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Journal of Digestive Endoscopy

Vol 3 | Supplement | January 2012 Si
 Review Article

Nanotechnology in gastrointestinal endoscopy:

A primer
Ashish Kumar Jha, Mahesh Kumar Goenka, Sandeep Nijhawan1, Ramesh Roop Rai1,
Usha Goenka, Arya Suchismita1
Institute of Gastro Sciences, Apollo Gleneagles Hospital, Kolkata, 1Department of Gastroenterology, SMS Medical College, Jaipur, India

Abstract Nanotechnology is the understanding, control of matter and development of engineered

devices in nanometer range (1-100 nm). Nanoparticles have different physicochemical
properties (small size, large surface area to volume ratio, and high reactivity) in comparison
to bulk materials of the same composition. The nanotechnology has proved its usefulness in
early diagnosis, proteonomics, imaging diagnostics and multifunctional therapeutics. Recent
studies have shown its role in early diagnosis and targeted therapy of various gastrointestinal
disorders such as hepatitis B virus and hepatitis C virus related liver disease, inflammatory
bowel disease, gastric ulcer, and malignancy. Application of this technology appears promising
in diagnostic and therapeutic endoscopy such as the endoscopic hemostasis of peptic ulcer
bleeding, prevention of clogging of plastic stent and advance capsule endoscopy. This
article will highlight the basic concepts of nanotechnology and its potential application in
gastrointestinal endoscopy.
Key words Nanotechnology, nanoparticles, nanomaterials, nanopowder, hemospray, nano‑based
capsule‑endoscopy

Introduction Various nanomaterials and their properties

Nanotechnology manipulates the chemical and physical
Nanotechnology is defined as the “intentional design, properties of a substance on molecular level leading to
characterization, production, and applications of materials, development of various nanomaterials with novel properties.
structures, devices, and systems by controlling their size and Nanoparticles (NPs) have greater surface area per volume of
shape in the nanoscale range (1 to 100 nm).[1] Nanotechnology smaller particle and therefore they are more reactive and can be
uses the properties and physical characteristics of nanomaterials coated with many molecules.[3] These are stronger and lighter
for the diagnosis and treatment of diseases at the subcellular than macroparticles. The inorganic nanomaterials have unique
and molecular level. It aims to develop and combine new electronic, magnetic and optical properties. All electrons in iron
materials by precisely engineering atoms and molecules to oxide magnetic NPs spin in the same direction and produce
yield new molecular assemblies on the scale of individual larger, localized magnetic field as compared with that of larger
cells, organelles or even smaller components, providing a particles. This larger magnetic field can increase the contrast
personalized medicine.[2] It is being used to refine discovery on magnetic resonance imaging.[4] In metal NPs, the electrons
of biomarkers, molecular diagnostics, drug discovery, drug can move between two energy levels: A ground state and an
delivery and therapeutics. It is a multidisciplinary field. excited state. The difference between these two energy levels
determines the fluorescence emission and color property of any
Access this article online metal NPs. The cadmium selenide semiconductor NP (known
Quick Response Code
as CdSe quantum dots, or Qdots) has fluorescence emission
Website:
www.jdeonline.in
far better than that of organic fluorescent dye molecules.[5]
Quantum Dot of a specific colour offers a cheap and easy way
to screen a blood sample for variety of proteins, viruses and
DOI: other desired substances at the same time.
10.4103/0976-5042.95040
Unlike microparticles, NPs can cross blood brain barrier.[6] It

Address for correspondence:

Dr. Ashish Kumar Jha, Institute of Gastro Sciences, Apollo Gleneagles Hospital, Kolkata, India. E‑mail: ashishjhabn@yahoo.co.in

Journal of Digestive Endoscopy

Vol 3 | Supplement | January 2012 S77
 Jha, et al.: Nanotechnology in gastrointestinal endoscopy

