219 Magnet Assisted Capsule Endoscopy (MACE) in the Upper GI Tract Is Feasible: First Human Series Using the Novel Mirocam-Navi System

Abstract

219 Magnet Assisted Capsule Endoscopy (MACE) in the Upper GI Tract Is Feasible: First Human Series Using the Novel Mirocam-Navi System Imdadur Rahman*, Mathieu Pioche, Chan Sup Shim, in Kyung Sung, Jean-Christophe Saurin, Praful Patel Gastroenterology, University Hospital Southampton, Southampton, United Kingdom; Gastroenterology and digestive endoscopy unit, Hopital Edouard Herriot, Lyon, France; Digestive disease center, Konkuk University Medical Center, Seoul, Democratic People’s Republic of Korea Introduction: Attempts in employing a simple technique of capsule endoscopy for visualisation of the upper GI tract has, thus far, been experimental, cumbersome and potentially expensive. We describe the first human series for comprehensive visualisation of the upper GI tract using the simple Intromedic MiroCam-Navi system. Our aim was to demonstrate the control and manoeuvrability of the MiroCamNavi magnetic capsule and evaluate its ability to completely visualise and maintain views in the upper gastrointestinal tract. Methods: 26 volunteers observed a 12 hour overnight fast but were allowed to drink clear water. 30 minutes before the examination volunteers drank a preparation mixture of 20mg of metoclopramide syrup, and 100mls of water with simethicone and pronase. After capsule ingestion, volunteers were allowed sips of water during the procedure. The MiroCam-Navi magnet was placed at strategic points on the body and rotated to hold and manoeuvre the capsule. Control and manoeuvrability was assessed by moving and holding the capsule for 1 minute to visualise each of the following stations: lower oesophagus, cardia, fundus, body, incisura, antrum and pylorus and also traversing across the stomach and through the pylorus. Total procedure time was taken from the moment of ingestion of the capsule to either reaching the duodenum, or, after attempting a maximum of 10 minutes to traverse the pylorus. All the procedures were performed on the same day in Seoul Konkuk University Hospital by 6 endoscopists (experts in capsule endoscopy). All volunteers underwent an upper GI endoscopy within 3 days of the procedure. Results: All volunteers completed the protocol. Median age was 38 (range 26-45), median BMI 24.1 (range 19.4 38.2), median additional volume of water consumed 800 mls (range 200mls-1500mls) and median procedure time 24 minutes (range 12-39 minutes). Table 1 shows the success of clear visualisation of landmarks and table 2 shows the use of the magnet to control the capsule and either hold it for 1 minute or manoeuvre it in the upper GI tract. There was positive concordance for 8 out of 9 minor pathological findings with conventional upper GI endoscopy. A small 4 mm submucosal lesion was missed by capsule endoscopy in the cardia of one volunteer where views were obscured. Conclusion: This is the first convincing demonstration of the potential value of MACE in the upper GI tract using the MiroCam-Navi system. There is a high degree of visualisation, control and manoeuvrability, with some improvement required for optimising fundal views and traversing the pylorus. Further prospective studies are needed to determine the diagnostic role of MACE for specific indications.