Manoeuvrable video capsule could offer alternative to endoscopies

The video capsule, subject to a study at George Washington University, uses an external magnet and hand-held video game style joysticks to move the capsule in three-dimensions in the stomach.

“A traditional endoscopy is an invasive procedure for patients, not to mention it is costly due to the need for anaesthesia and time off work,” Andrew Meltzer, a professor of Emergency Medicine at the GW School of Medicine & Health Sciences, said in a statement. “If larger studies can prove this method is sufficiently sensitive to detect high-risk lesions, magnetically controlled capsules could be used as a quick and easy way to screen for health problems in the upper GI tract such as ulcers or stomach cancer.”

Meltzer became interested in magnetically controlled capsule endoscopy after seeing patients in the emergency room with stomach pain or suspected upper GI bleeding who faced barriers to getting a traditional endoscopy as an outpatient.

“I would have patients who came to the ER with concerns for a bleeding ulcer and, even if they were clinically stable, I would have no way to evaluate them without admitting them to the hospital for an endoscopy. We could not do an endoscopy in the ER and many patients faced unacceptable barriers to getting an outpatient endoscopy, a crucial diagnostic tool to preventing life-threatening haemorrhage,” said Meltzer. “To help address this problem, I started looking for less invasive ways to visualise the upper gastrointestinal tract for patients with suspected internal bleeding.”

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The study is the first to test magnetically controlled capsule endoscopy in the United States. For patients who come to the ER or a doctor’s office with severe stomach pain, the ability to swallow a capsule and get a diagnosis on the spot – without a second appointment for a traditional endoscopy – is a real plus, and potentially life-saving, said Meltzer.

An external magnet allows the capsule to be driven to visualise all anatomic areas of the stomach and record video and photograph any possible bleeding, inflammatory or malignant lesions. 

According to the university, the joystick requires additional time and training, but software is being developed that will use artificial intelligence to self-drive the capsule to all parts of the stomach to record any potential abnormalities. In addition, the videos can be transmitted for off-site review if a gastroenterologist is not on-site to over-read the images. 

Meltzer and colleagues conducted a study of 40 patients at a doctor’s surgery using the magnetically controlled capsule endoscopy and found the doctor able to direct the capsule to all major parts of the stomach with a 95 per cent rate of visualisation. Capsules were driven by the ER doctor and the study reports were reviewed by a gastroenterologist off-site. 

Participants in the study also received a follow up endoscopy and the team found that no high-risk lesions were missed with the new method. Most (80 per cent) of the patients preferred the capsule method to the traditional endoscopy.

Meltzer cautioned that bigger trial with more patients must be conducted to make sure the method does not miss important lesions and can be used in place of an endoscopy.  A major limitation of the capsule includes the inability to perform biopsies of lesions that are detected. 

The study, “Magnetically Controlled Capsule for Assessment of the Gastric Mucosa in Symptomatic Patients (MAGNET): A Prospective, Single-Arm, Single-Center, Comparative Study,” has been published online by the American Society for Gastrointestinal Endoscopy.

Texas based AnX Robotica funded the research and developed NaviCam, the capsule endoscopy system used in the study. NaviCam - which has a diameter of 11.8mm and is 27mm long provides image resolution of 640*480 (CMOS Imager), variable frame rate of 0.5 – 6 FPS and an extended battery life of up to 16 hours (1fps).