Introduction There is little evidence that gastroscopy affects patient outcomes1, but it is uncomfortable and incurs the risk of intubation and sedation. Capsule endoscopy is a non-invasive tool used primarily to image the small and large bowel. Although a large volume organ, examination of the stomach might be enabled by magnetic control allowing manoeuvrability and positional change.
Methods A standard porcine stomach model, commonly used for endoscopy training purposes was used in a feasibility study of magnetically steerable capsule endoscopy. Different coloured/shaped beads were sewn into each major location of the stomach (cardia, fundus, greater and lesser curve, anterior and posterior wall, antrum and D1). The stomach was distended with 1000mls of water. Endoscopy was performed according to a set protocol using a handheld magnet, Mirocam Navi (Intromedic Ltd), positional changes (supine, 30° right lateral, head down, 30° left lateral) and a “real time” viewer. The order and time each tag was identified was recorded alongside the total procedure time.
Results All stomach tags were identified in 87.2% (41/47) of examinations. Missed tags (marked in figure as red dots, representing an incomplete examination) included antrum (3/6), cardia (2/6) and posterior wall (1/6): none were missed in the latter 25 procedures. Mean examination times for the first 23, second 23 and all procedures were 10.28, 6.26 (p < 0.001) and 8.27 (3.25–16.32) minutes and all were completed by 4 mins after 39 procedures. The order in which tags were identified in the mid-body of the stomach (greater, anterior and posterior) was variable and interchangeable. If this area was considered as one site, the order of tag identification would be: cardia (1), fundus (2), mid body (3), lesser curve (4), antrum (5) and D1 (6) in 76.6% of examinations. No difficulties were observed with the current procedure protocol and therefore no modifications recommended.
Conclusion Examination of the upper gastrointestinal tract is feasible using a magnet and positional change as demonstrated in this porcine model. A learning curve was evident and this model might be used for training in the future. Further investigation using porcine models and in humans is necessary to fully realise the scope of this exciting novel technology.
Disclosure of Interest None Declared.
Offman JJ, Rabeneck L The effectiveness of endoscopy in the management of dyspepsia: a qualitative systematic review. Am J Med. 1999 Mar; 106(3):335–46.
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