailored to individual needs. Despite challenges like procedural complexity and recurrence risks, ongoing innovations in tools, imaging, and techniques promise a future where endoscopy continues to replace traditional surgical interventions.

Tailoring endoscopy for specific applications
Endoscopic technologies have brought transformative advancements across various medical fields, particularly in urology and gastrointestinal (GI) procedures, while also extending to other areas of medicine. The integration of endoscopic tools has enabled minimally invasive surgeries that offer improved precision, reduced patient discomfort, and faster recovery times, revolutionizing patient care.

In urology, one of the standout innovations is the endoscopic snare, which has become a critical tool for urologists in removing abnormal tissue growths, such as tumors and polyps. This minimally invasive approach not only shortens hospital stays but also reduces the risk of post-surgery complications, ensuring better cosmetic and clinical outcomes for patients. The versatility of endoscopic snares continues to evolve, with improvements in cutting mechanisms and advancements in imaging technologies, such as augmented reality that provide real-time visualization during procedures.

In the field of gastroenterology, endoscopic techniques have significantly advanced the diagnosis and treatment of GI disorders. Procedures like esophagogastroduodenoscopy (EGD) and colonoscopy have been improved with enhanced imaging technologies, enabling early detection of diseases, such as cancer and inflammatory bowel disease (IBD). Narrow band imaging (NBI) and confocal laser endomicroscopy (CLE) have taken GI endoscopy to new heights, allowing for better visualization of mucosal and vascular patterns, critical for identifying early neoplastic lesions. Meanwhile, AI is playing a crucial role in endoscopy by improving diagnostic accuracy through real-time image analysis.

Endoscopic ultrasound (EUS) has also undergone significant advancements, such as contrast-enhanced EUS and elastography, which enhance tissue visualization and help in the diagnosis of conditions like pancreatic cancer. Robotic endoscopy, including magnetically controlled capsule endoscopy and robotic-assisted endoscopic submucosal dissection (ESD), have improved the precision and stability of complex procedures, offering minimally invasive solutions to traditionally challenging conditions.

The scope of endoscopic innovations is also expanding beyond GI and urology. Techniques like third space endoscopy, used for achalasia treatment and subepithelial tumor resection, offer minimally invasive alternatives to traditional surgeries. Furthermore, advancements in therapeutic endoscopy, including endoscopic full-thickness resection (EFTR) and radiofrequency ablation (RFA), are enabling more effective treatments for a range of GI conditions, including Barrett’s esophagus and gastric cancers.

Beyond these specialties, endoscopy is becoming increasingly versatile. The development of single-use endoscopes, for example, not only enhances patient safety by reducing the risk of cross-contamination but also streamlines the reprocessing process, improving the overall cost-effectiveness of procedures. In addition, virtual reality (VR) and augmented reality (AR) are enhancing training and procedural guidance, providing real-time data overlays and immersive training experiences for medical professionals.

Bridging technology and accessibility
The field of endoscopy has undergone significant advancements, from the early development of rigid telescopes to modern innovations, such as disposable capsule endoscopes and motorized spiral enteroscopy (MSE). These advancements have made diagnosing and treating conditions like gastrointestinal disorders more efficient and less invasive. However, despite the promising potential of these technologies, several challenges persist in making them accessible, affordable, and applicable in diverse healthcare settings around the world.

The cost of advanced endoscopic devices, like disposable capsule endoscopes and single-use instruments, remains a major barrier, especially in low-resource settings. While these innovations reduce infection risks, their high price makes them inaccessible for many healthcare facilities. Additionally, sophisticated devices like image-enhanced endoscopes and MSE are often limited to specialized institutions due to their prohibitive upfront costs.

In addition to cost concerns, training and expertise required for advanced endoscopic tools like POEM and red dichromatic imaging pose a significant barrier. Healthcare professionals need specialized education to effectively use these technologies for optimal patient outcomes. Developing training programs requires substantial time and resources from healthcare facilities.

Furthermore, while endoscopic advancements improve diagnostics, they may not align with the healthcare priorities of low-income countries, where basic needs like medications and preventive care are more urgent. Balancing innovation with global healthcare priorities is crucial. Making advanced devices accessible requires addressing disparities in care access, beyond just technological advancements.

Despite these challenges, significant progress is being made. Disposable endoscopic instruments offer flexibility, cost-effectiveness, and reduced operational costs, enhancing accessibility. Innovations like capsule endoscopes and image-enhanced techniques for POEM demonstrate safe, effective, and minimally invasive solutions. These advancements improve clinical outcomes while making endoscopy more accessible across medical settings.

Why investment in endoscopy matters now more than ever
Investment in endoscopy is crucial now more than ever as advancements in technology promise to revolutionize diagnostic capabilities. With over 20 million endoscopies performed annually in the US to detect conditions like tumors and ulcers, improving endoscopic equipment can significantly enhance early cancer detection and treatment outcomes. Researchers like Professor Shahrzad Towfighian are pioneering innovations, such as high-speed scanners using MEMS actuators, offering the potential for better-resolution imaging, real-time updates, and more accurate surgeries. Investing in these advancements not only improves patient care but also paves the way for life-saving breakthroughs in early diagnosis and treatment.

Endoscopy’s role in precision medicine
Endoscopy plays a crucial role in the advancement of precision medicine by enabling highly targeted diagnostic and therapeutic interventions. With its ability to provide real-time, minimally invasive visualizations of internal organs, endoscopy allows healthcare providers to obtain detailed insights into a patient’s unique condition, facilitating personalized treatment plans.

In particular, innovations like high-definition endoscopes, image-enhanced techniques, and robotic-assisted platforms enhance the precision of tumor detection, biopsies, and targeted therapies. This is especially important in oncology, where early detection of cancers, such as gastrointestinal tumors, can significantly impact treatment outcomes.

By tailoring interventions based on individual patient characteristics, endoscopy in precision medicine not only improves diagnostic accuracy but also ensures that treatments are more effective, less invasive, and better suited to each patient’s needs. As the technology evolves, endoscopy will continue to be an essential tool in the fight against complex diseases, contributing to the growing field of precision healthcare.

The future of endoscopy is bright, driven by advancements in AI, robotics, and molecular technologies like fluorescence-guided endoscopy and Raman spectroscopy. These innovations promise more precise, less invasive, and highly efficient procedures, revolutionizing diagnostics and treatments across specialties.

As we move forward, overcoming challenges related to cost, accessibility, and training will be key to ensuring these breakthroughs benefit all patients, especially in underserved regions. With continued collaboration among healthcare providers, manufacturers, and governments, endoscopy will transform healthcare globally, offering safer, more effective solutions and significantly improved patient outcomes.