Magnetically controllable gastrointestinal steering of video capsules

Abstract

Wireless capsule endoscopy (WCE) allows for comfortable video explorations of the gastrointestinal (GI) tract, with special indication for the small bowel. In the other segments of the GI tract also accessible to probe gastroscopy and colonscopy, WCE still exhibits poorer diagnostic efficacy. Its main drawback is the impossibility of controlling the capsule movement, which is randomly driven by peristalsis and gravity. To solve this problem, magnetic maneuvering has recently become a thrust research area. Here, we report the first demonstration of accurate robotic steering and noninvasive 3-D localization of a magnetically enabled sample of the most common video capsule (PillCam, Given Imaging Ltd, Israel) within each of the main regions of the GI tract (esophagus, stomach, small bowel, and colon) in vivo, in a domestic pig model. Moreover, we demonstrate how this is readily achievable with a robotic magnetic navigation system (Niobe, Stereotaxis, Inc, USA) already used for cardiovascular clinical procedures. The capsule was freely and safely moved with omnidirectional steering accuracy of 1°, and was tracked in real time through fluoroscopic imaging, which also allowed for 3-D localization with an error of 1 mm. The accuracy of steering and localization enabled by the Stereotaxis system and its clinical accessibility world wide may allow for immediate and broad usage in this new application. This anticipates magnetically steerable WCE as a near-term reality. The instrumentation should be used with the next generations of video capsules, intrinsically magnetic and capable of real-time optical-image visualization, which are expected to reach the market soon.