Zhuan Liao et al. Accuracy of Magnetically Controlled Capsule Endoscopy, Compared With Conventional Gastroscopy, in Detection of Gastric Diseases. Clinical Gastroenterology and Hepatology, 2016,14, 1266. DOI: https://doi.org/10.1016/j.cgh.2016.05.013
Background & Aims: Diseases of the stomach, including gastric cancer and peptic ulcer, are the most common digestive diseases. It is impossible to visualize the entire stomach with the passive capsule currently used in practice because of the large size of the gastric cavity. A magnetically controlled capsule endoscopy (MCE) system has been designed to explore the stomach. We performed a prospective study to compare the accuracy of detection of gastric focal lesions by MCE vs conventional gastroscopy (the standard method).
Methods: We performed a multicenter blinded study comparing MCE with conventional gastroscopy in 350 patients (mean age, 46.6 y), with upper abdominal complaints scheduled to undergo gastroscopy at a tertiary center in China from August 2014 through December 2014. All patients underwent MCE, followed by conventional gastroscopy 2 hours later, without sedation. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of detection of gastric focal lesions by MCE, using gastroscopy as the standard.
Results: MCE detected gastric focal lesions in the whole stomach with 90.4% sensitivity (95% confidence interval [CI], 84.7%–96.1%), 94.7% specificity (95% CI, 91.9%–97.5%), a positive predictive value of 87.9% (95% CI, 81.7%–94.0%), a negative predictive value of 95.9% (95% CI, 93.4%–98.4%), and 93.4% accuracy (95% CI, 90.83%–96.02%). MCE detected focal lesions in the upper stomach (cardia, fundus, and body) with 90.2% sensitivity (95% CI, 82.0%–98.4%) and 96.7% specificity (95% CI, 94.4%–98.9%). MCE detected focal lesions in the lower stomach (angulus, antrum, and pylorus) with 90.6% sensitivity (95% CI, 82.7%–98.4%) and 97.9% specificity (95% CI, 96.1%–99.7%). MCE detected 1 advanced gastric carcinoma, 2 malignant lymphomas, and 1 early stage gastric tumor. MCE did not miss any lesions of significance (including tumors or large ulcers). Among the 350 patients, 5 reported 9 adverse events (1.4%) and 335 preferred MCE over gastroscopy (95.7%).
Conclusions: MCE detects focal lesions in the upper and lower stomach with comparable accuracy with conventional gastroscopy. MCE is preferred by almost all patients, compared with gastroscopy, and can be used to screen gastric diseases without sedation.
An-Jing Zhao et al. Screening for gastric cancer with magnetically controlled capsule gastroscopy in asymptomatic individuals. Gastrointestinal Endoscopy, 2018, 88, 466. DOI: https://doi.org/10.1016/j.gie.2018.05.003
Summary
Background and Aims: Gastric cancer (GC) is the fourth most common cancer and the fourth leading cause of cancer death worldwide. In some Asian countries, screening EGD has greatly improved the survival rate. However, patients’ discomfort and the need for sedation may limit adherence to screening programs. Previous studies have shown good tolerance and good agreement of magnetically controlled capsule gastroscopy (MCCG) with EGD. This study was designed to assess the application of MCCG in GC detection in an asymptomatic population.
Methods: In this observational cohort study, 3182 asymptomatic individuals undergoing MCCG in 99 participating medical examination centers from April to December 2016 were enrolled. Patients with ulcers and suspected malignancies were referred for gastroscopy and biopsy. The detection rate of GC and focal lesions were used to explore the application of MCCG in asymptomatic individuals.
Results: Seven patients (0.22%) were diagnosed with GC among the enrolled 3182 individuals, accounting for 0.74% (7/948) in patients over 50 years. No gender disparity was observed. EGD and biopsy confirmed adenocarcinoma in all cases of suspected malignancy. Benign polyps, gastric ulcers, and submucosal tumors were found in 10.4%, 4.9%, and 3.6% of patients, respectively. There was a trend for the prevalence of focal lesions to increase with age. MCCG examination proved to be safe.
Conclusions: MCCG can detect cancer and benign lesions and is safe and clinically feasible in a large population. Studies of its role in a screening program should be considered.
Ji Xia et al , Use of artificial intelligence for detection of gastric lesions by magnetically controlled capsule endoscopy. Gastrointestinal Endoscopy, 2020, 93 (1), 133. DOI: https://doi.org/10.1016/j.gie.2020.05.027
Summary
Background and aims:
Magnetically controlled capsule endoscopy (MCE) has become an efficient diagnostic modality for gastric diseases. We developed a novel automatic gastric lesion detection system to assist in diagnosis and reduce inter-physician variations. This study aimed to evaluate the diagnostic capability of the computer-aided detection system for MCE images.
Methods
We developed a novel automatic gastric lesion detection system based on a convolutional neural network (CNN) and faster region-based convolutional neural network (RCNN). A total of 1,023,955 MCE images from 797 patients were used to train and test the system. These images were divided into 7 categories (erosion, polyp, ulcer, submucosal tumor, xanthoma, normal mucosa, and invalid images). The primary endpoint was the sensitivity of the system.
