Remote magnetic manipulation of a wireless capsule endoscope in the esophagus and stomach of humans (with videos)

Background: Remote manipulation of wireless capsule endoscopes might improve diagnostic accuracy and facilitate therapy. Objective: To test a new capsule-manipulation system. Setting: University hospital. Design and Interventions: A first-in-human study tested a new magnetic maneuverable wireless capsule in a volunteer. A wireless capsule endoscope was modified to include neodymium-iron-boron magnets. The capsule's magnetic switch was replaced with a thermal one and turned on by placing it in hot water. One imager was removed from the Pill Cam colon-based capsule, and the available space was used to house the magnets. A handheld external magnet was used to manipulate this capsule in the esophagus and stomach. The capsule was initiated by placing it in a mug of hot water. The capsule was swallowed and observed in the esophagus and stomach by using a gastroscope. Capsule images were viewed on a real-time viewer. Main Outcome Measurements: The capsule was manipulated in the esophagus for 10 minutes. It was easy to make the capsule turn somersaults and to ungulate at the cardioesophageal junction. In the stomach, it was easy to move the capsule back from the pylorus to the cardioesophageal junction and hold/spin the capsule at any position in the stomach. The capsule in the esophagus and stomach did not cause discomfort. Limitations: Magnetic force varies with the fourth power of distance. Conclusions: This study suggests that remote manipulation of a capsule in the esophagus and stomach of a human is feasible and might enhance diagnostic endoscopy as well as enable therapeutic wireless capsule endoscopy.