Robotic-Controlled, Fully Automated Capsule Endoscopy on Par With Conventional Method

NEW YORK (Reuters Health) - Fully automated, magnetically controlled capsule endoscopy performs as well as conventional transoral gastroscopy for examining the stomach and small bowel, according to results of a prospective, feasibility study conducted at two centers in China.

"The use of robotic control and full automation opens a new era for capsule endoscopy. Given that the technique is already well developed in China and shows promising results, it should be evaluated elsewhere urgently," writes the author of an invited comment in The Lancet Gastroenterology and Hepatology where the study is published.

In the STEEPEN study, Dr. Yu-Feng Xiao of The Third Military Medical University in Chongqing and colleagues used robotic fully automated, magnetically controlled capsule endoscopy (FAMCE) to image the stomach and small bowel in 114 patients with suspected gastric pathology, followed two hours later by conventional transoral gastroscopy.

The overall results of gastric examination with the fully automated technique were similar to those of conventional gastroscopy, with all gastric anatomical landmarks (cardia, fundus, body, angulus, antrum, and pylorus) visible using the fully automated technique, they report.

"The concordance between FAMCE and conventional transoral gastroscopy for the detection of five types of gastric lesion (gastritis, polyps, submucosal protuberances, mucosal erosion, and xanthoma) in various stomach segments was 99.61%," they report.

FAMCE and conventional transoral gastroscopy detected 214 lesions in the 114 study patients. Of those, 193 were detected by both modalities. FAMCE missed five pathologies (four cases of gastritis and one polyp) and conventional gastroscopy missed 16 pathologies (12 cases of gastritis, one polyp, one fundal xanthoma, and two antral erosions).

The capsule was released after gastric examination into the duodenum, and a full small bowel examination was completed in all 114 patients, with intestinal lesions detected in 50 (44%) patients.

No serious adverse events occurred and there was no evidence of capsule retention.

FAMCE took longer to complete than conventional gastroscopy (mean 19.17 min vs. 5.21 min), but the researchers believe that incorporating artificial intelligence will eventually reduce the time considerably.

"During the COVID-19 pandemic, FAMCE could reduce the risk of infection transmission compared with conventional transoral gastroscopy, due to the 5G model application and no direct human contact," Dr. Xiao and colleagues say.

"The COVID-19 pandemic has encouraged examination techniques that minimize contact and worldwide it is an opportunity to develop a non-invasive diagnosis tool for early gastric cancer detection," adds comment author Dr. Jean-Francois Rey of Arnault Tzanck Institute, in Saint Laurent du Var, France.

"Use of a robotic arm means that, unlike with magnetic capsule endoscopy, no human operator is needed, which reduces the need for trained operators and could help minimize human error," Dr. Rey writes.

"Large, multicenter trials of this new technology will be needed to encourage its use outside of China. From a clinical perspective, guided gastric capsule endoscopy is already becoming more popular than conventional gastroscopy in China because there is a shortage of endoscopists," Dr. Rey adds.

The study was funded by the National Key Research and Development Program. The authors have declared no relevant conflicts of interest.

SOURCE: https://bit.ly/39LHypc and https://bit.ly/3APbfle Lancet Gastroenterology and Hepatology, online September 20, 2021.