So, shifting gears a little bit from the technical and clinical applications, as well as indications, contraindications of capsule endoscopy, I'd like to shift the focus now to robotic and AI-powered capsule endoscopy. The future of GI diagnostics is really in capsule endoscopy in a big way, and we're going to talk about some of the implications of that, as well as some of the current systems that are out there that you may come across. The learning objectives of this talk include the evolution of endoscopy, a brief introduction to capsule endoscopy in terms of the innovations and the current systems that we might encounter, and how robotics and AI have been gradually integrated into these systems and where that leaves us as gastroenterologists in our practice going forward. I also want to spend some time talking about current market technologies, the benefits and limitations of these technologies, the future outlooks, and also give some practical tips about how to navigate these very new waters that affect all of us, all the way from the spectrum of being in academic institutions to being single-center and private-practice gastroenterologists. I want to emphasize that the focus of my talk today is going to be on practical applications, and also to give our audience a real-world sense of what's out there, what you're going to come across when you interface with patients and industry representatives, even something as simple as attending a conference like Digestive Disease Week, walking through the vendor booth, you're probably going to be bombarded by all of these different new therapeutics and new technologies. So, as far as capsule endoscopy goes, I wanted to highlight a few specific systems and what to look for and some of the promising technologies that are out there in capsule endoscopy. So, endoscopy, as we've talked about a lot today, has evolved significantly over the past 20 to 30 years. When we think of endoscopy, basically, just to refresh, we think about a clinical tool that uses a technical set of skills in order to image the GI tract in a direct and endoscopic fashion. Our most common example of this are standard diagnostic upper endoscopy and colonoscopy procedures. However, these procedures have, not only do they have a very specific set of implications and indications, but they can also carry some risks associated with them. So, for example, diagnostic endoscopy is often considered an invasive procedure. I put invasive in kind of air quotes because even though, as gastroenterologists, we do these procedures all day, every day, there is significant risk at times associated with doing these procedures, and we'll talk about that in a little bit. It's also very operator-dependent, so that can encompass things like the skill level of the endoscopist, experience level. We've talked a lot about fatigue in endoscopy and how that factors into lesion detection and the yield of having an optimal study. Diagnostic endoscopy also involves the use of anesthesia, so this can carry with it its own set of risks of possible complications, and the patient's comorbidities really do have to be taken into account when considering diagnostic endoscopy. And follow-up care is also really important because, as GI physicians, myself included, we love to do 10, 15 of these procedures in a day, but with that also comes pathology, follow-up care, clinic-based appointments that are needed, and possible point-of-care testing that may have to happen as a part of providing comprehensive GI care. So even though diagnostic endoscopy, or even screening colonoscopy for that matter, is often considered the fun and supposedly glamorous part of practicing GI, it does carry with it a lot of responsibility that we do need to take into account as gastroenterologists. Some of the brief risks of traditional endoscopy, and this is just to lay the context of what we're going to be talking about as far as capsule endoscopy goes here going forward. Some of the risks include the risk of bleeding. The incidence is about 1 in 1,000 or 1 in 2,000 procedures, depending on what literature source you may quote. It most often occurs in post-polypectomy bleeding. Bleeding at the time of endoscopy induced by the endoscopist is rather rare, but post-polypectomy bleeding is some of the most common source that we consider when considering bleeding and endoscopy. Usually this is mild and self-limited, but it may require endoscopic treatment, or in more severe cases, admission to the hospital, transfusion, and other associated management. It's also important to factor comorbid conditions into the management of traditional endoscopy and its associated complications, and delayed bleeding is also something to be aware of that can occur anywhere up to 7 to 14 days post-procedure. There's also the risk of perforation. This is about 1 in 2,500 to 1 in 3,000 diagnostic colonoscopies, potentially higher in therapeutic procedures. This does not include interventional procedures. I'm a general gastroenterologist myself, so just keeping the focus really basic here and laying the foundation of capsule endoscopy, risk factors for perforation can include therapeutic interventions like