Magnetically Guided Capsule Endoscopy Research Articles

Magnetically Guided Capsule Endoscopy and Magnetic Resonance Enterography in Children With Crohn's Disease: Manifestations and the Value of Assessing Disease Activity.

Objective: To investigate the value of magnetically guided capsule endoscopy (MGCE) and magnetic resonance enterography (MRE) in assessing the activity of pediatric Crohn’s disease. Methods: Clinical data from 82 subjects with pediatric Crohn’s disease, who underwent MGCE and MRE from October 2018 to March 2021 were analyzed retrospectively. Pairwise comparisons of several indexes, including MaRIA, CECDAI, PCDAI, and SES-CD, were performed by Spearman’s rank correlation test and kappa consistency analysis. CECDAI and MaRIA values predicted whether patients were moderately or severely active (PCDAI ≥30) clinically by logistic regression analysis. The area under the receiver operating characteristic curve (AUC) quantified the evaluation value of moderate to severe activity of pediatric CD. Results: In judging the severity of CD in the small intestine, the correlation coefficient between CECDAI and MaRIA was 0.406 (p < 0.05), and the kappa value of the consistency analysis was 0.299 (p < 0.05). MaRIA was weakly correlated with PCDAI (r = 0.254, p < 0.05), and they were weakly consistent in assessing the activity of Crohn’s disease (kappa = 0.135, p < 0.05). For predicting clinically moderate to severe activity, the fitted AUC based on CECDAI and MarRIA was 0.917, which was higher than applying a single parameter (CECDAI = 0.725, MarRIA = 0.899, respectively). MaRIA and serum albumin were significantly and negatively correlated (r = −1.064, p < 0.05). The consistency of the detection rate of gastric ulcers by MGCE and gastroscopy was moderate (kappa = 0.586, p < 0.05), and the detection rate of ulcers in the terminal ileum between MGCE and colonoscopy showed high consistency (kappa = 0.609, p < 0.05). Conclusions: MGCE and MRE are valuable, non-invasive methods for evaluating small bowel lesions in children with CD. The combined application of MGCE and MRE can better characterize the disease activity.

Alterations in the saliva microbiome in patients with gastritis and small bowel inflammation

The oral microbiome is an important part of the human microbiome. Accumulating data have shown that oral microbiome alterations are closely related to multiple human diseases. However, salivary microbiota distributions remain unclear in patients with gastritis and small bowel inflammation. Magnetically guided capsule endoscopy (MGCE) is a noninvasive diagnostic tool for patients with gastritis and small bowel inflammation. Herein, we analysed the alterations in saliva microbiota in the normal, small intestinal inflammation and chronic gastritis groups through 16S rRNA gene amplicon sequencing. We found that the abundance of Lactobacillaceae was dramatically higher in chronic gastritis group than healthy individuals (p = 0.001). The levels of Porphyromonas and Faecalibaculum in gastritis samples were increased (p = 0.028; p = 0.006), and the enrichments of Faecalibaculum and Kosakonia in small intestine inflammation samples were elevated (p < 0.001; p = 0.002) compared to those in normal individuals. Our findings clarify the saliva microbiota components and their importance of specific bacteria in gastritis and small bowel inflammation.

Rewiring of Microbiota Networks in Erosive Inflammation of the Stomach and Small Bowel.

The development of non-invasive, inexpensive, and effective early diagnosis tests for gastric and small-bowel lesions is an urgent requirement. The introduction of magnetically guided capsule endoscopy (MGCE) has aided examination of the small bowel for diagnoses. However, the distribution of the fecal microbiome in abnormal erosions of the stomach and small bowel remains unclear. Herein, alternations in the fecal microbiome in three groups [normal, small-bowel inflammation, and chronic gastritis (CG)] were analyzed by metagenomics and our well-developed method [individual-specific edge-network analysis (iENA)]. In addition to the dominant microbiota identified by the conventional differential analysis, iENA could recognize novel network biomarkers of microbiome communities, such as the genus Bacteroide in CG and small-bowel inflammation. Combined with differential network analysis, the network-hub microbiota within rewired microbiota networks revealed high-ranked iENA microbiota markers, which were disease specific and had particular pathogenic functions. Our findings illuminate the components of the fecal microbiome and the importance of specific bacteria in CG and small-bowel erosions, and could be employed to develop preventive and non-invasive therapeutic strategies.

