Magnetic Capsule Research Articles

PTU-034 Double Blind Randomised Controlled Trial Of Magnetically Steerable Gastric Capsule Endoscopy (msgce) Vs. Conventional Gastroscopy For Detection Of Beads In A Porcine Stomach

IntroductionGastroscopy is uncomfortable for patients and incurs the risks of intubation and sedation. Capsule endoscopy is well tolerated and recently a handheld magnet has been developed to enable steering of...

OC-019 Optimising The Performance Of Magnetic Assisted Capsule Endoscopy (mace) Of The Upper Gi Tract Using Ct Modelling

IntroductionCapsule endoscopy, employed to investigate the small bowel, is now being further developed to visualise the upper GI tract. In a pig model, using a hand held magnet, we have...

PTU-028 First Human Series Of Magnet Assisted Capsule Endoscopy (mace) In The Upper Gi Tract Using The Novel Mirocam-navi System

IntroductionAttempts 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...

A Pilot Trial of Ambulatory Monitoring of Gastric Motility Using a Modified Magnetic Capsule Endoscope

A Pilot Trial of Ambulatory Monitoring of Gastric Motility Using a Modified Magnetic Capsule Endoscope

A pilot trial of ambulatory monitoring of gastric motility using a modified magnetic capsule endoscope.

The magnetic capsule endoscope has been modified to be fixed inside the stomach and to monitor the gastric motility. This pilot trial was designed to investigate the feasibility of the magnetic capsule endoscope for monitoring gastric motility. The magnetic capsule endoscope was swallowed by the healthy volunteer and maneuvered by the external magnet on his abdomen surface inside the stomach. The magnetic capsule endoscope transmitted image of gastric peristalsis. This simple trial suggested that the real-time ambulatory monitoring of gastric motility should be feasible by using the magnetic capsule endoscope.

Mo1553 Optimising the Performance of Magnetic Assisted Capsule Endoscopy (MACE) of the Upper GI Tract Using 3D - CT Modelling

Capsule endoscopy, which is currently employed to investigate the small bowel, has recently been further developed to investigate other parts of the GI tract. In a pig model, we have recently demonstrated magnetic capsule endoscopy (MACE) to visualise the upper GI tract, involving a magnetic capsule endoscope (pill) and a hand held external magnet which can be used to manoeuvre the capsule endoscope in the upper GI tract. However, it is unclear what is the best methodology to achieve complete mucosal views if it is potentially to replace gastroscopy e.g.

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

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.

Magnetic mechanical capsule robot for multiple locomotion mechanisms

This paper proposes a magnetic mechanical capsule robot which crawls in a fluid-filled tube. The developed capsule robot employs two locomotion mechanisms simultaneously. It has spiral ribs at both ends, which are rotated by a small on-board motor. Such rotating spiral structures generate a driving force of the capsule robot. We invented a magnetic mechanical mechanism to transfer the rotational motion of the frontal part into the linear motion of the middle part. Using this original mechanism, the linearly moving part at the middle of the capsule robot generates a supportive driving force. The improved mobility is evaluated in experiments. The developed capsule robot employing multiple locomotion mechanisms moves 44% faster than the spiral motion-based capsule robot. The developed magnetic mechanical mechanism and the mobile robotic platform could be used for pipe inspection robots or medical robots.

Biopsy using a Magnetic Capsule Endoscope Carrying, Releasing, and Retrieving Untethered Microgrippers

This paper proposes a new wireless biopsy method where a magnetically actuated untethered soft capsule endoscope carries and releases a large number of thermo-sensitive, untethered microgrippers (μ-grippers) at a desired location inside the stomach and retrieves them after they self-fold and grab tissue samples. We describe the working principles and analytical models for the μ-gripper release and retrieval mechanisms, and evaluate the proposed biopsy method in ex vivo experiments. This hierarchical approach combining the advanced navigation skills of centimeter-scaled untethered magnetic capsule endoscopes with highly parallel, autonomous, submillimeter scale tissue sampling μ-grippers offers a multifunctional strategy for gastrointestinal capsule biopsy.