polypectomy, dilation, advanced age of our patients, patients with diverticulosis and or inflammatory bowel disease, and in some cases, management of this particular complication may require surgery or other forms of treatment with or without possible admission to the hospital. There's also the risk of missed lesions when we do endoscopy, especially with colonoscopy. There is a risk of right-sided colon lesions that carry with it an increased risk of being missed. This can be contributed, or contributing factors can include poor bowel preparation, flat or sessile lesions. Sometimes if there's inadequate sedation or the patient is moving or their body habitus makes it such that maneuvering, especially in the right side of the colon, is a little tricky. This can lead to a decreased observation and withdrawal time. And there are also endoscopist-dependent factors that can go into missing lesions during colonoscopy. These, as we've talked about previously, can include fatigue of the endoscopist, experience level and technique. So missing lesions during endoscopy is also a very important consideration, and we'll talk about how that factors into capsule endoscopy and some of the new technologies that have now emerged in order to mitigate that. There's also the risks of sedation that are associated with traditional endoscopy. These can include respiratory depression, hypotension, the need for possible emergent intubation. Contributing factors can include advanced age and other comorbidities. And then this carries along with it the need for sometimes very advanced clinical monitoring. So what we're trying to point out here is what can start out as a simple, hey, welcome to your gastroenterologist office, you're 45, you're healthy, need a screening colonoscopy. Sometimes that can lead to some associated risky situations if we're not careful. And these are all implications that we need to take into account when considering endoscopy of any kind. There's also cost of traditional endoscopy. So the national average or the national average cost of a colonoscopy, depending on what degree, is approximately $2,700. This can range from anywhere from $1,200 to almost $5,000. Again, I think the range of that, and depending on what literature you read, really highlights how variable the cost is, and of course the lack of price transparency in our healthcare system, separate talk for a separate day. And there's also the cost considerations of upper endoscopy, approximately $2,700 with a range of anywhere from $1,500 to $10,000. So cost and resource intensiveness is also a big consideration in traditional endoscopy. These can be influenced by factors like facility type, such as if you're doing endoscopy in an ASC or a hospital outpatient department, depending on where you're doing colonoscopies, depending on what services are rendered during these endoscopic procedures, whether that's polypectomy, biopsies, et cetera. There's also the cost of reprocessing. This can be per endoscope or on a per lab basis, depending on how you calculate things. And then there's also the increasing cost of healthcare in the US year over year, which just in almost the past year alone, increased by 7.5% to an average of $4.9 trillion, with an average spending of almost $15,000 per person. And this rate is only getting higher and higher. These are the types of things that make me say, maybe I should have been a vet. I'm just kidding. I was a dog person, so I had to throw that in there. So with all that said, what exactly is capsule endoscopy? And how does that factor into this growing trend of new emerging technologies? And how is it really serving us as not only as an adjunct, but sometimes as an alternative to traditional endoscopy? And how can we really benefit from it the most? That's what we're going to really focus on today, focusing on some specific systems that are out there to help you in your practice navigate this new world of capsule endoscopy, which has really taken on a life of its own over the past five to 10 years. As our course faculty have discussed in a lot of detail very, very nicely today, capsule endoscopy is a non-invasive visualization of the GI tract, so no sedation required. Patient ingests the capsule and goes on about his or her day, transmits images wirely to a reading device, and it has various indications, which we've talked about a lot today, such as obscure GI bleeding, iron deficiency anemia, IBD, polyposis syndromes, celiac disease, occult malignancy, and a host of other indications as well. Capsule endoscopy has evolved considerably over the past 15 years or so. I wanted to put this slide out there just to give you a brief overview of some of the specific capsules that you may come in contact with in your daily practice. Currently, the SB3 system, which was founded by Given Imaging and then later sold to Medtronic, is a very common system that is out there. The capsule size of these capsules is pretty much the size of a large vitamin or a potassium pill is what I like to tell patients. The battery life of these ranges from anywhere from about 8 to 10 hours, depending on the source that you quote. Each capsule is unique in that it has a frames-per-second