| As a painless endoscopic examination,magnetically controlled capsule endoscopy(MCE)can observe the stomach and the small bowel.With magnetic steering used to observe the gastric mucosa,the diagnostic accuracy of MCE is highly consistent with esophagogastroduodenoscopy(EGD).However,the passage of the capsule through the esophagus is a passive process,which precluds a thorough investigation of the esophagus.Besides,the procedure only provides once opportunity to visualize the esophagus,without the chance of focusing and reexamining a particular area of interest.So MCE was not accurate enough to replace EGD.In addition,like other small bowel capsule endoscopies,a major unresolved issue of MCE is that due to the long stay in the stomach,completion rate of the capsule endoscopy to the cecum did not reach 100%,which may lead to the omission of small bowel lesions.To overcome these limitations,we developed a detachable string device to completely view the esophagus.Besides,magnetic steering of capsule endoscopy in vitro was used to facilitate pyloric transit of the capsule endoscopy after full gastric examination,to improve the capsule endoscopy completion rate of the small bowel,and realizing the whole observation of the esophagus,stomach and small bowel of MCE.Part Ⅰ: Detachable string magnetically controlled capsule endoscopy for completely viewing the esophagus and stomach.Objective: This present pilot study aimed to evaluate the feasibility and safety of detachable string magnetically controlled capsule endoscopy(DS-MCE).Methods:We prospectively included healthy volunteers and patients with suspected esophageal diseases,who first underwent DS-MCE,and subsequently EGD within one week.This single-centered,self-controled study aimed to evaluate the feasibility,safety,diagnostic accuracy,discomfort associated with the procedure,z-line visualization and image quality of DS-MCE.Results:(1)Four healthy volunteers and 21 patients with suspected esophageal diseases(mean age 54 years,range 28-72 years;male 72%)from March 2018 to June 2018 were prospectively include.(2)The median esophageal recording time(time from the capsule entering to leaving the esophagus)was 6.2 minutes(2.2-22.2 minutes).DS-MCE was successfully performed on all the 25 subjects,with 100% technical success rates for completely viewing the esophagus,detachment of string and capsule at the end of esophageal examination and entering the stomach.In no instances were the strings and sleeves damaged,and no capsule was lost.(3)The esophageal diagnoses of the 25 subjects derived from DS-MCE were in agreement with those from EGD.The diagnoses of esophagus were reflux esophagitis(n=6),esophageal varices(n=6),esophageal cancer(n=5),esophageal polyp(n=1),esophageal leiomyoma(n=1),esophageal submucosal bulge(n=1),post-ESD change(n=1)and negative(n=4).(4)The mean overall discomfort score during DS-MCE in the 25 patients was 0.96(range 0-3;0: no discomfort;10: the overall discomfort of EGD).23 subjects preferred DS-MCE compared with EGD and 2 patients had no preference.(5)At least two quadrants,three and four quadrants of the z-line were successfully viewed in 20 participants(80%),13 participants(52%)and 6(24%)participants,respectively.(6)The mean scores of image quality was 8.05(range 7-9;1,the worst quality;10,the quality of the image captured by EGD).Conclusions: DS-MCE was feasible and safe for completely viewing the esophagus,and proceeding with gastric examination after string detachment,realizing the sequential inspection of the esophagus and stomach.Part Ⅱ: Magnetic steering of capsule endoscopy improves small bowel capsule endoscopy completion rateObjective: We performed this study to determine if magnetic steering could improve the capsule endoscopy completion rate compared to standard protocol.Methods: Patients referred for MCE in our center were prospectively enrolled.Magnetic steering of the capsule through the pylorus was performed after standard gastric examination.Capsule endoscopy completion rate(CECR),esophageal transit time(ETT),gastric transit time(GTT),pyloric transit time(PTT),small bowel transit time(SBTT),total transit time(TTT)and rapid gastric transit(GTT ≤ 30 min)rate were compared with a historical control group enrolled in our center.Results:(1)107 patients were included in the intervention group from June 2017 to November 2017(mean age 45.6±12.8 years,male 67%).120 patients were included in the control group from January 2017 to May 2017(mean age 46.4±14.0 years,male 61%).The two groups were well matched for age,gender,history of diabetes,histroy of abdominal surgery and indications for capsule endoscopy.(2)CECR was significantly higher in the intervention group(n=107)than control group(n=120)(100% vs.94.2%,P = 0.02),with a significantly shorter GTT(22.2 vs.84.5 min,P < 0.001)and PTT(4.4 vs.56.7 min,P < 0.001).(3)Rapid gastric transit rate in the intervention group was significantly higher than the control group(58.9% vs.15.0%,P < 0.001).(4)ETT,SBTT and TTT were similar between the intervention and control groups.(5)There were no statistical differences in the diagnostic yields between the two groups.Conclusions: Magnetic steering of capsule endoscopy improves small bowel CECR by reducing GTT,realizing the complete examination of small bowel after gastric examination. |
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