The Research About The Application And Diagnostic Value Of Magnetically Controlled Capsule Endoscopy Of Gastric Diseases

Objective:With the rapid development of controllable capsule endoscopy,traditional flexible endoscopy is no longer the only method to accomplish upper gastrointestinal tract examination.This study aims to investigate the value of magnetic-controlled capsule endoscopy of visualizing the stomach mucosa and the feasibility and safety of detecting lesions.Methods:This study is conducted in a tertiary referral center(Shanghai Ruijin Hospital)between July 2015 and February 2016.Clinical data regarding demographic features and indications were collected prospectively.Simethicone based premedication were applied to all 340 examinees.The movement of capsule endoscopy was manipulated through an external magnetic field to observe gastric mucosa and detect gastric lesions.The visualizing capability of MCE is measured as the visibility of the seven landmark of stomach mucosa: z-line,cardia,fundus,body,incisura,antrum and pylorus.The visibility of each landmark is assessed on a three category scale.Category I: clear view of landmark and mucosa;Category II: less than clear,landmarks can be identified;Category III: unclear view,unable to distinguish.Visibility of each landmark is assessed and the relevance and difference between landmarks are analyzed.Gastric lesions were classified according to morphological features and location.All examinees are required to score the comfort of the examination process from 0 to 10.The higher the score,the less the comfort.Results:MCEs were conducted in 340 examinees(158 males,182 females,M/F ratio 1: 1.15)with a mean age of 40.7 ± 17.5 years(ranges from 7 to 90 years).38 examinees were 14 years old or less,30 examinees were 65 years old or above.Upper gastrointestinal symptoms accounts for 53.8%(183/340)of indications,other symptoms accounts for 21.5%(73/340),health examination accounts for 24.7%(84/340).Visualization of each landmark(Caterogy I + Caterogy II)is as follows: z-line 36.5%(124/340),cardiac 92.1%(313/340),fundus 95.3%(324/340),body 98.2%(334/340),incisura 97.9%(333/340),antrum 100.0%(340/340),pylorus 99.7%(339/340).In 88.0%(299/340)examinees,all landmarks besides z-line could be observed.The visibility of cardia,fundus and body are significantly relevant(P <0.01).Difference between the visibility of fundus and incisura,fundus and antrum,fundus and pylorus are significant(P <0.05).Overall visibility of stomach has no significant correlation(P> 0.05)with sex,age,BMI,indication,bile reflux.MCE found 242 lesions in 196 examinees.The positive rate is 57.6%.340 cases of subjects in 19.7%(67/340)found elevated lesions,47.4%(161/340)found that flat lesions,4.1%(14/340)found that depressed lesions.Lesions of corpus account for 25.6%(62/242);lesions of antrum account for 61.2%(148/242);pangastric lesions accounts for 13.2%(32/242).Comfort scale was scored 0-2 in 85.9%(292/340)examinees,3-5 in 8.2%(28/340),6-8 in 1.5%(5/340).The main cause of discomfort including overweight of portable data recorder,abdominal distension caused by ingestion of too much water,choking occurred during repetitive water ingestion to distend the gastric cavity and throat discomfort during endoscopic delivery of capsules.Capsule retention occurred one in one examinee and retrieved through the double-balloon enteroscopy.Conclusion:Magnetic-controlled capsule endoscopy is a feasible and safe way to visualize the gastric mucosa.MCE can visualize all landmarks in most cases.Observeration of the distal stomach was significantly better than the proximal stomach.With the same premedication of simethicone,age,sex,BMI,indication and bile reflux shows no significant influence on the visibility of gastric mucosa.