capture and a field-of-view measurement. That's often how a lot of these capsule technologies are sort of differentiated from one or another. The size of the capsule is mostly the same, but the frames-per-second and the resolution and the viewing angle can be differentiating factors. So there's one by Medtronic, which is the pill cam. There's Olympus has its own product. Miracam has its own product as well. And there's sort of a newer technology on the market called OMOM by Ginseng Science and Technology. This also has its own capsule product, which we'll talk about in some detail in a few slides here. So how does robotics factor into capsule endoscopy? So far, what we've talked about a lot today is the patient physically taking a capsule, ingesting it, and then the images being captured automatically. The study gets downloaded onto a recorder device, and then that recorder device is then hooked up to a computer, and then we can then view capsule images ourselves. There are some exceptions to that where images are captured on the capsule directly. The capsule cam system, for example, is one where the capsule has to be retrieved, and then it uses that sort of technology to then view the study. But how does robotics kind of factor into all of this? Well, to use an analogy from our surgical colleagues, the da Vinci robot or the concept of a robot that could assist in surgery many years ago was sort of a foreign concept. In fact, it maybe have been an affront to some surgeons that said, hey, I went through surgical training myself, why can't I do this operation with my bare hands? But now fast forward many years, the robot has been highly integrated into many surgical practices and now is often viewed as an essential tool in completing surgeries that were before done by our bare hands. The role of robotics and capsule endoscopy is kind of following a similar trend in its very, very early stages. So Medtronic in its infancy pioneered this system, or they tried it out, where you have basically a paddle-based system where you could robotically at least assess the location of the capsule and different parameters. And then Siemens and Olympus have developed an MRI-based system where MRI was used as an adjunct to perform capsule endoscopy. And more recently, ANX Technologies, which we'll talk about here in some detail, now has a magnetically controlled capsule endoscopy system, which is now coming into the forefront as almost a new standard or trying to set a new standard for a new type of endoscopy that sort of merges the idea behind being able to control your endoscopy and your endoscopic camera and the basic principles of capsule endoscopy. So what is MCCE? I'm sure that as you go to conferences or as you read literature, you may come across this concept of MCCE. Well, MCCE stands for Magnetically Controlled Capsule Endoscopy. This is a system where the patient lays on a table, which is similar to an MRI or a fluoroscopic table. And then there is this almost like C-arm-like device, which sort of stands or hovers over the patient, and then the patient ingests the capsule, and then this device is able to magnetically maneuver the capsule inside the patient's body. Now this had originally come into the forefront with gastric cancer screening programs, mainly in Eastern countries, because gastric cancer has a very high prevalence in some countries like China, Japan, Korea. So there had to be a more automated way or a more scalable way to perform diagnostic or even screening upper endoscopy in patients who may be at risk for development of gastric cancer. So that's really where this technology was kind of born. And now more recently, it has been ported over to the United States and trying to gain some traction in becoming almost an alternative to upper endoscopy in patients who may not be able to undergo traditional upper endoscopy, which we'll talk about in a second here. So as we discussed, basically you have this magnet set up, and that controls the capsule within the movement in the upper GI tract. You have a joystick here, which allows for translational and rotational movement along separate axes. So basically you can go up, down, sideways, and also in a rotational sense. And the technology is also becoming increasingly automated with continued research and development. So there are also new efforts to try to reduce some of the operator dependence of this technology, and we'll talk about that here in just a minute. So this is the system in some closer detail. So you have your control desk over here. It's got a keyboard and what looks like a pretty traditional capsule endoscopy software, as we may know it, Vendor Agnostic. And you've got two joysticks here. One is on the left and one is on the right. And sort of like a helicopter pilot, the operator, which doesn't necessarily have to be an endoscopist, we'll talk about that too, can then use these two joysticks to control the capsule within the stomach. This also uses the help of the magnet, which can be raised or lowered or rotated, much like a C-arm during an ERCP or a fluoroscopic procedure, in order to achieve optimal views of the gastric lumen and the gastric mucosa. So this