Nanotechnology in multimodal theranostic capsule endoscopy

Video capsule endoscopy (VCE) has become a clinically accepted diagnostic modality in the last 20 years and has established a technological roadmap for other capsule endoscopy (CE) devices, incorporating microscale technology, a local power supply and wireless communication. However, VCE does not provide a therapeutic function and research in therapeutic capsule endoscopy (TCE) has been limited. This paper proposes a new route towards viable TCE based on multiple CE devices including essential nanoscale components. A first device is used for multimodal diagnosis, with quantitative microultrasound as a complement to video imaging. Ultrasound-enhanced fluorescent marking of sites of pathology allows follow-up with a second device for therapy. This is based on fluorescence imaging and ultrasound-mediated targeted drug delivery. Subsequent treatment verification and monitoring with a third device exploits the minimally invasive nature of CE. Clinical implementation of a complete patient pathway remains the subject of research but several key components have been prepared in early prototype form. These are described, along with gaps that remain to be filled.