Post written by Zhuan Liao, MD, from the National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China.

We first described an updated magnetically controlled capsule gastroscopy (MCCG-2) highlighted with improvements in frame rate, image resolution, field of view, battery life, and data transmission compared to first generation MCCG (MCCG-1), and we aimed to evaluate its clinical availability for upper gastrointestinal examination.

The complete visualization of upper gastrointestinal tract under MCCG continues to present some challenges. The technical improvements in MCCG described in our study will help to alleviate this problem and achieve better clinical application.

Eighty patients were enrolled and randomly allocated to receive MCCG-1 or MCCG-2 examination under standardized procedure. MCCG-2 group showed better performance in mucosal visualization (frames captured for esophageal mucosa and Z-line, circumferential viewing of Z-line, detection of Z-line and duodenal papilla, and image quality), examination duration (gastric examination and total running time), and maneuverability (fluency, stability and comfortableness), and detected 2cancers confirmed by subsequent conventional endoscopy, making better diagnosis of UGI diseases a possibility. Compared to current reported wireless magnetically assisted capsule endoscopy, MCCG-2 also showed superiority especially in technical parameters such as control method, image resolution, frame rate, battery life, magnetic force, and data transmission, which can be considered as a new diagnostic tool for upper and middle gastrointestinal tract due to its good balance between the excellent visualization of upper gastrointestinal tract and complete examination of small bowel. Shorter gastric examination and improved maneuverability of MCCG are also highlighted, which established the foundation for more large-scale gastrointestinal investigations and potentially benefited countries with gastric cancer screening programs the most by reducing the burden of gastroscopy requirement.

Although we first validated the optimized visualization of upper gastrointestinal tract under the updated MCCG, the authentic diagnostic efficiency should be tested compared with conventional gastroscopy, and complete visualization of upper gastrointestinal tract is still our next investigation target. Increasing the magnetic effect in the lower esophagus and adding a string or detachable string attachment on the capsule endoscopy may be potential effective methods. We also believe that MCCG will get a broader range of applications with the rapid technical developments, especially under the introduction of artificial intelligence in endoscopy.

Representative images of anatomical landmarks under MCCG-2. Middle esophagus (A); Cardiac and fundus (B); Gastric body (C, D); Angulus (E); Antrum (F); Pylorus (G); Duodenal papilla (H).

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