An interview with Torrey Smith, CEO of Endiatx, on PillBot™, the world’s first motorised pill camera for telemedicine. Mr Smith shares his vision for the revolutionary new field of micro-robotics within the human body.
Stomach cancer, also known as gastric cancer, is the fifth most common cancer worldwide. In Singapore, it is the seventh most common in males and ninth most common in females. Lifestyle factors, dietary habits, genetic predisposition, and infections such as Helicobacter pylori play instrumental roles in influencing its prevalence.
The early diagnosis of stomach cancer is crucial in its prevention and management. Detecting the disease at an early stage offers several significant benefits that contribute to better outcomes and reduced mortality rates. Currently, upper gastrointestinal endoscopy is generally accepted as the gold standard for the clinical evaluation of stomach cancer. This is an expensive and invasive procedure that may discourage individuals from undertaking the check-up. Today, we have Torrey Smith, CEO of Endiatx, to share about the world’s first motorised pill camera that will make stomach cancer diagnosis more palatable and accessible.
1. To diagnose stomach cancer today, doctors perform an upper endoscopy. What does this procedure entail?
The upper endoscopy or EGD involves inserting an endoscope (a semi-flexible tube 1 cm in diameter and 120-160 cm long) down the throat of an unconscious patient in a hospital setting. This standard procedure of gastrointestinal (GI) medicine hasn’t changed much in 50 years, and it comes with significant drawbacks.
Most people find it highly invasive and would prefer to avoid it – even under sedation. Though exact costs vary by locale, the EGD is expensive both for each procedure itself and for the endoscopy and anaesthesia equipment required to set up the clinic.
Each EGD takes tremendous human resources, including 3-4 hospital personnel, and results in significant lost time and discomfort for the patients. In the United States, due to overbooking, 4-6 months commonly elapse between patients experiencing gastrointestinal pain and receiving an EGD.
When the EGD finally becomes available, it requires, in addition to the physician endoscopist, an anesthesiologist, at least one trained nurse, and a technician to clean the endoscope and prepare it for the next patient. This cleaning itself can take 200 litres of deionised water. This comes in addition to up to half a kilogram of waste produced in the form of discarded IV lines, sanitary equipment, etc.
These drawbacks combine to make GI medicine rank among the most resource-intensive wings of any hospital in terms of its personnel and infrastructure demands and carbon footprint.1 EGD also poses risks to patients in the form of perforation or infection, in addition to the risks of anaesthesia itself, which are especially high in the overweight and those with underlying heart or lung disease. The procedure seems especially burdensome when you consider that approximately 72% of EGDs do not conduct a biopsy and instead effectively visually scan the patient’s anatomy. Even in the best of outcomes—a patient being cleared of serious pathology—they will have spent four hours at a hospital, drawn heavily on human and natural resources, and undergone significant medical risk for a five-minute investigation of their GI tract.
2. PillBot™ is the world’s first motorised robotic camera platform for telemedicine. How does it work?
PillBot™, the world’s first virtual endoscope, lets a basic EGD happen from the comfort of home. Think of PillBot™ as a multicopter drone flying in the stomach. It’s a single-use motorised robotic video camera platform—a little bit larger than a multivitamin pill—that manoeuvres in all directions using pumpjet thrusters.
In preparation for being scanned by PillBot™, the patient simply skips one meal and then drinks water to temporarily fill the stomach with clear liquid. The patient then signs into a telemedicine call with a remote physician. The doctor activates PillBot™ and the patient sees the device’s lights come on right before they swallow it. PillBot™’s onboard camera operates at maximum frames per second to capture images of the oesophagus in the first few seconds after being swallowed. Then, for the next 5-10 minutes, the remote physician steers the device into the patient’s stomach via the Internet using their smartphone. The doctor manoeuvres PillBot™ to see the entire stomach, but zooms in as needed to examine any lesions present. They might see, for example, a peptic ulcer, or inflammation of the stomach lining called gastritis.
Most importantly, they may see stomach cancer early enough that it can still be treated. If gastric cancer is diagnosed and treated before it has spread outside the stomach, the five-year survival rate is 70%. However, if it has spread to surrounding tissues or organs and/or the lymph nodes, the five-year survival rate is just 32%. Many of the 11,000 in the US and 800,000 globally who die from stomach cancer are diagnosed too late to treat.2 PillBot™ is truly lifesaving technology.
The patient remains awake while they use PillBot™ and can converse with the doctor and see the same video imagery that the doctor sees. PillBot™ transmits data at 915MHz, through the water in the stomach and the patient’s body, to an external receiver that looks like a USB flash drive. This receiver sends the information into the cloud where it is securely stored for later analysis. The physician then permanently shuts down PillBot™, which passes through the body and, 6-24 hours later, into the toilet.
The majority of PillBot™ examinations will clear patients of significant pathology. The doctor may diagnose a more mild condition, such as gastritis, and prescribe a treatment plan during the real-time visual examination. In cases where PillBot™ identifies a serious condition requiring intervention, the patient can be quickly brought to a hospital for an EGD or other testing.
3. What are the short-term and long-term benefits of PillBot™ as opposed to regular upper endoscopy?
PillBot™ will save lives by dramatically increasing access to GI medicine. It will be manufactured in the United States for a total cost of about $50, with further reduction as the company scales. The fact that PillBot™ is primarily made from simple, off-the-shelf components places its price within reach for practical use throughout the world. Though reimbursement codes will vary between countries, PillBot™ will generally be far less expensive than an EGD, and will therefore profoundly lower barriers to entry for screening of the stomach.
