Diagnostic devices are coming on in leaps and bounds but you may be surprised to learn that one device thatโs remained much the same since the late 1950s is the colonoscope. One researcher working to transform colonoscopies is Professor
Pietro Valdastri, Chair in Robotics & Autonomous Systems at the University of Leeds.
โColon cancer is one of the deadliest forms of cancer, detected in the very early stages, 95% of people diagnosed survive for more than five years. Conversely, once the disease is showing symptoms, the likelihood of survival after five years is just 5%, so early diagnosis is crucial.
โDetecting colon cancer in its early stages is difficult and thatโs where colonoscopies help, by inspecting the colon and potentially finding signs of the disease early, so over one million people are referred for a colonoscopy in the UK each year.โ
Colonoscopy challenges
โColonoscopies are an invasive procedure that can be painful, so much so that in the US patients are given a general anaesthesia, whilst in the UK we use a mild sedative. Faecal blood tests are also used to detect colon cancer and although they are less invasive, they are a less powerful diagnostic tool in this instance.
โAlthough the vision module used in colonoscopies has been updated over the years, the procedure itself hasnโt changed much since 1957, it still involves a rather rigid tube measuring about 1.5 metres being inserted and pushed up inside of the large intestine. Itโs a difficult procedure, pain is a big problem and one in ten colonoscopies are not completed.
โColonoscopes are difficult to use, requiring a lot of training, there is a shortage of trained gastroenterologists, which means waiting lists are long, much longer than the NHS target.
Our work is all about making colonoscopies painless and easier to carry out so waiting lists can be reduced.โ
Harnessing magnetic manipulation
โOur solution is to employ magnetic manipulation. A robotic arm, fitted with a magnet, will gently manoeuvre a tiny robotic capsule (fitted with a magnet) through the colon, thus avoiding the pushing, snagging and discomfort traditionally associated with colonoscopies.
โThe magnetic forces used are harmless and can pass through human tissue, doing away with the need for a physical connection between the robotic arm and the capsule. The robotic capsule is also much thinner and extremely flexible when compared to traditional colonoscopes, helping to reduce discomfort.
โThe capsule can be changed depending on the procedure. My research team, in collaboration with the University of Glasgow, has developed a capsule that can capture micro-ultrasound images.
โAn artificial intelligence system (AI) ensures the capsule can position itself correctly against the gut wall to get the best quality images. A feasibility study has shown that if the capsule get dislodged, the AI system can navigate it back to the required location.โ
micro-ultrasound technology
The tiny robotic capsule or โSonopillโ which incorporates micro-ultrasound technology, has the potential to change the way doctors conduct examinations of the gastrointestinal tract. โSonopillโ can power itself, undertake precise movements as well as collect and communicate data.
โPrevious studies have shown that micro-ultrasound can capture high-resolution images and visualise small lesions in the superficial layers of the gut,โ explains Professor Valdastri, โmaking it better able to identify some types of cell change associated with cancer and provide valuable information about the early signs of disease.
โMirco-ultrasound would provide in situ diagnostic, preventing the need for getting samples of tissue and sending them to the labโ explains Professor Valdastri, โenabling malignant tissues to be identified on the spot. When time is of the essence in both diagnosing and treating colon cancer this is an important step forward.โ
Sonopill success
Funded by a five-year EPSRC programme grant, โSonopillโ has been developed by a consortium of researchers based across four institutions, Glasgow, Leeds, Dundee and Herriot Watt. The lead researcher on the project is Sandy Cochran, Professor of Ultrasound Materials and Systems at the University of Glasgow.
โWith an increasing demand for colonoscopies, it is more important than ever to be able to deliver a precise, targeted, and cost-effective treatment that is comfortable for patients,โ explains Professor Sandy Cochran. โWe are one step closer to delivering that.
โWe hope that in the near future, the โSonopillโ will be available to all patients as part of regular medical check-ups, effectively catching serious diseases at an early stage and monitoring the health of everyoneโs digestive system.โ
Transforming colonoscopies
All in all, the reimagined colonoscopy, incorporating โSonopillโ technology, has the potential to transform how the large intestine is examined, providing benefits for patients and clinicians alike.
โThe procedure will be much less painful for patients and easier to carry out, requiring less training, so waiting lists can come down more quickly,โ explains Professor Valdastri. โGiven time is of the essence in diagnosing and treating colon cancer, increasing access to colonoscopies and reducing waiting times is central to saving lives.
โOur device is less expensive to produce than a traditional colonoscope, it is also disposable, thereby reducing cleaning and maintenance costs too, which also helps the NHS and assists in building a business case for the new device.
โCancer Research UK has funded the colonoscopy project and we aim to carry out the first human trial in November 2020. The technology also has the potential to be applied to other areas like diagnosing throat or stomach problems.โ
Into the future
โLooking to the future, itโs possible the technology will have more applications. Weโre working on a project supported by the European Research Council to miniaturise the technology further so it can be used in the bronchial tree of the lungs, in the bloodstream or to perform neurosurgery, potentially allowing access to deep lesions.
โTreating deep brain tumours and haemorrhages without causing disruption is a challenge. By creating flexible instruments that can move around sensitive areas of the brain, we hope to make accessing the brain possible without causing trauma โ this is our blue-sky research.โ