Magnetic Resonance Imaging for Monitoring of Magnetic Polyelectrolyte Capsule In Vivo Delivery

Layer-by-layer (LbL) assembled polyelectrolyte capsules have been widely studied as promising delivery systems due to their well-controlled architectures. Although their potential applications in vitro have been widely investigated, at present, it is still a challenging task to track their real-time delivery in vivo, where and how they would be located following their administration. In this work, the noninvasive magnetic resonance imaging (MRI) technique was applied to monitor the delivery of polyelectrolyte capsules in vivo, incorporating magnetite nanoparticles as imaging components. First, MRI scan was performed over 6 h after sample administration at the magnetic field of 3.0 T; magnetic capsules, both poly(allylamine hydrochloride)/poly(styrenesulfonate sodium salt)-based and poly-l-arginine hydrochloride/dextran sulfate (Parg/DS)-based, were detected mostly in the liver region, where the transverse relaxation time (T2) was shortened and hypointense images were visualized, demonstrating a contrast-enhanced MRI effect between liver and adjacent tissue. A continuous MRI scan found that the contrast-enhanced MRI effect can last up to 30 h; in the mean time, the Parg/DS-based capsules with smaller diameter were found to have a pronounced clearance effect, which resulted in a weakened MRI effect in the liver. No obvious toxicity was found in animal studies, and all mice survived after MRI scans. Histology study provided evidences to support the MRI results, and also revealed the destination of these magnetic capsules over 30 h after administration.

Magnets in the GI tract

Magnets in the GI tract

Grand challenges in magnetic capsule endoscopy

Wireless capsule endoscopy (WCE) was introduced at the beginning of this century [1] as a technological revolution for comfortable, safe and easy explorations of the GI tract with a swallowable cap...

Comparison of magnetic resonance enterography, capsule endoscopy and gastrointestinal radiography of children with small bowel Crohn’s disease

The aim of this study was to compare magnetic resonance enterography (MRE) findings with those of video capsule endoscopy (VCE) or conventional gastrointestinal radiography (CGR) in pediatric patients with small bowel Crohn’s disease. A total of 55 cases of small bowel Crohn’s disease that were diagnosed through clinical, laboratory, surgical and histopathological findings were reviewed. Prior to the examination, children suspected of having other types of diseases of the small intestinal were identified. The pulse sequences included coronal T2-true-fast imaging with steady-state precession (TrueFISP) images, navigation axial and coronal T1-weighted images, T2-weighted fat-suppressed images and coronal fat-suppressed three-dimensional gradient-echo images, immediately followed by contrast-enhanced axial and coronal T1-weighted fat-suppressed images. Findings from MRE were compared with those of VCE (n=39) and CGR (n=37). MRE results exhibited a number of features characteristic to small bowel Crohn’s disease, including wall thickening, mesenteric fibrofatty changes and mesenteric vasculature changes. VCE, MRE and CGR demonstrated sensitivities of 94.6, 85.7 and 71.1% with specificities of 72.7, 70 and 40%; accuracies of 89.6, 82.2 and 61.1%; positive predictive values of 92.1, 90.9 and 59.6%; and negative predictive values of 80, 58.3 and 40%, respectively. VCE depicted mucosal pathologies missed by MRE in three patients. MRE revealed 83 extraenteric findings in 55 patients and CGR was able to show the dynamic evolution of the gastrointestinal function. MRE is a simple, safe, non-invasive and effective method for evaluating small bowel Crohn’s disease. VCE allows visualization and readily characterizes subtle mucosal lesions missed by MRE, whereas MRE yields additional mural, perienteric and extraenteric information. However, oral barium CGR utilizes radiation, which is not suitable for repeated use in children.

Experimental assessment of a novel robotically-driven endoscopic capsule compared to traditional colonoscopy

Despite colonoscopy represents the conventional diagnostic tool for colorectal pathology, its undeniable discomfort reduces compliance to screening programmes. To evaluate feasibility and accuracy of a novel robotically-driven magnetic capsule for colonoscopy as compared to the traditional technique. Eleven experts and eleven trainees performed complete colonoscopy by robotic magnetic capsule and by conventional colonoscope in a phantom ex vivo model (artificially clean swine bowel). Feasibility, overall accuracy to detect installed pins, procedure elapsed time and intuitiveness were measured for both techniques in both operator groups. Complete colonoscopy was feasible in all cases with both techniques. Overall 544/672 pins (80.9%) were detected by experimental capsule procedure, while 591/689 pins (85.8%) were detected within conventional colonoscopy procedure (P=ns), thus establishing non-inferiority. With the experimental capsule procedure, experts detected 74.2% of pins vs. 87.6% detected by trainees (P<0.0001). Overall time to complete colon inspection by robotic capsule was significantly higher than by conventional colonoscopy (556±188s vs. 194±158s, respectively; P=0.0001). With the limitations represented by an ex vivo setting (artificially clean swine bowel and the absence of peristalsis), colonoscopy by this novel robotically-driven capsule resulted feasible and showed adequate accuracy compared to conventional colonoscopy.

