• capsule endoscopy
• diagnostic accuracy
• gastrointestinal examination
• gastroscopy
• safety

• Drug delivery
• Inflammatory bowel disease
• Remote
• Site-specific
• Smart capsule

• Capsules
• Humans
• Drug Delivery Systems/methods
• Inflammatory Bowel Diseases/drug therapy
• Animals
• Administration, Oral
• Gastrointestinal Tract/metabolism
• Gastrointestinal Tract/drug effects

• capsule endoscopy
• dog
• foreign body
• stomach
• vomiting

• Assessment
• long-term
• magnetically controlled capsule gastroscopy
• teaching
• training

• Humans
• Gastroscopy/education
• Gastroscopy/methods
• Retrospective Studies
• Female
• Clinical Competence
• Male
• Capsule Endoscopy/methods
• Capsule Endoscopy/education
• Adult
• Feasibility Studies
• Educational Measurement/methods
• Magnetics
• China

• detection
• early gastric cancer
• gastrointestinal diseases
• magnetically controlled capsule endoscopy

• gastric disease
• magnetically controlled capsule endoscopy
• preparation
• proton pump inhibitor
• simethicone

• capsule endoscopy
• diagnosis
• guideline
• magnetically controlled capsule gastroscopy
• upper gastrointestinal tract

• Humans
• Gastroscopy/methods
• Magnetics

• 5G
• magnetically controlled capsule endoscopy
• remote endoscopy
• small bowel
• stomach
• telemedicine
• videocapsule investigation of gastroduodenum

• X-ray
• capsule endoscope
• gastrointestinal
• in vivo
• magnetic navigation system

The proliferation of video capsule endoscopy (VCE) would not have been possible without continued technological improvements in imaging and locomotion. Advancements in imaging include both software and hardware improvements but perhaps the greatest software advancement in imaging comes in the form of artificial intelligence (AI). Current research into AI in VCE includes the diagnosis of tumors, gastrointestinal bleeding, Crohn’s disease, and celiac disease. Other advancements have focused on the improvement of both camera technologies and alternative forms of imaging. Comparatively, advancements in locomotion have just started to approach clinical use and include onboard controlled locomotion, which involves miniaturizing a motor to incorporate into the video capsule, and externally controlled locomotion, which involves using an outside power source to maneuver the capsule itself. Advancements in locomotion hold promise to remove one of the major disadvantages of VCE, namely, its inability to obtain targeted diagnoses. Active capsule control could in turn unlock additional diagnostic and therapeutic potential, such as the ability to obtain targeted tissue biopsies or drug delivery. With both advancements in imaging and locomotion has come a corresponding need to be better able to process generated images and localize the capsule’s position within the gastrointestinal tract. Technological advancements in computation performance have led to improvements in image compression and transfer, as well as advancements in sensor detection and alternative methods of capsule localization. Together, these advancements have led to the expansion of VCE across a number of indications, including the evaluation of esophageal and colon pathologies including esophagitis, esophageal varices, Crohn’s disease, and polyps after incomplete colonoscopy. Current research has also suggested a role for VCE in acute gastrointestinal bleeding throughout the gastrointestinal tract, as well as in urgent settings such as the emergency department, and in resource-constrained settings, such as during the COVID-19 pandemic. VCE has solidified its role in the evaluation of small bowel bleeding and earned an important place in the practicing gastroenterologist’s armamentarium. In the next few decades, further improvements in imaging and locomotion promise to open up even more clinical roles for the video capsule as a tool for non-invasive diagnosis of lumenal gastrointestinal pathologies.