particular system allows for translational movement on a two millimeter degree axis, rotational movement, horizontal rotation, and vertical rotation. So almost what you can't do is kind of like fly diagonally from one side of the stomach to the other, but it's a pretty cool technology. And it is something that I know this company in particular, they're trying to gain adoption, but it is something on the GI landscape that I think that we should all be aware of when considering new advances in capsule endoscopy. Some of the benefits of MCC-E-based system include active control of the capsule versus passive control. So lots of times when we use a capsule endoscopy, we're relying on the peristalsis and the natural movement of the capsule within the small bowel, especially. This system, as far as the stomach or the upper GI tract goes, allows us or the endoscopist or the technician to actively control the capsule. It allows for stomach and proximal small bowel visualization. There are increasing resolutions and viewing angles with new iterations of technological advances. There's easy location of the capsule. So instead of trying to, for example, view a spontaneous passage or take x-rays a few weeks later after an ingested capsule, you can actually see the capsule and where it is in the body using this technology. And it also has the potential to be a non-contact solution. So in the COVID era and in the post-COVID era with telemedicine and remote GI diagnostics now coming into the fold, this technology has the potential to find applications in that space. There are some relative contraindications to this type of procedure. These include pacemakers and ICDs. And there are some more ongoing studies with different vendors to assess the safety profiles in these patients. Next, we'll talk about artificial intelligence and GI diagnostics. So AI is all the rage now in any sector, whether it's medicine or automotive industry or therapeutics or you name it, AI is here to stay. And that's one of the take-home messages that I feel is really important, especially in capsule endoscopy. Artificial intelligence in GI diagnostics is going to be really important in how these technologies evolve in the future. We were also seeing that in parallel in colon and colonoscopy diagnostics as well. There were some early stage artificial intelligence assistive devices that had been debuted in the colonoscopy market. And now these devices are becoming more and more ubiquitous to the point where even patients are asking, do you use artificial intelligence-assisted devices and polydetection? This is something that trainees in their fellowship programs increasingly want exposure to, and health systems are looking to acquire technologies like this to incorporate into their practice in order to gain appeal for recruiting and for increasing their patient recruitment as well. So this whole movement that we've seen in the colonoscopy space, I think is a really good parallel in what we're going to see in the small bowel and capsule endoscopy space. And part of that, as we've talked about a lot today, has to do with the operator dependence of capsule endoscopy and how these technologies can be used to assist in lesion detection and to reduce the time that it takes to read a study, which can then allow us to do more studies and hopefully provide an increased level of GI care to patients in need. So the general principle with artificial intelligence in capsule endoscopy is you have a computer system that is trained based on image recognition, and then the machine essentially leverages these deep learning algorithms to basically get smarter. It sounds a little iRobot-y, but it works in a very similar fashion, where the machine learning models can help increase the predictive analytics sensitivity for lesion detection, and this is then updated on a continuing basis. So this can lead to improved accuracy, again, reduction in interpretation time, and assist clinicians in identifying abnormalities more effectively. So what are some of the systems out there that you may come in contact with in your daily practice or as you go to conferences and conventions that incorporate this AI technology? Well, one is called the OMOM, O-M-O-M, and this is from their little brochure, and it's a capsule endoscopy system that, again, is ingested, and similar idea to most of the systems that are out there. Ingest the capsule, images are downloaded wirelessly to a recorder, and then recorder is hooked up to a computer, and then we then read the study. So this system in particular has a 172 degree wide viewing angle. It has 512 by 512 pixel resolution, an adaptive frame rate capture between 2 to 10 frames per second, and a battery life of up to 12 hours. So this capsule system, it sort of skipped the pleasantries of being first introduced as a traditional diagnostic capsule system, and then hopefully after years of gaining traction and market share, then possibly could they then upgrade their software and upgrade their system to becoming AI-based technology. This company in particular, they just kind of went for it. They said that AI and robotics is a new thing in capsule endoscopy, and we want to be