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Swallowing A Swimming Pill

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BOSTON, Mass. (Ivanhoe Newswire) - New research aims to give doctors a unique view inside the human body using a remote-controlled capsule which could find a problem and treat it.

A miniaturized doctor and his team swim through a human body to save a life in the sci-fi classic Fantastic Voyage. Decades later, a new swimming pill could give doctors a new way to save lives.

"This capsule can stop or move or aim at the disease lesions so you can actually try to cure the lesion," Noby Hata, co-inventor of the swimming endoscopic capsule, told Ivanhoe.

The capsule is designed to be swallowed like a pill. Doctors will be able to control the camera magnetically from outside using an MRI machine's magnetic signals. There is a coil to induce the current remotely.

Hata said the MRI works much like a GPS.

"You will see the cross section of the body and also the little capsule in the middle and you can navigate this capsule using this map as guidance," Hata said.

So far, he's successfully tested a prototype of the capsule in a fish tank inside an MRI machine. The goal is to one day be able to deliver drugs or laser treatments directly to tumors or injuries in the digestive track.

Dr. Kunal Jajoo, associate physician in the Department of Medicine at Brigham and Women's Hospital believes this could change the way colonoscopies are performed.

"It's an amazing advance to be able to steer something that small within the body and really direct it to areas that might need therapy or biopsy or the like," said Dr. Jajoo.

The inventor of the capsule said MRI machines are already in place in hospitals all over the country. Once the swimming capsule is produced, it can be easily distributed without a great deal of expense.

RESEARCH SUMMARY

BACKGROUND: At least 50 percent of the Western population develops a colorectal tumor by age of 70. In 10 percent of these individuals, the tumor progresses to malignancy. In adults, colorectal cancer is the second leading cancer that causes death worldwide. According to recent published reports in the New England Journal of Medicine, colonoscopies have helped cut the death rate from colon cancer in half. (Source: Medscape.com, The New England Journal of medicine)

LOOK FOR POLYPS: A colonoscopy is a test that allows your doctor to look at the inner lining of your large intestine (rectum and colon). The doctor uses a thin, flexible tube called a colonoscope to look at the colon. A colonoscopy helps find ulcers, colon polyps, tumors, and areas of inflammation or bleeding. During a colonoscopy, tissue samples can be collected (biopsy) and abnormal growths can be taken out. Colonoscopy can also be used as a screening test to check for cancer or precancerous growths in the colon or rectum (polyps). (Source: WebMD)

NEW TECHNOLOGY: Researchers at Brigham and Women's Hospital are now developing a "swimming capsule'' that they hope will combine the best of both approaches: the control of the endoscope with the safety and ease of a pill. Doctor Kunal Jajoo believes that new technology could change the way colonoscopies are done. "This swimming capsule could possibly be able to steer a capsule through the body with a MRI," Dr. Kunal Jajoo, from Brigham and Women's Hospital and an Associate Physician in the Department of Medicine, told Ivanhoe. In a paper published in the journal Biomedical Microdevices, they showed they could "swim'' their capsule through a tank of water, powered by a conventional MRI machine.

The swimming capsule could also make colon cancer screenings more accurate. Today's capsule endoscopes - tiny cameras encased in plastic - can't be used for cancer screening because they take pictures at random intervals and so only catch cancers by chance or if the tumor is extremely large. The images can be seen only later, once the capsule has sent them wirelessly to a data recorder worn on the patient's belt, so a second procedure is often needed to confirm a diagnosis. Capsule endoscopes are naturally excreted and painless. The goal of this new pill will be to find a way to deliver images in real time, allowing doctors to identify and explore areas of concern with one procedure. "Anything that can increase the likelihood of someone getting a screening colonoscopy can save lives and prevent colon cancer," Dr. Jajoo told Ivanhoe.( Source: Interview with Ivanhoe Broadcast News, The Boston Globe)

INTERVIEW

Dr. Kunal Jajoo, from Brigham and Women's Hospital and an Associate Physician in the Department of Medicine, talks about new research that aims to give doctors a unique view inside the human body by using a remote-controlled capsule.

Tell me a little bit about this technology.