Portable magnetic-assisted capsule endoscopy (MACE) provides satisfactory patient experience and safety with comparable performance in diagnosis of organic lesions when compared to conventional upper gastrointestinal endoscopy. In this study, a total of 58 homecare patients were included for MACE either in the hospital (n = 42) or at home (n = 16), with mean age of 71.1 ± 12.4 years. A total of 55 patients (94.83%) had completed the MACE with diagnosis of reflux esophagitis (43.6%), gastritis (54.5%), erosions (21.8%), fundic polyps (14.5%), peptic ulcers (25.9%), etc. Most patients (n = 47, 85.5%) were satisfied with the experience, and all patients who received MACE at home (n = 15, 100%) appreciated the convenience of endoscopy at home. Less than half of the patients (n = 24, 43.6%) could afford MACE if the expense was not covered by health insurance (USD 714). Time consumption from both traffic and capsule manipulation was also challenging for the physicians, as it took an average of 24.7 min to complete MACE, but it added up to a total of 92.7 min at home, which is about 15 times that of conventional endoscopy in hospital. More efforts are needed to ease the financial burden of patients, and optimization of workflow in community practice may help lift the obstacles revealed in this study.

While capsule endoscopy (CE) is the gold standard diagnostic method of detecting small bowel (SB) diseases and disorders, a novel magnetically controlled capsule endoscopy (MCCE) system provides non-invasive evaluation of the gastric mucosal surface, which can be performed without sedation or discomfort. During standard SBCE, passive movement of the CE may cause areas of the complex anatomy of the gastric mucosa to remain unexplored, whereas the precision of MCCE capsule movements inside the stomach promises better visualization of the entire mucosa.

To evaluate the Ankon MCCE system’s feasibility, safety, and diagnostic yield in patients with gastric or SB disorders.

Of outpatients who were referred for SBCE, 284 (male/female: 149/135) were prospectively enrolled and evaluated by MCCE. The stomach was examined in the supine, left, and right lateral decubitus positions without sedation. Next, all patients underwent a complete SBCE study protocol. The gastric mucosa was explored with the Ankon MCCE system with active magnetic control of the capsule endoscope in the stomach, applying three standardized pre-programmed computerized algorithms in combination with manual control of the magnetic movements.

The urea breath test revealed Helicobacter pylori positivity in 32.7% of patients. The mean gastric and SB transit times with MCCE were 0 h 47 min 40 s and 3 h 46 min 22 s, respectively. The average total time of upper gastrointestinal MCCE examination was 5 h 48 min 35 s. Active magnetic movement of the Ankon capsule through the pylorus was successful in 41.9% of patients. Overall diagnostic yield for detecting abnormalities in the stomach and SB was 81.9% (68.6% minor; 13.3% major pathologies); 25.8% of abnormalities were in the SB; 74.2% were in the stomach. The diagnostic yield for stomach/SB was 55.9%/12.7% for minor and 4.9%/8.4% for major pathologies.

MCCE is a feasible, safe diagnostic method for evaluating gastric mucosal lesions and is a promising non-invasive screening tool to decrease morbidity and mortality in upper gastro-intestinal diseases.

• Bowel diseases
• Capsule endoscopy
• Diagnostic techniques
• Gastrointestinal diseases
• Gastric mucosa
• Helicobacter pylori

• Capsule Endoscopes
• Capsule Endoscopy/adverse effects
• Capsule Endoscopy/methods
• Feasibility Studies
• Female
• Gastric Mucosa
• Humans
• Intestinal Diseases
• Male
• Prospective Studies

• colon capsule endoscopy
• colonoscopy
• colorectal cancer detection
• electrical impedance sensor
• tripolar electrode
• tumor detection

In the past 20 years, several magnetically controlled capsule endoscopes (MCCE) have been developed for the evaluation of gastric lesions, including NaviCam (ANKON), MiroCam-Navi (Intromedic), Endocapsule MGCE (Olympus and Siemens), SMCE (JIFU), and FAMCE (Jinshan). Although limited to observing esophageal and duodenal lesions and lacking the ability of biopsy, MCCE has the advantages of comfort, safety, no anesthesia, no risk of cross-infection, and high acceptability. Several high-quality RCTs showed that the diagnostic accuracy of MCCE is comparable to the traditional gastroscopy. Due to the nonnecessity of anesthesia, MCCE may be more suitable for the elderly with obvious comorbidities as well as children. With more evidences accumulated and more innovative technologies developed, MCCE is expected to be an important tool for screening of early gastric cancer or the diagnosis of gastric diseases.