Feasibility and safety of magnetically guided capsule endoscopy in minors

Objective: To clarify the feasibility and safety of magnetically guided capsule endoscopy (MGCE) in minors. Methods: A descriptive cohort study was carried out to retrospectively collect the data of minors (<18 years) who underwent MGCE in Ruijin Hospital from April 2015 to October 2018. Exclusion criteria: patients with dysphagia, obvious gastrointestinal bleeding, diagnosed or suspected gastrointestinal obstruction, or congenital gastrointestinal malformations or intestinal fistula; patients with previous bowel surgery, or in poor general condition; patients with implants; pregnant patients; patients with incomplete data or without data. A total of 218 patients, including 122 males and 96 females, with mean age of (12.0±3.1) (5-17) years and 236 times of examination were included. The capsule size of the Ankon MGCE system was 11.8 mm×27 mm, taking two pictures per second, with a viewing angle of 140 degrees. Data of gastric visualization (0% to 100%), gastric cleanliness (satisfactory cleanliness was defined as a clear display of the gastric mucosa; the effect of bubbles or mucus on the visual field was negligible, or the gastric mucosa was slightly blurred; a small amount of air bubbles or mucus affected slightly the field of view), gastric or small bowel examination time, lesion detection rate, etc. were recorded. All the patients were followed up for 2 weeks to confirm capsule excretion and to record adverse events. Results: A total of 202 patients (217 times) completed gastric examination and 112 patients (125 times) completed small bowel examination. The median gastric visualization of cardia, fundus, body, angulus, antrum and pylorus was 100%, 90% (75%,100%), 100% (80%,100%), 100%, 100%, and 100%, respectively. The cleanliness of the gastric cardia, fundus, body, angle, antrum, and pylorus was assessed to be satisfactory in 100.0%, 76.5% (153/200), 92.5% (185/200), 97.5% (195/200), 99.5% (199/200), and 100.0% of patients, respectively. In 202 patients undergoing gastric examination, the median gastric exanimation time was 10.5 (7.3, 13.9) minutes. In 112 patients undergoing small bowel examination, the median gastric transit time was 51.5 (20.6, 112.0) minutes and the median small bowel transit time was 232.4 (181.8, 321.6) minutes. The small bowel transit rate was 91.1% (102/112). The lesion detection rates of stomach, duodenum and jejunoileum were 18.8% (38/202), 8.1% (10/124) and 26.8% (30/112) respectively. No complications or adverse events occurred. Conclusion: MGCE is feasible and safe to detect both gastric cavity and small bowel in minors.

Magnetically Guided Capsule Endoscopy in Pediatric Patients with Abdominal Pain.

Background and Aims Magnetically guided capsule endoscopy (MGCE) offers a noninvasive method of evaluating both the gastric cavity and small intestine; however, few studies have evaluated MGCE in pediatric patients. We investigated the diagnostic efficacy of MGCE in pediatric patients with abdominal pain. Patients and Methods We enrolled 48 patients with abdominal pain aged 6–18 years. All patients underwent MGCE to evaluate the gastric cavity and small intestine. Results The cleanliness of the gastric cardia, fundus, body, angle, antrum, and pylorus was assessed satisfactorily in 100%, 85.4%, 89.6%, 100%, 97.9%, and 100% of patients, respectively. The subjective percentage visualization of the gastric cardia, fundus, body, angle, antrum, and pylorus was 84.8%, 83.8%, 88.5%, 87.7%, 95.2%, and 99.6%, respectively. Eighteen (37.5%) patients had 19 gastrointestinal tract lesions: one esophageal, three in the gastric cavity, and 15 in the small intestine. No adverse events occurred during follow-up. Conclusions MGCE is safe, convenient, and tolerable for evaluating the gastric cavity and small intestine in pediatric patients. MGCE can effectively diagnose pediatric patients with abdominal pain.

Magnetically guided capsule endoscopy.

Wireless capsule endoscopy (WCE) is a powerful tool for medical screening and diagnosis, where a small capsule is swallowed and moved by means of natural peristalsis and gravity through the human gastrointestinal (GI) tract. The camera-integrated capsule allows for visualization of the small intestine, a region which was previously inaccessible to classical flexible endoscopy. As a diagnostic tool, it allows to localize the sources of bleedings in the middle part of the gastrointestinal tract and to identify diseases, such as inflammatory bowel disease (Crohn's disease), polyposis syndrome, and tumors. The screening and diagnostic efficacy of the WCE, especially in the stomach region, is hampered by a variety of technical challenges like the lack of active capsular position and orientation control. Therapeutic functionality is absent in most commercial capsules, due to constraints in capsular volume and energy storage. The possibility of using body-exogenous magnetic fields to guide, orient, power, and operate the capsule and its mechanisms has led to increasing research in Magnetically Guided Capsule Endoscopy (MGCE). This work shortly reviews the history and state-of-art in WCE technology. It highlights the magnetic technologies for advancing diagnostic and therapeutic functionalities of WCE. Not restricting itself to the GI tract, the review further investigates the technological developments in magnetically guided microrobots that can navigate through the various air- and fluid-filled lumina and cavities in the body for minimally invasive medicine.

