T. Brunk, Vivantes Clinic in Friedrichshain Berlin, Germany, compiled an overview on capsule-based endoluminal diagnostic systems. The article reviews the current technical developments and innovative methodologies. Besides, it describes the evolving clinical indication areas and application in diagnostic pathways.

The article first describes different systems for video capsule endoscopy (VCE), the first of which was introduced to the market in 2000, and which have become an essential tool for routine and preventive diagnostics in the small intestine, but also have gained in importance in the upper gastrointestinal tract and the colon in recent years. The evaluation of the visual material, however, requires 30-60 min of evaluation time as well as training and experience. Artificial intelligence-aided image analysis is a promising methodical approach.

Although computer-assisted methods facilitate recognition of gastrointestinal bleeding in VCE image analysis, widespread use of VCE in emergency cases of suspected endoluminal blood is not possible because of its availability only in gastroenterological centers.
For this indication area, currently the use of a novel non-imaging capsule system called HemoPill® acute (Ovesco Endoscopy) is examined. The HemoPill detects blood/hematin in the upper gastrointestinal tract and small intestine by photometric measures. One substantial unique characteristic of the HemoPill is the possible application in non-fasting patients. The principle of measurement is superior to the visual evaluation of endoscopic images, as the photometric sensor can detect blood in dilutions up to 6.25 %. The evaluation of the examination result is simple and does not require elaborate training. The costs of examination by HemoPill acute are substantially lower when compared to common VCE systems. Preliminary data of first clinical studies show fast and reliable detection of active bleeding in the upper and middle GI tract by the HemoPill acute.

A promising further development of the HemoPill technology is the HemoPill monitor. It consists of the photometric capsule in combination with an OTSC-Clip, which allows the fixation of the capsule in the area of a high-risk lesion and allows real-time monitoring.
The author concluded that capsule-based diagnostic systems are becoming increasingly important in enteral diagnostics. Through automation and artificial intelligence, they have the potential to become non-invasive alternatives to endoscopy.