Endoscopy: First video capsule endoscopy in stomach
The first human gastric examination using video capsule endoscopy was completed by researchers in France, who discovered several findings missed by subsequent gastroscopy, with the results published in the July edition of Endoscopy.

Video capsule endoscopy (VCE) is considered a standard method of examination in small-bowel diagnostics and has been used with unclear value in the esophagus and colon, according to J.F. Rey, MD, of the Arnault Tzank Institute in Saint Laurent du Var, France, and co-authors. Despite substantial medical interest surrounding video endoscopy, gastric examination by VCE has been considered unfeasible because of the need to steer the capsule through the stomach, according to Rey and colleagues.

Twenty-nine volunteers and 24 patients enrolled in the study, which involved the VCE followed by a gastroscopy 24 hours later. Participants were required to drink 1300 mL of water, at specified intervals before the exam, to provide a necessary medium through which the capsule could be maneuvered.

Patients swallowed the capsule, which was then navigated by physicians using low-intensity magnetic fields. The device, developed by Siemens Healthcare and Olympus, contained a camera on either end that shot four frames per second by means of multiple antennae attached to the patient. The videos could be viewed simultaneously by physicians on a dual-screen panel while steering the device through the stomach. The physicians were able to navigate the capsule using five maneuvers, including turning, rotating and diving.

The mean examination time was 30 minutes (37 in volunteers and 21 in patients), with one failed exam due to technical defects. "Visualizations of the gastric pylorus, antrum, body, fundus and cardia were subjectively assessed as complete in 96 percent, 98 percent, 96 percent, 73 percent and 75 percent of participants, respectively," the authors reported.

Of the 30 pathological findings detected through VCE and gastroscopy, 14 were identified by capsule endoscopy and reproduced using gastroscopy. These findings included 11 cases of diffuse inflammation or erosions, one angiodysplasia, one diverticulum and one hiatal hernia. Ten lesions were detected by capsule endoscopy that were not discovered by conventional gastroscopy, including one polyp, three inflammations, one angiodysplasia, three ulcers, one important bile reflux and one hypertrophic fold. Six lesions were identified by gastroscopy but missed by VCE, including three cases of inflammation, two cases of atrophy and one of hypertrophic folds.

The authors noted that the capsule provided clear panoramic views of the stomach, while more detailed images were sometimes lacking. Moreover, the researchers reported difficulties in visualizing the cardia, though with this and other structures the authors reported greater successes with repeated trials.

Only one patient reported side effects linked to the capsule endoscopy itself, which related to the passing of the capsule.

The authors noted several limitations to the pilot study. The operators and reviewers were not blinded to patients, although the VCE occurred before the gastroscopy, limiting diagnostic bias to some extent. Moreover, the assessment of exam completeness was evaluated by the operator, rather than by independent reviewers or objective metrics.

"The first human trial of gastric examination with a magnetically navigated capsule opens a new field for digestive endoscopy," the authors highlighted. Rey and colleagues are conducting further, blinded VCE comparative trials to gastroscopy.