The clinical application of magnetically guided capsule endoscopy to 500 cases of gastric examination

Objective To investigate the clinical application value of magnetically guided capsule endoscopy (MGCE) to stomach examination. Methods Data of 500 patients who received MGCE examination from January 2014 to February 2016 in our hospital were retrospectively analyzed. The feasibility and safety of MGCE were studied by analyzing the detection rate of gastric lesions, transit time, adverse events, clarity and visibility, in comparison with esophagogastroduodenoscopy(EGD). Results The lesion detecting rate was 57.8%(289/500), the average transit time was (106.0±101.1)min. Overall effective rate of cleanliness was 91.8%. The visibility satisfaction rate was 98.8%. Compared with EGD, MGCE had good detection ability in stomach focal lesions. The sensitivity, specificity and accuracy were 92.0%, 85.7% and 88.3%, respectively. Except for capsule retention occurred in one patient, no other complication happened. Conclusion MGCE, stable and safe, shows high detection and accuracy rates for gastric diseases, and can be used as an effective examination tool. Key words: Capsule endoscopes; Diagnosis; Comparative study; Stomach diseases

Feedback survey on application of magnetically guided capsule endoscopy in diagnosis of upper gastrointestinal diseases

Objective To evaluate the feasibility and acceptability of magnetically guided capsule endoscopy (MCE) as a screening or diagnostic means for upper gastrointestinal diseases. Methods One hundred and forty six patients underwent MCE during October 2013 to September 2014. All patients and endoscopists received a feedback survey with a self-administrated questionnaire; the items included the satisfaction of patients and endoscopists, the endoscopic image score, examination results, the endoscopy completion and operation time. Results Among 146 patients, 145 completed MCE examination with a completion rate of 99.3% (145/146). The operation time of MCE was(15.20±4.85)min. The score of patient and endoscopist satisfaction was both 4, and patient tolerance score was 0. The divergence rate score was 3; the cleaness score of stomach was 3; and the vision relative definition was 79.31±14.16. The most common examination result was chronic superficial gastritis (67/145, 46.2%), followed by bile reflex gastritis (48/145, 33.1%), normal stomach (39/145, 26.9%), gastric polyps (20/145, 13.8%), chronic atrophic gastritis (18/145, 12.4%), bleeding from erosive gastritis (14/145, 9.7%), reflux esophagitis (6/145, 4.1%), 2.7%(4/145), gastrointestinal ulcer, (3/145, 2.1%), upper gastrointestinal cancer (2/145), duodenal bulb inflammation (2/145), yellow melanoma (1/145), esophageal cyst (1/145) and esophageal varices (1/145). All patients expressed their willingness to receive the same type of upper GI endoscopy if necessary. No capsule retention, perforation or bleeding occurred. Conclusions MCE avoids the discomfort of conventional gastroscopy and can improve the compliance and acceptability of patients with excellent safety, maneuverability and feasibility. Key words: Capsule endoscopy; Gastrointestinal diseases; Diagnosis; Questionnaires

Current status of capsule endoscopy through a whole digestive tract.

More than a decade has passed since small-bowel capsule endoscopy (CE) was first reported. Small-bowel CE is a non-invasive tool that allows visualization of the entire small-intestinal mucosa and facilitates detection of small-intestinal abnormalities. Several studies have shown benefit of small-bowel CE for certain disorders. Because it is non-invasive, CE has been applied to other organs including the esophagus, stomach, and colon. The main indications for esophageal CE (ECE) are screening for gastroesophageal reflux disease/Barrett's esophagus, and esophageal varices. However, the clinical benefit of ECE is unconfirmed. Magnetically guided CE (MGCE) was developed to visualize the gastric mucosa. MGCE is a new concept with room for improvement of capsule navigation and the preparation protocol. Recently, two new small-bowel CE tools were released. First-generation colon CE (CCE-1) has moderate sensitivity and specificity compared with colonoscopy for colorectal neoplasia surveillance. To obtain higher accuracy, a second-generation CCE (CCE-2) was developed with a high sensitivity for detecting clinically relevant polypoid lesions. A possible application of CCE is for inflammatory bowel disease. In the near future, CE may include diagnostic and therapeutic functions such as magnifying endoscopy systems, targeted biopsy forceps, and drug delivery systems.