Dr. Jajoo: It's some very exciting work. This swimming capsule could possibly be able to steer a capsule through the body with a MRI. Anything that can increase the likelihood of someone getting a screening colonoscopy can save lives and prevent colon cancer. There are some people who are very skittish about the prospects of a colonoscopy. Currently, our colonoscopies require sedation and a full day cleanout, so people generally have to take a day off from work. Although most people are very comfortable, there are people who are concerned about discomfort during the procedure. This should be a very exciting advance to maybe allow for more people to be screened.

What do you think the capsule will allow you to do as a doctor that maybe you're not able to do as well as you would like to?

Dr. Jajoo: I think it will allow for you to have an un-sedated colonoscopy. The ability to go in to the bowel and steer around without having to have a long scope attached to it is amazing. It's an amazing advance to be able to steer something that small within the body and really direct it to areas that might need therapy or biopsy or the like.

How would you say this is going to change the game for what you're doing?

Dr. Jajoo: If it's able to be realized in a fashion that would allow for broad scale screening it would change the game in the sense that it might become the way colonoscopy is performed.

What do you think is the fear?

Dr. Jajoo: There's concern for anything going in to the body. There's concerns about that and I think that there's fear about going to anything preventative that might include pain. I have many of my patients tell me that they told other friends how easy it was and then those friends finally came and who also thought it was easy. The hardest part is usually the clean out before and pretty much everything currently requires the clean out before for us to be able to see small polyps and remove them.

Do you think that something like this is a lot less invasive?

Dr. Jajoo: Right. It has great potential and it would be much less invasive. The beauty about colonoscopy is that we can both see and do at the same time. You go to look for polyps and if you don't find any you're done. If you find them right then and there they're removed. We are yet to see whether these capsules will have the ability to also do more than just see a polyp, because then you would need to be able to remove it. If you see it and don't have the ability to remove it, then you still need to have a colonoscopy when it could have all been done at the same time. Of course, if that allows for more people to be screened then that's still a great advance. But you want to be able to see and do at the same time.

What else could the capsule do?

Dr. Jajoo: The capsules that we have now, they record as they tumble through the bowel, and can miss things. Later on a doctor is reading and looking at the recordings and then trying to extrapolate where in the bowel this may be. This swimming capsule when it's released will be able to steer and in real time look at and identify and locate where it is. The small bowel is about twenty two to twenty five feet long, with the current capsules we try to figure out based on the amount of time it took to get there, how far in the bowel we may be, but that's not very accurate. Whereas this capsule would hopefully allow it to be done with MRI and together locate exactly where in the bowel it is.

How does it work on the digestive system?

Dr. Jajoo: When you're doing and upper endoscopy, we enter through the mouth and travel through the esophagus to examine the stomach and examine the beginning of the small bowel, the area known as the duodenum. When a screening colonoscopy is performed to look for polyps we enter through the anus, go around the scope, the scope traverses the colon through the transverse colon down to the top of the colon in an area called the cecum. Then we often look in to the area called the terminal ilium, the very end of the small bowel. However there's about twenty two to twenty five feet of small intestine that just kind of loops around the abdomen. The patient swallows the and it goes in to the stomach and kind of just tumbles through the bowel as it's taking pictures. Those pictures are downloaded to a disc and a doctor reviews them to try to find where there may be an abnormality.

Have you been able to catch other things in the body?

Dr. Jajoo: The swimming capsule has not yet been tested in humans as far as I know. But yes, the capsules that we have currently have, allows it to look more in the esophagus but not the stomach. When I do a standard endoscopy, I use air to fill up the stomach to look between the folds to look for ulcers, growths, polyps, things like that, which is also the case for the colon. We do use air to be able to see between the folds and to look for polyps that might be hiding behind or within the crevices of folds. The current capsule that has been tested for the colon, I believe it has only been tested abroad, is about sixty four percent accurate by the biggest study that we have to date.

How does that compare?

Dr. Jajoo: Sixty four percent compared directly to colonoscopy. The patients had a capsule colonoscopy and then had a regular colonoscopy following it. It found about sixty four percent of the things that the standard colonoscopy found. I do think that if this magnetic capsule is made for routine clinical use, it will take some time to be able to go all the way through the colon, so a patient would have to sit in the MRI for quite some time and there are people who are afraid of sitting in a small place like an MRI as well. We'll have to overcome each of those issues.

FOR MORE INFORMATION, PLEASE CONTACT:

Noby Hata
Brigham and Women's Hospital
(617) 525-8596

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