Patient burden and patient preference: Comparing magnetic resonance enteroclysis, capsule endoscopy and balloon‐assisted enteroscopy

We aimed to prospectively determine patient burden and patient preference for magnetic resonance enteroclysis, capsule endoscopy and balloon-assisted enteroscopy in patients with suspected or known Crohn's disease (CD) or occult gastrointestinal bleeding (OGIB). Consecutive consenting patients with CD or OGIB underwent magnetic resonance enteroclysis, capsule endoscopy and balloon-assisted enteroscopy. Capsule endoscopy was only performed if magnetic resonance enteroclysis showed no high-grade small bowel stenosis. Patient preference and burden was evaluated by means of standardized questionnaires at five moments in time. From January 2007 until March 2009, 76 patients were included (M/F 31/45; mean age 46.9 years; range 20.0-78.4 years): 38 patients with OGIB and 38 with suspected or known CD. Seventeen patients did not undergo capsule endoscopy because of high-grade stenosis. Ninety-five percent (344/363) of the questionnaires were suitable for evaluation. Capsule endoscopy was significantly favored over magnetic resonance enteroclysis and balloon-assisted enteroscopy with respect to bowel preparation, swallowing of the capsule (compared to insertion of the tube/scope), burden of the entire examination, duration and accordance with the pre-study information. Capsule endoscopy and magnetic resonance enteroclysis were significantly preferred over balloon-assisted enteroscopy for clarity of explanation of the examination, and magnetic resonance enteroclysis was significantly preferred over balloon-assisted enteroscopy for bowel preparation, painfulness and burden of the entire examination. Balloon-assisted enteroscopy was significantly favored over magnetic resonance enteroclysis for insertion of the scope and procedure duration. Pre- and post-study the order of preference was capsule endoscopy, magnetic resonance enteroclysis and balloon-assisted enteroscopy. Capsule endoscopy was preferred to magnetic resonance enteroclysis and balloon-assisted enteroscopy; it also had the lowest burden. Magnetic resonance enteroclysis was preferred over balloon-assisted enteroscopy for clarity of explanation of the examination, bowel preparation, painfulness and burden of the entire examination, and balloon-assisted enteroscopy over magnetic resonance enteroclysis for scope insertion and study duration.

Small bowel leiomyosarcoma: A case report and literature review

Small bowel neoplasms are very uncommon, especially leiomyosarcoma of the small bowel. Therefore, there is often a delay before small bowel leiomyosarcoma is diagnosed and treatment is started. A 60-year-old Caucasian male was admitted to our hospital with progressive melena. Gastroscopy and colonoscopy did not reveal the cause of the melena, but magnetic resonance imaging showed a jejunal tumor. After laparoscopic resection, the tumor appeared to be a grade 2 leiomyosarcoma. Small bowel neoplasms can be accurately detected by magnetic resonance enterography or wireless capsule endoscopy. Treatment almost always consists of resection of the primary tumor and its metastases. The role of chemo- and radiotherapy is not yet clear and prognosis remains very poor, with low five-year survival rates.

Magnetic resonance enterography and wireless capsule endoscopy in the evaluation of patients with inflammatory bowel disease

BackgroundMagnetic resonance enterography (MRE) is increasingly used in children due to growing concerns of radiation. ObjectiveTo determine the performance of MRE, imaging findings were compared to wireless capsule endoscopy (WCE) and histology results in children with/or suspected inflammatory bowel disease (IBD). Materials and methodsPathology and WCE reports were retrospectively reviewed in 23 patients who had MRE. ResultsThe sensitivity of MRE was 75.0% while the sensitivity of WCE was 77.8%. ConclusionMRE and WCE are complementary techniques in evaluation of the small bowel in IBD.

Comparison of magnetic resonance enteroclysis and capsule endoscopy with balloon-assisted enteroscopy in patients with obscure gastrointestinal bleeding

New modalities are available for visualization of the small bowel in patients with possible obscure gastrointestinal bleeding (OGIB), but their performance requires further comparison. This study compared the diagnostic yield of magnetic resonance enteroclysis (MRE) and capsule endoscopy in patients with OGIB, using balloon-assisted enteroscopy (BAE) as the reference standard. Consecutive consenting patients who were referred for evaluation of OGIB were prospectively included. Patients underwent MRE followed by capsule endoscopy and BAE. Patients with high grade stenosis at MRE did not undergo capsule endoscopy. The reference standard was BAE findings in visualized small-bowel segments and expert panel consensus for segments not visualized during BAE. Over a period of 26 months, 38 patients were included (20 female [53 %]; mean age 58 years, range 28 - 75 years). Four patients (11 %) did not undergo capsule endoscopy due to high grade small-bowel stenosis at MRE (n = 3; 8 %) or timing issues (n = 1; 3 %). Capsule endoscopy was non-diagnostic in one patient. The reference standard identified abnormal findings in 20 patients (53 %). MRE had sensitivity, specificity, and positive and negative likelihood ratios of 21 %, 100 %, infinity, and 0.79, respectively. The corresponding values for capsule endoscopy were 61 %, 85 %, 4.1, and 0.46. The reference standard and capsule endoscopy did not differ in percent positive findings (P = 0.34), but MRE differed significantly from the reference BAE (P < 0.001). Capsule endoscopy was superior to MRE for detecting abnormalities (P = 0.0015). Capsule endoscopy performed better than MRE in the detection of small-bowel abnormality in patients with OGIB. MRE may be considered as an alternative for the initial examination in patients with clinical suspicion of small-bowel stenosis.

