H.19 Locomotive VCE

Video capsule endoscopy (VCE) is a noninvasive technology designed to provide diagnostic imaging
of the digestive tract. Largely, it provides difficult-to-access visualization of the small bowel, as well
as information regarding the esophagus, stomach, and cecum. VCE is appreciated for its ability to
offer high diagnostic yield without need for sedation or invasive measures like its traditional
endoscopic cousins. However, VCE cannot be maneuvered and relies entirely on the innate
peristalsis and administration of pro-kinetic agents to push the device through the GI tract. For
example, this limits diagnostic utility in the stomach in particular, as gravity pulls the device to the
antrum for the majority of its transit time of the stomach.

The search for solutions to improve the utility of VCEs is currently underway, with recent
publications centered on harnessing better locomotive control. Paddling legs and propellers have
been explored, but proposed developments required too much power to last throughout the GI
tract. Several biotechnology companies are developing external magnetic control measures 1 , using
handheld magnetic devices to manipulate the device. However, this removes the simplicity of what
is otherwise an ambulatory procedure.

Improving locomotive control of VCEs would broaden the application of VCEs to increase detection
of abnormal gastric pathology as well as possibly offer utility in patients with motility issues such as
achalasia or gastroparesis. It would also reduce the risk of gastric retention, which for now often
necessitates medical treatment (3%), endoscopic removal (7%), or even surgery (60%) 2 . There
exists exciting potential to optimize the video capsule endoscopic technology for use in the clinical
setting, especially in the sector of motor control.

1. Oh, Dong & Kim, Kwang & Lim, Yun Jeong. (2020). A New Active Locomotion Capsule
Endoscopy under Magnetic Control and Automated Reading Program. Clinical Endoscopy.
53. 395-401. 10.5946/ce.2020.127.

2. Rezapour M, Amadi C, Gerson LB. Retention associated with video capsule endoscopy:
systematic review and meta-analysis. Gastrointest Endosc. 2017 Jun;85(6):1157-1168.e2.
doi: 10.1016/j.gie.2016.12.024. Epub 2017 Jan 6. PMID: 28069475.

Figure: An example of video capsule endoscope. From Olympus Press Center. Small intestinal
capsule endoscope. Available from
https://www.olympus.de/corporate/de/press_centre/press_releases/medical/small_intestinal_cap
sule_endoscope_.jsp?view=img>; 2013 [accessed 4.12.20].