one of the key players in this space. So when you come across this system, that's one of the main sort of value propositions of their system in particular. They have a few salient features. One is called Smart Scan. This is their version of an AI assist feature. So this can essentially take all the images of your capsule endoscopy study, filter out the redundant images where it may be just lengths of normal small bowel, or images may be, lumen may be obscured by debris or things of that nature, and it can reduce redundant images by up to 90 percent. The system can identify and tag up to 16 types of abnormalities, and then it employs a tool called Smart Finding, which can provide predictive descriptions of detected abnormalities. So basically, filter the images, find the pertinent things, tell you, the endoscopist, what the system thinks this particular lesion is, and then off you go to then read and interpret the study. And this particular system has a study download time of approximately five minutes. So that's one of the things that this vendor in particular also advertises as a differentiator instead of several minutes to hours, for example, of some of the older systems or the previous generation systems that may be out there. So if you hear a Smart Scan or Smart Finding, think about this system in particular when you give it a look. As you can see here, their interface is pretty standard, and their reporting system, it looks pretty familiar overall as to the current capsule endoscopy systems that are out there. That's one thing that a lot of these vendors have in common. They try to make their interface and their usability pretty similar, and they do that not only to help make our lives easier, but they do that for adoption reasons as well in order to help decrease their barrier to entry so that we as endoscopists can say, oh, sure, that's like the XYZ system that I used in my fellowship or that I used in my previous practice, or so on and so forth. So that's the OMAM robotic capsule system. There's also a system called the ANX Navicam Small Bowel Capsule System. ANX is also an emerging vendor or company in this space. The concept was originally designed in 2008, and then there was a Chinese company called Ancon Technologies, and this then, through more years of research and development, spawned ANX, which is the U.S. version of Ancon Technologies, and the goal of this firm or this company is to provide capsule endoscopy services specifically to U.S. markets. So this may be another system that you come in contact with as you go to conferences and even in your daily practice. So ANX, similar to other systems or similar to the OMAM system that we just talked about, they use a feature called ProScan. So ProScan is their version of an integrated AI system, and they say that they use image training from about 150,000 images collected from about 2,000 patients, and again, use deep learning models utilized for system processor training, and there is a sensitivity of approximately 99.8% in per-patient analysis and 99.9% in per-lesion analysis, and this system also advertises that they can reduce the reading time to approximately four to six minutes. So as you go through your practice and as you assess different technologies, these are some of the main features that AI is being really touted as to help physicians and help clinicians. That is to reduce reading time, increase lesion detection, and have a system in which your machine actually learns as it goes. This is also their interface here, so you can see, again, you have your image viewer, and this is a quad view example in their picture here, and then you have your progress bar, so it looks very similar to a lot of the systems that you all may be familiar with, and again, that's by design to help make our lives easier as endoscopists. A&X also has an express system that they use in the stomach, so this kind of combines the magnetically controlled capsule endoscopy system and some AI-based tools into what looks like more of a portable type of system. So you may see this in marketing materials or as you go to conferences and things, but this is also a potential application of capsule endoscopy in the future, meaning so far what we have patients do is come to our GI lab and they ingest a capsule, and we then perform the study and then interpret it itself. This is a way of taking the study to the patient, so I wanted to highlight that here for the purposes of this talk just to show how this technology is evolving and how some companies are really thinking outside the box in how to take this technology and deliver it to the patients, especially when there may be a barrier to the patients getting to you. So this could be an example of this application could be, for example, a patient is in the emergency department having a GI bleed and capsule and may not necessarily be a candidate to undergo anesthesia, so this is a potential type of system that could be employed to take an endoscopic procedure, mitigate some of the risks involved, and deliver that at the bedside as a point of care testing. This particular vendor has what they call a gastro scan integrated AI system, so as we talked