This paper presents an active locomotion capsule endoscope system with 5D position sensing and real-time automated polyp detection for small-bowel and colon applications. An electromagnetic actuation system (EMA) consisting of stationary electromagnets is utilized to remotely control a magnetic capsule endoscope with multi-degree-of-freedom locomotion. For position sensing, an electronic system using a magnetic sensor array is built to track the position and orientation of the magnetic capsule during movement. The system is integrated with a deep learning model, named YOLOv3, which can automatically identify colorectal polyps in real-time with an average precision of 85%. The feasibility of the proposed method concerning active locomotion and localization is validated and demonstrated through in vitro experiments in a phantom duodenum. This study provides a high-potential solution for automatic diagnostics of the bowel and colon using an active locomotion capsule endoscope, which can be applied for a clinical site in the future.

• active locomotion capsule endoscope
• capsule localization
• deep learning
• magnetic capsule endoscope
• polyp detection

• Animals
• Capsule Endoscopy/methods
• Gastroscopy/methods
• Imaging, Three-Dimensional/methods
• Magnets
• Male
• Stomach/injuries
• Stomach/pathology
• Stomach Diseases/diagnosis
• Swine

• Ministry of Health and Welfare

• magnetic control
• stomach
• wireless capsule endoscopy

Capsule endoscopy has been widely used for the diagnosis of small bowel diseases due to its safety, noninvasiveness, and acceptability. Despite the potential benefits of capsule endoscopy, there are obvious challenges to capsule endoscopy application in the upper gastrointestinal tract, due to the fast transit speed in the esophagus and large space of the gastric cavity. With the development of innovative technologies, such as magnetic navigation and tethered capsule endoscopy, the indications for capsule endoscopy have recently been expanded. Various capsule endoscopes have been applied to clinical practice, and several state-of-the-art research-oriented designs and devices provide hope for further use in the diagnosis of upper gastrointestinal diseases. In this review, we will summarize the current status and future developments of upper gastrointestinal tract capsule endoscopy.

• Upper gastrointestinal tract
• Capsule endoscopy
• Diagnosis

• Capsule Endoscopy
• Gastroscopy
• Humans
• Stomach Neoplasms

• asymptomatic individuals
• gastric tumors
• gastrointestinal lesions
• magnetic-controlled capsule endoscopy
• precancerous lesions

• Crohn’s capsule endoscopy
• Small-bowel capsule endoscopy
• artificial intelligence
• colon capsule endoscopy
• magnetically controlled upper gastrointestinal capsule

Gastric cancer (GC) is one of the major cancers in China and all over the world. Most GCs are diagnosed at an advanced stage with unfavorable prognosis. Along with some other countries, China has developed the government-funded national screening programs for GC and other major cancers. GC screening has been shown to effectively decrease the incidence of and mortality from GC in countries adopting nationwide screening programs (Japan and Korea) and in studies based on selected Chinese populations. The screening of GC relies mostly on gastroendoscopy, the accuracy, reliability and safety of which have been indicated by previous studies. However, considering its invasive screening approach, requirements on skilled endoscopists and pathologists, and a high cost, developing noninvasive methods to amend endoscopic screening would be highly needed. Numerous studies have examined biomarkers for GC screening and the combination of biomarkers involving pepsinogen, gastrin, and Helicobacter pylori antibodies has been proposed for risk stratification, seeking to narrow down the high-risk populations for further endoscopy. Despite all the achievements of endoscopic screening, evidence on appropriate screening age, intervals for repeated screening, novel biomarkers promoting precision prevention, and health economics need to be accumulated to inform policymakers on endoscopic screening in China. With the guide of Health China 2030 Planning Outline, we have golden opportunities to promote prevention and control of GC. In this review, we summarize the characteristics of screening programs in China and other East Asian countries and introduce the past and current approaches and strategies for GC screening, aiming for featuring the latest advances and key challenges, and illustrating future visions of GC screening.

