Diagnostic devices are coming on in leaps and bounds but you may be surprised to learn that one device that’s 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.
“Colon 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.
“Detecting colon cancer in its early stages is difficult and that’s 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.”
“Colonoscopies 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.
“Although the vision module used in colonoscopies has been updated over the years, the procedure itself hasn’t 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. It’s a difficult procedure, pain is a big problem and one in ten colonoscopies are not completed.
“Colonoscopes 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.”
Harnessing magnetic manipulation
“Our 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.
“The 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.
“The 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.
“An 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.”
The tiny robotic capsule or ‘Sonopill’ which incorporates micro-ultrasound technology, has the potential to change the way doctors conduct examinations of the gastrointestinal tract. ‘Sonopill’ can power itself, undertake precise movements as well as collect and communicate data.
“Previous studies have shown that micro-ultrasound can capture high-resolution images and visualise small lesions in the superficial layers of the gut,” explains Professor Valdastri, “making it better able to identify some types of cell change associated with cancer and provide valuable information about the early signs of disease.
“Mirco-ultrasound would provide in situ diagnostic, preventing the need for getting samples of tissue and sending them to the lab” explains Professor Valdastri, “enabling 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.”
Funded by a five-year EPSRC programme grant, ‘Sonopill’ 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.
“With 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,” explains Professor Sandy Cochran. “We are one step closer to delivering that.
“We hope that in the near future, the ‘Sonopill’ 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 everyone’s digestive system.”
All in all, the reimagined colonoscopy, incorporating ‘Sonopill’ technology, has the potential to transform how the large intestine is examined, providing benefits for patients and clinicians alike.
“The procedure will be much less painful for patients and easier to carry out, requiring less training, so waiting lists can come down more quickly,” explains Professor Valdastri. “Given time is of the essence in diagnosing and treating colon cancer, increasing access to colonoscopies and reducing waiting times is central to saving lives.
“Our 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.
“Cancer 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.”
Into the future
“Looking to the future, it’s possible the technology will have more applications. We’re 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.
“Treating 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 – this is our blue-sky research.”