Capsule endoscopy: Do we still need it after 24 years of clinical use?

Table 2 Pitfalls and technological solutions for capsule endoscopy[45-71]

Pitfall	Solution	Advances	Ref.
Incomplete examination owing to battery runout	Near-field WPT	Enables charging of the capsule during maneuver to enable complex procedures and good visualization with high-quality photos and videos without battery runout	Miah et al[45]; Zhuang et al[46]; Meng et al[47]; Basar et al[48]
	Power management strategies	AI-based technologies to allow rational consumption of the battery and adaptive lighting that further allow good visualization	Hale et al[49]
	UWB/IBC	UWB is a wireless communication technology that operates over a wide range of frequencies to allow lower power consumption while IBC Intrabody communication allows for the delivery of information through the body tissue to not rely solely on wireless communication to allow reduced signal loss, lower power requirement, and improved reliability as it is more stable	Basar et al[50]; Jung et al[51]; Jung et al[52]; Shang and Yu[53]; Li and Guo[54]; Hafezi et al[55]; Lamanna et al[56]
Retention of the capsule	Magnetically controlled capsule MCCE	This revolutionary technology enables external control of the capsule, allowing its maneuver for better visualization. It also supports the development of features that could make CE as effective in diagnosis and therapy as fibro-optic endoscopies. MCCE offers precise, controllable propulsion through the body	Yim et al[27]; Xiao et al[57]; Park et al[58]; Leon-rodriguez et al[59]; Nguyen et al[60]; Guo et al[61]; Hua et al[62]; Hoang et al[63]
	Legged locomotion capsule	These capsules equipped with an internal locomotion system are desirable as they offer enhanced diagnostic capabilities and therapeutic advantages. They do not rely solely on peristaltic movement	Hua et al[62]; Quirini et al[64]
	Paddling-based capsule endoscope	This is another type of internal locomotive capsule that uses the padding technique instead of legging	Kim et al[65]
Limited therapeutic use and inability to take biopsies	Magnetically controlled capsule MCCE	Integrated micro biopsy device, multi-point targeted liquid sampling, Passive and active drug delivery control	Yim et al[27]; Xiao et al[57]; Park et al[58]; Leon-rodriguez et al[59]; Nguyen et al[60]; Guo et al[61]; Hua et al[62]; Hoang et al[63]
Image quality	Multi-element lenses and adaptive illumination	These superior-quality lenses allow a wider angle of view, and the adaptive illumination aids in picture clarity and enhances battery consumption
	CapsoCam SV1	These cams have four-side viewing, allowing for a 360° panoramic view to improve mucosal visualization
	3D imaging reconstruction	to add more comprehensive surface topography using a software-enabled technique to convert 2D images to 3D images
	UWB/IBC	UWB in conjunction with IBC allows for better and more reliable data transmission to permit sending of high-quality photos and videos	Basar et al[50]; Jung et al[51]; Jung et al[52]; Shang and Yu[53]; Li and Guo[54]; Hafezi et al[55]; Lamanna et al[56]
Missed lesions	MCCE, legged locomotion capsules, and paddling-based capsules	The external and internal control by these methods allow for better controllable movement of the capsule without missing lesions by peristalsis	Yim et al[27]; Xiao et al[57]; Park et al[58]; Leon-rodriguez et al[59]; Nguyen et al[60]; Guo et al[61]; Hua et al[62]; Hoang et al[63]; Kim et al[65]
Does not provide real-time feedback	UWB/IBC		Basar et al[50]; Jung et al[51]; Jung et al[52]; Shang and Yu[53]; Li and Guo[54]; Hafezi et al[55]; Lamanna et al[56]
Difficulty and time of interpreting lots of images by the physician	AI-based autonomous lesion detection	Machine learning algorithms to allow for easier analysis of the large number of photos and videos retrieved from the capsule and aid in objective diagnosis	Hale et al[49]; Sharma et al[66]; Hajabdollahi et al[67]; Rustam et al[68]; Alaskar et al[69]
Location problems	Hybrid RF with vision-aware fusion scheme	Multi-sensor approach of the capsule by both RF in addition to vision-based and magnetic type are used simultaneously in the capsule to aid in its locating capabilities instead of relying on only one of them. This problem emerged because of the hard localization of the capsule in the small bowel owing to its length and its compact structure	Vedaei and Wahid[70]; Narmatha et al[71]

AI: Artificial intelligence; 2D: Two-dimensional; 3D: Three-dimensional; IBC: Intrabody communication; MCCE: Magnetically controlled capsule endoscopy; RF: Radio frequency; UWB: Ultra-wideband; WPT: Wireless power transfer.