about earlier with the MCCE system when you have the two joysticks and you have to kind of helicopter pilot your way around the stomach, this particular system has another iteration where you can basically just program a series of pre-program movements and the technician does not really have to operate the joystick very much or at all, and the capsule can then make its way around the stomach and the gastric lumen with the assist of a magnet and then the study can then be completed that way. So this is one example of how there exists a capsule-based technology that is trying to reduce some of the operator dependence that we see in traditional endoscopy. Really, really fascinating stuff, so I just wanted to take a moment to highlight that just for the purposes of seeing what's out there and kind of where this industry is all heading compared to where it started many years ago. So what are some of the challenges and considerations in adopting AI technology? Well, first of all, reimbursement. Lots of times when you have come in contact with a rep from a device manufacturer or you go to a conference or even your own practice, you may attend this session today and say, wow, this is a really great tool I think that can really benefit our practice in my hospital, in my institution, so I want to take this to my manager who runs our GI lab and hopefully I want to take this to the CFO so that we can acquire this. Usually, whoever you take this to is going to ask you one question right off the bat, what's the reimbursement? And that is often or currently one of the biggest challenges in adopting AI technology, not only in medicine but in capsule endoscopy in particular. One of the main challenges with this or where this comes from is a lack of dedicated billing codes to describe what we're trying to do here. So currently, Medicare or CMS uses this Medicare Physician Fee Schedule or MPFS, and that's how all of our diagnostic CPT codes and things like that get translated to RVUs and everything. So there isn't really a code yet for an AI-assisted capsule endoscopy that can then be translated into a facility fee and a work RVU component, etc., etc. We're still a long ways away from having that hardwired into our reimbursement system in the United States. So currently, that is going to be a challenge in trying to acquire and adopt these technologies for use in our daily practices. So endoscopists and gastroenterologists and teams are really going to try to have to get creative in trying to mitigate some of that, but still try to acquire new technologies if you feel they may be useful to your patients. There are also financial considerations for the practices and institutions themselves. So while I, as an individual gastroenterologist, may feel that my small-dowel practice would highly benefit from the use of integrated AI technologies, there is a cost to doing all this. This can include acquisition of the technology itself, especially when you're considering machinery and magnets and all kinds of things, and there's also training and maintenance and certification components. So again, without reimbursement mechanisms firmly in place, these expenses can become financial burdens for gastroenterology practices, and this can affect adoption and the rate of adoption, which hopefully we'd like to see here in the near future. And thirdly, there is also a complex valuation process to this. So the theme here is how do we take what we're doing now with integrated AI technology and robotics, and how does that change how we value physicians' work and time and intensity? Because these are currently the factors which CMS, in a lot of ways, uses to value what we do. So when these work RVUs, which often govern a lot of our lives, when these are calculated, they take into account things like physician time, work intensity, geographic location, etc., etc. So now if you have a cloud-based system that is now being thrown into that mix, well, how do you value what that's worth, and how do you value that in a reimbursement sense? I don't have the answers to that today, but these are some of the questions that not only physicians but policymakers are asking when it comes to adopting AI technologies in gastroenterology. There are some potential pathways and avenues for GI practices to mitigate some of these challenges. There's something called a new technology add-on payment, or NTAP, and this is a program that you can enroll in in CMS if you have a new technology that you require to demonstrate substantial clinical improvement and hopefully translate that into some reimbursement. This is a way to try to offset some of the cost of adopting new technologies or try to establish some groundwork for reimbursement practices, not only for your own practice but hopefully for others in the future. Some of the downsides of this program is that it's a pretty rigorous process to apply for and qualify for, and additional payments are sometimes time limited, so they'll kind of give you a set sort of period in which it will be an evaluation process, but at least it is one avenue that can potentially be explored as we navigate these new and uncharted waters of AI in capsule