Physicians will be able to more quickly provide initial diagnostics, and patients in distress will be more quickly able to receive dignified care. In the United States today, crowded facilities mean people often wait months or face “presumptive diagnosis” whereby doctors guess the cause of pain based on symptoms. With PillBot™, most people will be able to receive a screening within 24 hours. Even in remote regions such as the interior of Australia, those in distress could have PillBot™ shipped to them within a few days, and soon receive medical care without having to leave their homes.
PillBot™ will be of particular benefit to the elderly, the obese, the sick, and the handicapped, who can’t easily travel. Hesitant and underserved people will have access to the world’s best doctors via telemedicine. Picture, for example, someone in an assisted living facility without the mobility to travel to a hospital. That person will instead have the GI suite brought to them over an internet connection. But regardless of baseline health status, almost everyone with stomach pain will instinctively prefer the fast, painless, dignified PillBot™ experience to the complex invasion of an EGD.
PillBot™ environmental impact is also far less than that of a standard EGD, which produces significant waste from packaging, cleanliness materials, and intravenous lines. Requiring no infrastructure or capital equipment, no commuting to a facility, and no equipment to use, PillBot™ dramatically reduces carbon emissions. The entire GI suite gets dematerialised into a package the size of a deck of cards. PillBot™ itself ends up in a landfill – perhaps shredded to some degree depending on the bar screen sizing of the waste treatment plant.
4. What about institutional resistance? Will gastroenterologists be willing to change how they make money? How will PillBot™ change the GI field?
In the case of gastrointestinal medicine, physicians eagerly await a device that can do what PillBot™ does. They recognise that GI medical examination methods have not kept pace with general technological evolution. These doctors have been clamouring for a way to quickly and safely examine patients remotely, and PillBot™ gives them that answer. So while institutional resistance may exist in other fields, in the case of PillBot™ the opposite is true: enormous market demand exists and PillBot™ need only reap the reward by being the first to provide what so many desire. With a state-of-the-art telehealth platform in which patients and doctors can be separated by thousands of miles, PillBot™ leverages the latest technology to let doctors perform at their best.
The tool needed to use PillBot™ sits in most doctors’ and patients’ pockets all day: a smartphone. Both simply download the PillBot™ app and are then furnished with a quick tutorial – the patient, in preparing for the procedure, and the doctor, in manoeuvring PillBot™ using the app interface. The smartphone app stores data so that both doctor and patient have a record of the procedure to use as they see fit.
The enhanced accessibility that PillBot™ provides will lead not only to more rapid diagnosis but to increased patient engagement with the healthcare system. By removing the requirement for a hospital visit, sedation, and time missed from work, patients will no longer dread an endoscopy but accept it as tolerable, painless, and quick. Preventative robotic capsule screening in the upper GI tract will in many cases replace reactive diagnosis via traditional endoscopy. When PillBot™ becomes part of a routine preventative care regimen, doctors can allocate resources to more demanding procedures. They can also save the full EGD for when PillBot™ has deemed it absolutely necessary.
5. With the rapid development of robotic technology, what else can we look forward to from Endiatx in the future?
We at Endiatx are visionary engineers. We dream big and set our sights on lofty targets.
As PillBot™ enters the market and provides care to the previously underserved, we will equip it with further automation. If the physician-operated PillBot™ reduces costs by one order of magnitude, its future AI-operated version will reduce them by another order of magnitude. Equipped with AI, PillBot™ will improve with every additional instance of its use and will build a vast database of GI imagery and illnesses. This data itself may be a source of revenue, in addition to being of enormous benefit to the GI medical space. The information will be used to improve the effectiveness of diagnoses and treatments globally.
We are already developing future versions of PillBot that will offer additional lifesaving features. After PillBot™ will come PillSurgeon™, which will be built on the PillBot™ platform but feature tools for polypectomy, wound cauterisation, microbiome sampling, targeted drug delivery, and more. Our advantage lies in being at the forefront of technological innovation. We will not be constrained by what others say is too challenging.
In the long term, as Endiatx pioneers the field of micro-robotics within the human body, we will expand beyond the GI tract to other tissues and systems. We will develop robotic devices of ever-decreasing size and ever-increasing scope of functionality. A decade from now, a swarm of rice grain-sized robotic surgeons may quietly eliminate your brain tumour as you go about your day. [APBN]
References
- de Melo, S. W., Taylor, G. L., & Kao, J. Y. (2021). Packaging and Waste in the Endoscopy Suite. Techniques and Innovations in Gastrointestinal Endoscopy, 23(4), 371-375. https://doi.org/10.1016/j.tige.2021.07.004
- Stomach Cancer: Statistics: Cancer.Net; 2022
This article was first published in the September & December 2023 print version of Asia-Pacific Biotech News.
About the Interviewee
Torrey Smith, Endiatx CEO
Prior to co-founding Endiatx, Mr Smith developed medical devices in the areas of endometrial ablation, atherectomy, therapeutic hypothermia, sleep apnea, and vascular closure. An aerospace engineer by training, he takes a keen interest in the deep tech sector and is a proud mentor of up-and-coming founders at the Founder Institute. He is also the principal founder of the international arts collective known as Sextant and has had his art featured in the Smithsonian.