850 Prospective Blinded Study of a Magnetically Guided Gastric Capsule As Compared to Conventional Gastroscopy in Patients With Upper Abdominal Complaints

Upper GI endoscopy is mostly performed under sedation and has a low yield of relevant gastric lesions in patients without alarm symptoms. A simpler filter tests such as capsule endoscopy would be helpful, but current passive capsules do not provide adequate gastric visualization. The current study evaluates a magnetically guided capsule endoscopy (MGCE) in patients with routine indications for gastroscopy.

Chromoendoscopy in magnetically guided capsule endoscopy

BackgroundDiagnosis of intestinal metaplasia and dysplasia via conventional endoscopy is characterized by low interobserver agreement and poor correlation with histopathologic findings. Chromoendoscopy significantly enhances the visibility of mucosa irregularities, like metaplasia and dysplasia mucosa. Magnetically guided capsule endoscopy (MGCE) offers an alternative technology for upper GI examination. We expect the difficulties of diagnosis of neoplasm in conventional endoscopy to transfer to MGCE. Thus, we aim to chart a path for the application of chromoendoscopy on MGCE via an ex-vivo animal study.MethodsWe propose a modified preparation protocol which adds a staining step to the existing MGCE preparation protocol. An optimal staining concentration is quantitatively determined for different stain types and pathologies. To that end 190 pig stomach tissue samples with and without lesion imitations were stained with different dye concentrations. Quantitative visual criteria are introduced to measure the quality of the staining with respect to mucosa and lesion visibility. Thusly determined optimal concentrations are tested in an ex-vivo pig stomach experiment under magnetic guidance of an endoscopic capsule with the modified protocol.ResultsWe found that the proposed protocol modification does not impact the visibility in the stomach or steerability of the endoscopy capsule. An average optimal staining concentration for the proposed protocol was found at 0.4% for Methylene blue and Indigo carmine. The lesion visibility is improved using the previously obtained optimal dye concentration.ConclusionsWe conclude that chromoendoscopy may be applied in MGCE and improves mucosa and lesion visibility. Systematic evaluation provides important information on appropriate staining concentration. However, further animal and human in-vivo studies are necessary.

Mo2085 Feasibility Study of a Haptic Interface in Magnetically Guided Capsule Endoscopy for Palpation Inside the Human Stomach

Magnetically guided capsule endoscopy (MGCE) was introduced in 2010 (Endoscopy 2010;42:541). A capsule endoscope with a magnet inside is steered through the water-filled stomach by externally generated magnetic fields using 2 joysticks. Currently, the operator only uses visual feedback for navigation as in conventional gastroscopy. With an investigated future integration of additional sensors for relative or absolute position tracking of the capsule a new feedback method becomes available. By integrating a haptic joystick device into the system, it is possible to control the capsule movements and additionally “feel” the forces acting on it. It allows feeling the shape of the stomach and mucosa as well as the pressure the capsule puts on it. This is a key to a new navigation method and a variety of new diagnosis and treatment procedures. We sought to prove the feasibility of a new haptic control and feedback method for navigation and diagnosis in the human stomach using MGCE. In an MGCE simulation, we integrated sensors for absolute and relative position tracking of the capsule and interfaced a haptic device “omega.7” by Force Dimension (Lausanne, Switzerland). The device allows forces to be felt in all 3 spatial dimensions. Based on this, we developed different control designs and algorithms to calculate suitable haptic forces. Virtual examinations were performed in repeated trials to measure performance in means of completeness of the examination and intuitive control. Two control designs were selected: (1) Control relative to camera view, for example, a horizontal joystick shift forward moves the capsule towards its current view; and (2) control relative to MGCE coordinate system, for example, any horizontal joystick shift moves the capsule in the coronal plane of a patient in supine position. Both designs had completeness results at the same level as the conventional control. Although design 1 was more intuitive with the camera view present, design 2 allowed an additional blind navigation without a camera. The mucosa wall and structure could be felt clearly with the haptic output, but the quality heavily relied on sample rate and accuracy of the sensors. The method proved feasible for MGCE in a simulator with different pathologies like lymphomas or ulcers. A variety of new diagnosis and treatment procedures become available: (1) Perform palpation inside the stomach; (2) feel the strength of stomach contractions and the effect it has on the capsule; (3) guide a blind capsule holding sensors other than cameras (eg, electrochemical or spectroscopic sensors); and (4) control and feel the pressure of a tool attached to a capsule for possible new MGCE intervention procedures.

Sa1210 New Views in the Human Stomach With Magnetically Guided Capsule Endoscopy (MGCE)

Sa1210 New Views in the Human Stomach With Magnetically Guided Capsule Endoscopy (MGCE)