endoscopy. Next, alternative payment models are also a potential avenue for capturing some of the value that's associated with what we're doing here. Currently, one of the challenges of a largely fee-for-service reimbursement system is that there is not a whole lot of reimbursement that is solely based on quality. This is now shifting a lot with value-based care models and capitation models and outcomes and Medicare improvement plans and all kinds of things, but the central theme here is that if we continue to reimburse based on fee-for-service, it will be difficult to take a concept like AI in capsule endoscopy and apply it to that fee-for-service model because what we're trying to achieve here, as we've talked about a lot today, is increased yield of lesion detection, better quality outcomes for patients, and more optimal studies of areas of the GI tract that we couldn't necessarily get to in an image before, but if our payment models on a national scale don't necessarily reflect that being a benefit, then there could be a discrepancy there in adoption of these technologies. Again, these are very broad themes and incorporate a lot of sociopolitical landscape issues that we certainly don't have time to talk about today, but just something to be aware of in that as we try to adopt new technologies, the reimbursement challenges are often right at the forefront when we're trying to pretty much convince our institutions to pay for these things so that we can use them in our clinical practice. Now, going forward for some future outlooks here, capsule endoscopy with AI and robotics really has the potential, in my opinion, to be a key player in the telemedicine and remote GI care space because if we have a product or a platform or a service that's an endoscopic service that can be deployed somehow in a remote fashion, either via cloud-based technology or some similar technology, then this then has the potential to have a very far reach in places where specialty GI care may not exist. A lot of the pandemic era really accelerated this, and to CMS's credit, some of the reimbursement policies that they have put in place have now stuck, especially with telemedicine visits. So this is one potential avenue where capsule endoscopy can establish a stronghold, and if we as gastroenterologists continue to utilize this technology and find benefit from it, we could have a real impact in providing remote care to patients who may not be necessarily situated to receive in-person GI care all that readily. Similarly, in the personalized medicine space, which is very active, especially in biotech and pharma, what we're trying to do here with AI and robotics is develop data-driven diagnoses and treatments. So this can then feed into patient profiles, which can then lead to increased personalized medicine and precision medicine as well. Some practical tips for navigating AI and robotics in capsule endoscopy. Staff training and services are going to be really important, just to make sure that everybody is up to date with not only using the technology, but maintaining it as well. It's really important to have clear ingestion study protocols for capsule patients. We've talked about that a lot today with things like use of simethicone, for example, and when to ingest capsules, how long to be in PO for, things of that nature. And there are also some ethical considerations that I wanted to touch on briefly. One is HIPAA compliance for image storage. This is also a new forefront in the sense that if we're going to be taking thousands and thousands of images of a patient's GI tract and then potentially storing them either on a hard drive space or in a cloud-based system, then HIPAA compliance is a key issue and driver of that. And also informed consent for AI usage. There is still really no clear consensus on how we provide clear and informed consent for AI usage in GI. This can be everything from using virtual scribes in our clinic practice or large machine language models in capturing clinic visits and conversation pieces. And the same thing can go for AI usage in capsule endoscopy. So also something to keep an eye out for and be mindful of is how we provide appropriate informed consent for our patients when we do these studies. So in summary, a capsule endoscopy is generally recognized as a safe and increasingly utilized diagnostic tool. It aids traditional endoscopy and GI imaging modalities. It continues to evolve and now includes very innovative AI and robotic technologies. Hopefully we highlighted some of the current vendors in the market to give you the audience some tools on how to navigate what's out there and some of the right questions to ask when considering adopting these new technologies. These can include the ANX platform, OMAM technologies, and other capsule iterations. And hopefully we also touched on some of the challenges, considerations, and reimbursement considerations that will depend on payment models going forward. And with that, I'd like to thank everyone for your attention and I'll turn it back over to the panelists.

capsule endoscopy

robotics

AI

gastrointestinal diagnostics

Magnetically Controlled Capsule Endoscopy

telemedicine

ethical concerns