New ingestible video capsule endoscope can be moved around inside the body using remote control.

Although ingestible video capsule endoscopes have been around for some time, they had limitations – they could not be controlled by doctors and could only navigate the body passively. Fortunately, a new approach has been developed by a team at George Washington University. By utilizing an external magnet and handheld video game style joysticks, doctors can now remotely control the movement of the video capsule. This breakthrough enables physicians to observe and capture images of potential problem areas in all parts of the stomach, bringing the technology closer to the capabilities of a conventional tube-based endoscopy.

Andrew Meltzer, a professor of Emergency Medicine at the GW School of Medicine & Health Sciences, said:

“A traditional endoscopy is an invasive procedure for patients, not to mention it is costly due to the need for anesthesia and time off work. 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 observing patients in the emergency room with stomach pain or suspected upper GI bleeding who faced obstacles in receiving 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 hemorrhage. To help address this problem, I started looking for less invasive ways to visualize the upper gastrointestinal tract for patients with suspected internal bleeding.”

This study marks the first attempt to implement magnetically controlled capsule endoscopy in the United States. Patients who are suffering from severe stomach pain can now swallow the capsule and obtain a diagnosis instantly, without having to schedule another appointment for a traditional endoscopy, which could potentially save their lives. The external magnet drives the capsule effortlessly to survey all the anatomical regions of the stomach and captures video and pictures of any potential bleeding, inflammatory, or malignant lesions, which can be beneficial.

Software is being created to enable the capsule to self-drive throughout the stomach with a simple push of a button, thanks to artificial intelligence. This feature can record any potential risky abnormalities, making the system a convenient diagnostic tool or screening test. Furthermore, the videos can be easily transmitted for off-site review if a gastroenterologist is unavailable to over-read the images.

Meltzer and colleagues conducted a study of 40 patients at a physician office building using the magnetically controlled capsule endoscopy. They found that the doctor could direct the capsule to all major parts of the stomach with a 95 percent rate of visualization. Capsules were driven by the ER physician, and then the study reports were reviewed by an attending gastroenterologist who was not physically present on-site.

The study compared a new method with traditional endoscopy. To compare, the participants received a follow-up endoscopy. The new method did not miss any high-risk lesions, and 80 percent of the patients preferred it to the traditional method. The team did not find any safety problems with the new method.

However, Meltzer warns that the study is a pilot and a larger trial with more patients is necessary to ensure that the method does not miss important lesions and can replace the endoscopy. A major limitation of the capsule method is that it cannot perform biopsies of detected lesions.

The study, “Magnetically Controlled Capsule for Assessment of the Gastric Mucosa in Symptomatic Patients (MAGNET): A Prospective, Single-Arm, Single-Center, Comparative Study,” was published (insert date) in iGIE, the open-access, online journal of the American Society for Gastrointestinal Endoscopy.