Tu1913 Differential Regulation of Oxidative Stress and Apoptosis Related Genes During Active and Inactive Crohn's Disease (CD)

Background: An increase of oxidative stress (OxS) and a decrease of apoptosis have been reported as key factors in Crohn's disease (CD) pathogenesis. We have previously shown that OxS in CD depends on an increased production of H2O2 which detoxification is independent of catalase (CAT) enzyme because CAT showed permanently inhibited in CD patients1. CAT could be more implicated in regulating cellular processes, as apoptosis, than in detoxifying H2O2. Aims: To characterize the genetic expression of CAT and other OxS and apoptosis related genes in CD at beginning of the disease and when remission has been achieved. Methods: Blood samples were obtained from 18 healthy subjects (H), 20 patients at onset of CD and yet to begin any specific medication (active CD, aCD) and from 10 patients who achieved clinical, analytical and morphological remission (inactive CD, iCD). Patients were diagnosed according to Leonard-Jones criteria and disease activity was scored based on the Harvey-Bradshaw index, serological markers of inflammation (CRP, fibrinogen) and evaluation of morphological lesions (magnetic resonance enterography, colonoscopy or capsule endoscopy). PWMC were isolated by Histopaque sedimentation. Total RNA from leukocytes was extracted according to manufacturer's protocol (LeukoLOCKTM; Ambion). mRNA expression was measured by Sequenom's MassARRAY® quantitative gene expression analysis application. The genes analyzed were: CAT, SOD2, NOS2A, STAT1, NFKB1, PKCgamma, PKCzeta, PSKH1, PPID, ABCB1, ASK1, FASR, FASLG, TERT, IL-2, IL23R. Results: Genes differentially expressed in CD are summarized in the table. Specific upregulated genes during flair were SOD2, STAT1, and PSKH1, and down-regulated were FASL and ABCB1. In iCD, FASR and NFKB1 were up-regulated. The down-regulation of CAT gene expression was persistent. Conclusions: Up regulation of SOD2, STAT1 and PSKH1 only during a flare, indicates the relation between OxS and aCD. Down regulation of FASL and ABCB1 shows an apoptotic and multidrug resistance alteration at onset of the disease. Increased expression of FASR and NFKB1 in iCD could indicate that apoptosis are genetically affected in CD. Permanent inhibition of CAT activity in CD patients correlates to a persistent down regulation of the CAT-gene mRNA. The implications of CAT inhibition in regulating cellular processes such as apoptosis should be studied. 1) Beltran B, et al. Inflamm Bowel Dis. 2010 16:76-86.

Laparoscopic surgical exploration is an effective strategy for locating occult primary neuroendocrine tumors

BackgroundMany patients with neuroendocrine tumors (NETs) have metastases at diagnosis. Despite extensive metastases the primary tumors remain small and difficult to locate. MethodsRecords of patients diagnosed with metastatic abdominal NETs from 2006 to 2010 were reviewed retrospectively. Results of preoperative imaging, procedures, and surgical explorations were compared for their efficacy at finding primary tumors. ResultsSixty-three patients were identified. Seventeen percent (11 of 63) of tumors were located by preoperative testing. The sensitivities of preoperative colonoscopy (23% [n = 26]), computed tomography scan (6.7% [n = 60]), and somatostatin receptor scintigraphy (2.0% [n = 52]) were low. No tumors were found by magnetic resonance imaging (n = 9), upper endoscopy (n = 24), capsule endoscopy (n = 2), or bronchoscopy (n = 4). Surgical exploration was the most sensitive (79% [n = 63]) method of tumor detection. Seventy-two percent of surgical localizations were laparoscopic. ConclusionsSurgical exploration was superior to all other modalities for locating primary NETs. Laparoscopy had a high probability of finding occult primary neuroendocrine tumors.