Results
The system detected gastric focal lesions with 96.2% sensitivity (95% confidence interval [CI], 95.7%-96.5%), 76.2% specificity (95% CI, 75.97%-76.3%), 16.0% positive predictive value (95% CI, 15.7%-16.3%), 99.7% negative predictive value (95% CI, 99.74%-99.79%), and 77.1% accuracy (95% CI, 76.9%-77.3%) (sensitivity was 99.3% for erosions; 96.5% for polyps; 89.3% for ulcers; 87.2% for submucosal tumors; 90.6% for xanthomas; 67.8% for normal; and 96.1% for invalid images). Analysis of the receiver operating characteristic curve showed that the area under the curve for all positive images was 0.84. Image processing time was 44 milliseconds per image for the system and 0.38 ± 0.29 seconds per image for clinicians (P < .001). The kappa value of 2 times repeated reads was 1.
Conclusions
The CNN faster-RCNN-based diagnostic program system showed good performance in diagnosing gastric focal lesions in MCE images.
Shuai Wang et al. Magnetically controlled capsule endoscopy as a non-invasive tool for risk stratification of gastroesophageal varices in compensated cirrhosis (CHESS1801): A prospective multicenter study. Journal of Hepatology, 2019, 7, e154. DOI: https://doi.org/10.1016/S0618-8278(19)30272-5
Summary
Background and aims: Variceal hemorrhage is a lethal complication in liver cirrhosis. The assessment of at-risk gastroesophageal varices (GOV) is of great therapeutic implications that once varices at risk for rupture are found, the primary prophylaxis of variceal hemorrhage is recommended. Therefore, an accurate non-invasive tool is needed to improve the risk stratification of GOV. The study aims to evaluate the performance of magnetically controlled capsule endoscopy (MCCE) for at-risk GOV in compensated cirrhosis.
Xuelian Xiang et al. Does Magnetic-Controlled Capsule Gastroscopy Have Diagnostic Value In Patients With Reflux Or Heartburn? Gastrointestinal Endoscopy, 2019, 89, AB550. DOI: https://doi.org/10.1016/j.gie.2019.03.1315
Summary
Magnetic-controlled capsule gastroscopy (MCCG) has been proved to be useful for gastric lesions and diseases. Whether it has some diagnostic ability in patients with reflux and heartburn whose esophagus and small intestine (mainly duodenum) are also needed to be paid attention is not clear. This study was aimed to assess the application of MCCG in upper gastrointestinal (GI) lesion detection in patients with reflux or heartburn.
Xue Chen et al. Screening for Gastric and Small Intestinal Mucosal Injury with Magnetically Controlled Capsule Endoscopy in Asymptomatic Patients Taking Enteric-Coated Aspirin. Gastroenterology Research and Practice, 2018, Article ID 2524698. DOI: https://doi.org/10.1155/2018/2524698
Summary
Objective. To investigate gastric and small intestinal mucosal injury in asymptomatic patients taking enteric-coated aspirin using magnetically controlled capsule endoscopy. Methods. Patients taking enteric-coated aspirin (aspirin group) and healthy controls (control group) were recruited from Beijing Anzhen Hospital, Capital Medical University, between September 2017 and May 2018, and undertook magnetically controlled capsule endoscopy. Results. Twenty-six subjects were recruited to the aspirin group and twenty-six to the control group; the median Gastrointestinal Symptom Rating Scale scores were 3.50 and 3.00 (P = 0.200), the median gastric Lanza scores were 2.50 and 1.00 (P < 0.001), the small intestinal Lanza scores were 1.00 and 0.00 (P < 0.001), the gastric controlled examination times were 50.0 and 51.0 min (P = 0.171), the small intestinal transit times were 240.0 and 238.0 min (P = 0.654), and the capsule excretion times were 24.0 and 24.0 hours (P = 0.965), respectively. Conclusions. Rates of gastric and small intestinal mucosal injuries were significantly higher in patients without obvious gastrointestinal symptoms taking enteric-coated aspirin compared to healthy controls. Magnetically controlled capsule endoscopy constitutes a safe, real-time screening modality for gastric and small intestinal mucosal injury in patients taking enteric-coated aspirin.
Seung-Joo Nam et al. Evaluation of Gastric Disease with Capsule Endoscopy, Clinical Endoscopy, 2018, 51, 323. DOI: https://doi.org/10.5946/ce.2018.092
Summary
The clinical indication for capsule endoscopy has expanded from small bowel evaluation to include esophagus or colon evaluation. Nevertheless, the role of capsule endoscopy in evaluation of the stomach is very limited because of the large volume and surface. However, efforts to develop an active locomotion system for capsule manipulation in detailed gastric evaluation are ongoing, because the technique is non-invasive, convenient, and safe, and requires no sedation. Studies have successfully reported gastric evaluation using a magnetic-controlled capsule endoscopy system. Advances in technology suggest that capsule endoscopy will have a major role not only in the evaluation of gastric disorders but also in the pathologic diagnosis, intervention, and treatment of any gastrointestinal tract disorder.