• Gastric cancer
• Helicobacter pylori
• gastrin 17
• gastroendoscopy
• pepsinogen
• screening

• Adverse events
• Predictors
• Systematic review and meta-analysis
• Temporal-trend
• Video capsule endoscopy

• Aged
• Capsule Endoscopy/adverse effects
• Humans
• Inflammatory Bowel Diseases
• Intestine, Small

• 81900600 National Natural Science Foundation of China
• 18YF1422800 Shanghai Sailing Program
• 19YF1446700 Shanghai Sailing Program
• National high level talents special support plan

With the rapid advancements of medical technologies and patients’ higher expectations for precision diagnostic and surgical outcomes, gastroscopy has been increasingly adopted for the detection and treatment of pathologies in the upper digestive tract. Correspondingly, robotic gastroscopes with advanced functionalities, e.g., disposable, dextrous and not invasive solutions, have been developed in the last years. This article extensively reviews these novel devices and describes their functionalities and performance. In addition, the implementation of artificial intelligence technology into robotic gastroscopes, combined with remote telehealth endoscopy services, are discussed. The aim of this paper is to provide a clear and comprehensive view of contemporary robotic gastroscopes and ancillary technologies to support medical practitioners in their future clinical practice but also to inspire and drive new engineering developments.

Upper gastrointestinal (UGI) tract pathology is common worldwide. With recent advancements in robotics, innovative diagnostic and treatment devices have been developed and several translational attempts made. This review paper aims to provide a highly pictorial critical review of robotic gastroscopes, so that clinicians and researchers can obtain a swift and comprehensive overview of key technologies and challenges. Therefore, the paper presents robotic gastroscopes, either commercial or at a progressed technology readiness level. Among them, we show tethered and wireless gastroscopes, as well as devices aimed for UGI surgery. The technological features of these instruments, as well as their clinical adoption and performance, are described and compared. Although the existing endoscopic devices have thus far provided substantial improvements in the effectiveness of diagnosis and treatment, there are certain aspects that represent unwavering predicaments of the current gastroenterology practice. A detailed list includes difficulties and risks, such as transmission of communicable diseases (e.g., COVID-19) due to the doctor–patient proximity, unchanged learning curves, variable detection rates, procedure-related adverse events, endoscopists’ and nurses’ burnouts, limited human and/or material resources, and patients’ preferences to choose non-invasive options that further interfere with the successful implementation and adoption of routine screening. The combination of robotics and artificial intelligence, as well as remote telehealth endoscopy services, are also discussed, as viable solutions to improve existing platforms for diagnosis and treatment are emerging.

• artificial intelligence
• gastric cancer
• gastroscopy
• machine learning
• robotic gastroscopy

Capsule endoscopy (CE) is the first-line diagnostic modality for detecting small bowel lesions. CE is non-invasive and does not require sedation, but its movements cannot be controlled, it requires a long time for interpretation, and it has lower image quality compared to wired endoscopy. With the rapid advancement of technology, several methods to solve these problems have been developed. This article describes the ongoing developments regarding external CE locomotion using magnetic force, artificial intelligence-based interpretation, and image-enhancing technologies with the CE system.

• 3-D imaging
• Artificial intelligence
• Capsule endoscopy
• Locomotion
• Magnetics

• compliance rate
• conventional gastroscopy
• gastric disease
• gastric examination
• standing-type magnetically guided capsule

• Adult
• Capsule Endoscopes
• Capsule Endoscopy/instrumentation
• Feasibility Studies
• Female
• Gastroscopy
• Humans
• Magnetics
• Male
• Patient Preference
• Single-Blind Method
• Stomach Diseases/diagnosis

• 2015B020233007 Science and Technology Project of Guangdong
• 2018A070701005 Science and Technology Project of Guangdong
• 2017B020209003 Guangdong Gastrointestinal Disease Research Center

• Capsule Endoscopes
• Capsule Endoscopy
• Equipment Design
• Gastrointestinal Tract/diagnostic imaging
• Humans
• Magnetics
• Robotics