has ability to evade the interception by immune system, and colonic cancer), (c) gene therapy in gastric and colonic cancers,
therefore have longer half‑life and can be used as drug delivery (d) hepatoproteonomics [gene expression (genomics) and protein
vehicle.[7] NPs is acceptable to tumor cells and therefore, production (Proteomics)] and (e) gastrointestinal endoscopy.[30-38]
useful in cancer treatment.[8] It can specifically interact with
biomolecules both on the cell surface and within the cell and Nanotechnology and gastrointestinal endoscopy
can deliver diagnostic and therapeutic agents to specific cells Nanopowder as hemostatic agent in gastric ulcer
and organelles. Because of these unique properties of NPs and bleed
the inherent nanoscale functions of the biological components Endoscopic hemostasis by electrocautery, injection tamponade
of living cells, nanotechnology can be applied to medical fields. and hemoclips has been established as the treatment of choice
for peptic ulcer bleeding. However, endoscopic hemostasis
The various classes of nanomaterials are being developed can be difficult and unsuccessful in situation of severe active
for use in medical sciences and includes liposome’s, stealth bleeding and difficult anatomy. Giday et al. used a novel
liposome’s, emulsions, micelle, polymer‑drug conjugates, nanopowder (TC‑325) application in spurting arterial bleed
biocompatible ceramic NPs with porous characteristics (silica, in stomach in an animal model at endoscopy and showed its
titania, and alumina), metallic particles (iron‑oxide NPs, safety and high effectiveness in achieving hemostasis in an
gold shell NPs, nanocrystalline silver and aluminosilicate anticoagulated severe arterial gastrointestinal bleeding.[34] In
NPs), quantum Dots, calcium phosphate NPs, carbon NPs another prospective pilot clinical study, 20 patients of peptic
(fullerenes and nanotubes), nanocapsules, nanogels, dendrimer, ulcer bleeding (Forrest score Ia or Ib) underwent endoscopic
nanoshell, nanopores, nanodevices and nanomachines application of hemospray within 24 hours of hospital
(nanobots, nanotweezers, smart scalpels and intelligent admission. Hemostasis was achieved in 95% of patients. The
pill).[9‑27] Few of these have been approved by the Food and one patient in whom acute hemostasis was not successful
Drug Administration (FDA) for use in humans such as had a Forrest Ia ulcer. Bleeding recurred in 2 patients within
iron oxide (Feridex and Resovist for MRI contrast in liver), 72 hours. No major complications were reported during 30‑day
gold (Verigene for in vitro diagnostics in genetics), protein follow‑up. Limitation of study was that the only spurter of this
(Abraxane for breast cancer therapy), liposome (Doxil/Caelyx study did not respond to therapy.[35] Hemospray if revalidated
for various cancer therapy), and polymer (Oncaspar for acute appears simple, easy to use and effective method of endoscopic
lymphoblastic leukemia therapy). Some of these nonmaterial’s treatment of active gastrointestinal bleeding.
are currently undergoing clinical trials such as iron oxide
(Combidex for MRI contrast and Nano Therm for cancer Prevention of clogging of plastic stents
therapy), gold (Aurimmune for cancer therapy), nanoshells Endoscopic placement of biliary plastic stents is widely applied
(Auroshell for cancer therapy), quantum dot (Qdots, EviTags in the management of malignant and benign biliary disorders.
and semiconductor nanocrystals for fluorescent contrast However, the major limitation of plastic stents for biliary
in vitro diagnostic), polymer (CALAA‑01 for cancer therapy), drainage is their occlusion by sludge. The biliary plastic stents
dendrimer (VivaGel for microbicide) and micelle (Genexol‑PM are occluded by sludge because stents surface allows adherence
for cancer therapy).[28] of protein, glycoproteins or bacteria. Nanotechnology provides
new possibilities for the modification of surface by soil‑release
Nanotechnology and gastrointestinal tract phenomenon (the lotus effect‑ lotus leaves stay clean because
Gastrointestinal tract is one of the portals for environmental easily flowing water takes any particle from surface). Sol‑gel
NPs to enter the human body. Once ingested it readily traverse technology allows for systematic design of abrasion‑stable
through mucus layer and comes into contact with enterocytes. nanometer‑thin coating with determined physical and chemical
They are scavenged by M‑cells overlying the intestinal mucosa characteristics. An in vitro study has shown, sludge deposition
and therefore escape from active uptake by enterocytes. After to be reduced on biliary plastic stent made of teflon with
cellular trafficking it can reach the blood stream and distribute sol‑gel coating consisting of organic epoxide of 190 g/mol, or
all over the body. Faster diffusion through mucus layer is 500 g/mol and propylaminosilane as comparison to uncoated
explained by smaller diameter of NPs.[29] teflon and clear coating. The nanocoating of plastic stents may
therefore, prevent biliary plastic stents from clogging.[36]
Each part of gastrointestinal tract has distinct feature and
application of diagnostics and therapeutics is not always Nano‑based capsule‑endoscopy
easy, as the targeted delivery of drugs or endoscopy in Capsule endoscopy is a widely accepted new tool in the
distal small intestine is still far from perfection. Knowing diagnosis of small‑bowel and colonic diseases. The procedure
the properties of NPs, application of nanotechnology in is easy to perform and is well accepted by patients. Major
gastrointestinal tract appears promising. It has been tried in limitations of capsule endoscopy are inability to detect deep
many gastrointestinal conditions with varied success, such as; tissue disorders and absence of therapeutic capability.
(a) targeted delivery of therapeutic agents in terminal ileum and
colon (e.g. inflammatory bowel disease) and stomach (e.g. gastric The concept of merging two technological platforms:
ulcer), (b) theragnostic use in cancer (e.g. pancreatic, gastric and nanotechnology for targeting and marking the affected organ
Journal of Digestive Endoscopy
S78 Vol 3 | Supplement | January 2012
 Jha, et al.: Nanotechnology in gastrointestinal endoscopy

and capsule‑endoscopy to detect the marked disorder has disorders such as hepatitis B virus and hepatitis C virus related
recently been addressed. Nano‑based capsule‑Endoscopy liver disease, inflammatory bowel disease, gastric ulcer, and
with Molecular Imaging and Optical biopsy, (NEMO) malignancy. Application of this technology appears promising
project, supported by European Union is trying to integrate in diagnostic and therapeutic endoscopy such as the endoscopic
optical technology with nano‑technology, bio‑sensing and hemostasis of peptic ulcer bleeding, prevention of clogging
maneuvering technology to create a capsule endoscope capable of plastic stent and advance capsule endoscopy. The diversity
of secretion analysis and the detection of marked and deep of NPs, technical difficulties and potential adverse effects
tissue disorders.[37] This may be useful especially in highlighting however, represent the major challenges.
cancerous and precancerous lesions in the gastrointestinal tract.
In conclusion, the nanotechnology has emerged as a technical
Nanorobots are innovative nanometric robots potentially tool that enables us to keep the pace of advancement in
capable of endoscopic procedures. The ultra‑sound transducers, diagnostics and therapeutics with the rapid progress of science
bioanalytical and mechanical sensors and robotic arms could and technology. We can hope that some of our unachieved
be combined in capsule endoscopy system (called as “robotic dreams in diagnostics and therapeutic field of gastrointestinal
beetle”) to obtain tissue samples and provide treatment such sciences will be fulfilled by use of this technology.
as targeted drug releasing and thermal tissue destruction.[31]
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