Yuting Qian et al. Magnetic-Guided Capsule Endoscopy in the Diagnosis of Gastrointestinal Diseases in Minors. Gastroenterology Research and Practice, 2018, Article ID 4248792. DOI: https://doi.org/10.1155/2018/4248792
Summary
Objective. This study aimed at investigating the clinical value of magnetic-guided capsule endoscopy (MGCE) in the diagnosis of gastrointestinal diseases in minors. Methods. Eighty-four minor patients hospitalized in the pediatric department at Ruijin Hospital between June 2015 and January 2018 were enrolled for this study. Following bowel preparation, all patients underwent MGCE. The feasibility, safety, diagnostic yield, and sensitivity of MGCE were analyzed. Patients were followed up for more than 2 weeks. Results. The main indications for MGCE in minors were Crohn’s disease, gastrointestinal bleeding, and abdominal pain. The main causes of gastric disease were gastric inflammatory hyperplasia, exudative gastritis, and polyps. The most common small bowel diseases in minors were Crohn’s disease, Henoch-Schonlein purpura, and polyps. The diagnostic yield in the stomach and small intestine was 13.1% and 28.6%, respectively, and the sensitivity was 100% and 96.0%, respectively. No adverse events occurred. Conclusion. MGCE is a safe, effective, and well-tolerated procedure with good sensitivity and has a potential clinic value for the diagnosis of gastrointestinal diseases in minors.
Yang-Yang Qian et al. Preliminary study of magnetically controlled capsule gastroscopy for diagnosing superficial gastric neoplasia. Digestive and Liver Disease, 2018, 50, 1041. DOI: https://doi.org/10.1016/j.dld.2018.04.013
Summary
Background: Magnetically controlled capsule gastroscopy (MCCG) is a newly developed non-invasive method designed for gastric examination. Although favorable diagnostic accuracy has been reported, there is little if any data about its ability to diagnose gastric cancer.
Aims: To compare the detectability of superficial gastric neoplasia by MCCG and gastroscopy.
Methods: This study was a self-controlled comparison study. Ten subjects diagnosed with superficial gastric neoplasia and scheduled to undergo endoscopic submucosal dissection (ESD) at a tertiary hospital were prospectively invited for an MCCG examination. The diagnostic agreement of MCCG, ESD and pathology were compared, including location, size and endoscopic appearance of the lesions.
Results: Of the 10 enrolled patients, 6 were confirmed as having early gastric cancer/high-grade intraepithelial neoplasia, 2 gastric low-grade intraepithelial neoplasia (LGIN), 1 tubular adenoma with LGIN and 1 neuroendocrine tumor. The per-patient and per-lesion sensitivities of MCCG for superficial gastric neoplasia detection were 100% and 91.7%. Location and size of the lesions were compared favorably to gastroscopy whilst one cardiac lesion was missed. Endoscopic appearances of these lesions observed on MCCG and EGD demonstrated good consistency. No adverse events were observed.
Conclusion: With good gastric preparation and careful examination of stomach, MCCG is able to detect superficial gastric neoplasms.
Yanping Tang et al. The Clinical Utility of Magnetically Controlled Capsule Endoscopy in Pediatric Patients. Gastrointestinal Endoscopy, 2016, 83, AB299. DOI: https://doi.org/10.1016/j.gie.2016.03.480
Summary
Magnetically controlled capsule endoscopy (MCE) has emerged as a feasible and efficient diagnostic modality for gastric diseases in adults. This study aims to assess the feasibility and safety of MCE in the diagnosis and management of pediatric patients.
Wen-Bin Zou et al. Magnetic-controlled capsule endoscopy vs. gastroscopy for gastric diseases: a two-center self-controlled comparative trial. Endoscopy, 2015, 47, 525. DOI: http://dx.doi.org/10.1055/s-0034-1391123
Summary
Background and study aims: We developed a novel magnetic-controlled capsule endoscopy (MCE) system for use in the human stomach. The aim of the current study was to compare the diagnostic accuracy of MCE with that of standard gastroscopy for gastric diseases.
Patients and methods: A total of 68 patients were enrolled in this self-controlled trial. Patients were evaluated by both MCE and gastroscopy. Gastroscopy was performed 4 – 24 hours after completion of the MCE examination.
Results: The positive percent agreement between MCE and gastroscopy was 96.0 %, and the negative percent agreement was 77.8 %. The overall agreement was 91.2 % with a kappa value of 0.765 (P < 0.001). A total of 68 pathological findings were detected, of which 53 were identified by both methods. The MCE and standard gastroscopy missed seven and eight findings, respectively.
Conclusions: MCE showed a diagnostic accuracy similar to that of standard gastroscopy. These results suggest that MCE is a promising alternative to gastroscopy for noninvasive screening of gastric diseases.