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The aim of this work is the development of a custom vision system for capsule endoscopy enabling real time data stream at 20 fps. The core components of the system is a custom imager purposely developed for the target application, combined with a red, green and blue LEDs illumination system and a low power FPGA for sensor control, image compression and interfacing with transmission. The FPGA is also responsible for the control of LEDs, which are synchronized with image acquisition in order to implement automatic lightning tuning and to work also in a global shutter condition. The novelty of this approach is that the camera setting is maintained fixed while the lightning control is modulated in order to set the proper amount of light for an optimum image quality in terms of croma, light exposure and flickering effects. The vision system was implemented in a miniaturized electronic board and tested ex-vivo.