• R03 EB018593 NIBIB NIH HHS

Routine use of magnet-controlled capsule endoscopy of the stomach has been limited by the inadequate views of specific stomach regions. In the present study, radiology and upper gastrointestinal endoscopy (UGIE) were used to determine optimal subject body positioning and suitable external control magnet placement for capsule endoscopy. Healthy adult volunteers were subjected to upper gastrointestinal X-ray radiography (n=5), spiral computed tomography with volume reconstruction (n=4) or UGIE (n=1). Stomach fundus-to-body (FB) and body-to-antrum (BA) angles were compared when subjects were supine, prone, lying on their left side and on their right side, and when they were standing upright. Vertical distances from the surface of the body to the distal points of the fundus and antrum were also compared in this range of subject positions. Obtuse angles were considered the most beneficial for capsule movement and short vertical distances were considered desirable for optimizing magnetic force. The FB angle was sharply acute in the supine position, relatively open where subjects were on their side, and almost 180° in the standing position. The BA angle was obtuse in the standing position but acute in all other positions. With the subject in any position, the left lower lateral chest had the shortest distance to the fundus, while the ventral wall was closest to the antrum. The present modeling analysis indicates that standing is superior to all decubitus positions for magnetic-capsule endoscopy, including the commonly used supine position. Both the abdominal anterior wall and left lateral lower chest appeared to be advantageous locations for external control magnet placement.

• body positioning
• external control magnet placement
• gastric angles
• magnet-controlled capsule endoscopy
• standing position

Current magnet-controlled capsule endoscopy (MCE) for the stomach is not yet satisfactory with respect to navigation control, especially in the gastric fundus and cardia. A newly developed MCE system conducted in a standing rather than supine position may improve capsule maneuverability within the stomach. The aim of this phase 1 study was to assess the feasibility and safety of this system for examining the human stomach in healthy volunteers.

A cohort of 31 healthy volunteers were enrolled. Each swallowed a capsule after drinking water and gas producing agents intended to produce distention. Under the newly developed standing MCE system, subjects were examined endoscopically while standing with external guide magnets placed on the abdominal wall and left lower chest. Safety, gastric preparation, maneuverability, visualization of anatomical landmarks and the gastric mucosa, and examination time were the primary parameters assessed. The gastric preparation and examination procedures were well accepted by the subjects and there were no adverse events.

Gastric examination took 27.8 ± 8.3 min (12–45 min). Gastric cleanliness was good in 24 participants (77.4%) and moderate in 7 participants (22.6%). Gastric distention was good in all of 31 participants (100%). Capsule maneuverability was also graded as good in all 31 subjects (100%), and manipulation in the fundus and cardia regions was as easy as that in the antrum and body. Visualization of the gastric cardia, fundus, body, angulus, antrum and pylorus was assessed subjectively as complete in all 31 subjects (100%). Visualization of the gastric mucosa was also good (> 75%) in all 31 subjects (100%). In areas where the mucosa could not be visualized, the low visibility was due to opaque fluid or foam. Polyps and erosive lesions were found in 25 subjects.

MCE of the stomach conducted in a standing position is feasible and safe with satisfactory maneuverability.

• Cardia
• Endoscope
• Fundus
• Magnetic
• Stomach
• Visibility

• Diagnostic efficiency
• Gastric disease
• Magnetic-controlled capsule endoscopy
• Safety evaluation
• The elderly

Magnetically guided capsule endoscopy (MGCE) offers a noninvasive method of evaluating both the gastric cavity and small intestine; however, few studies have evaluated MGCE in pediatric patients. We investigated the diagnostic efficacy of MGCE in pediatric patients with abdominal pain.

We enrolled 48 patients with abdominal pain aged 6–18 years. All patients underwent MGCE to evaluate the gastric cavity and small intestine.

The cleanliness of the gastric cardia, fundus, body, angle, antrum, and pylorus was assessed satisfactorily in 100%, 85.4%, 89.6%, 100%, 97.9%, and 100% of patients, respectively. The subjective percentage visualization of the gastric cardia, fundus, body, angle, antrum, and pylorus was 84.8%, 83.8%, 88.5%, 87.7%, 95.2%, and 99.6%, respectively. Eighteen (37.5%) patients had 19 gastrointestinal tract lesions: one esophageal, three in the gastric cavity, and 15 in the small intestine. No adverse events occurred during follow-up.

MGCE is safe, convenient, and tolerable for evaluating the gastric cavity and small intestine in pediatric patients. MGCE can effectively diagnose pediatric patients with abdominal pain.

• conventional gastroscopy
• diagnostic accuracy
• gastric diseases
• magnetically controlled capsule endoscopy
• screening