Inspection of the human stomach using remote-controlled capsule endoscopy: a feasibility study in healthy volunteers

Background: Remote control of capsule endoscopes might allow reliable inspection of the human stomach. Objective: To assess the safety and efficacy of manipulation of a modified capsule endoscope with magnetic material (magnetic maneuverable capsule [MMC]) in the human stomach by using a handheld external magnet. Design: Open clinical trial. Setting: Academic hospital. Patients: Ten healthy volunteers. Interventions: Subjects swallowed the MMC and sherbet powder for gastric distention. An external magnetic paddle (EMP-2) was used to manipulate the MMC within the stomach. MMC responsiveness was evaluated on a screen showing the MMC film in real time. Main Outcome Measurements: Safety and tolerability (questionnaire), gastric residence time of the MMC, its responsiveness to the EMP-2, area of gastric mucosa visualized. Results: There were no adverse events. The MMC was always clearly attracted by the EMP-2 and responded to its movements. It remained in the stomach for 39 +/- 24 minutes. In 7 subjects, both the cardia and the pylorus were inspected and 75% or more of the gastric mucosa was visualized (>= 50% in all of the remaining subjects). A learning curve was clearly recognizable (identification of MMC localization, intended movements). Limitations: Small amounts of fluid blocked the view of apical parts of the fundus; gastric distention was not sufficient to flatten all gastric folds. Conclusions: Remote control of the MMC in the stomach of healthy volunteers using a handheld magnet is safe and feasible. Responsiveness of the MMC was excellent, and visualization of the gastric mucosa was good, although not yet complete, in the majority of subjects. The system appeared to be clinically valuable and should be developed further. (Clinical trial registration number: DE/CA05/2009031008.) (GaStrointest Endosc 2011;73:22-8.)