Preoperative Use of a Magnetically Controlled Capsule Endoscopy in Patients Undergoing Bariatric Surgery

Detailed Description:

The NaviCam® Xpress™ Stomach System represents a novel approach to upper gastrointestinal visualization in the bariatric surgery population. This magnetically controlled capsule endoscopy (MCCE) system consists of a single-use wireless capsule that contains imaging components and magnetic materials that allow external control through a physician-operated magnet.

Technical Specifications and Procedure:

The capsule is equipped with cameras capable of capturing both still images and continuous video footage. After the patient swallows the capsule with 500ml of water, it initially descends the esophagus via natural peristalsis while continuously recording. The capsule is initially attached to a tether, which is released via a 15ml air injection mechanism once the capsule reaches the appropriate position. Once inside the stomach, the external magnetic control system allows the physician to systematically manipulate the capsule's position and orientation, enabling thorough visualization of the gastric mucosa.

Clinical Significance:

This study addresses a critical gap in pre-bariatric surgery evaluation. While traditional esophagogastroduodenoscopy (EGD) remains the gold standard, it presents unique challenges in the bariatric population due to:

Increased sedation risks associated with high BMI Higher technical complexity of the procedure Greater risk of respiratory complications during sedation

Innovation and Technological Advancement:

This represents one of the first applications of MCCE technology specifically targeted at the bariatric surgery population. The study's focus on patients with BMI >38 kg/m² will provide valuable data about the system's performance in body habitus previously considered challenging for magnetic control systems.

The feasibility assessment incorporates multiple technical parameters:

Magnetic control responsiveness across varying body habitus Quality of mucosal visualization in different anatomical regions System reliability and technical performance metrics Procedure duration and technical success rates

This study will help establish the potential role of MCCE in the standard pre-bariatric surgery evaluation pathway and may inform future technological refinements specific to this patient population.

Inclusion criteria

• Age ≥ 18 years old
• Diagnosed with morbid obesity
• Undergoing primary bariatric surgery by current international guidelines
• BMI greater than 38 kg/m² and less than or equal to 65 kg/m²
• Waist circumference less than or equal to 77 inches

Exclusion criteria

• Patients with permanent pacemakers and other surgically placed metallic devices which function can interfere with the magnetic field
• Patients with dysphagia and those who are at risk of capsule retention (gastric outlet obstruction, intestinal stenosis, inflammatory bowel disease, previous abdominal surgeries with suspicious of adhesive bowel disease)
• Patients with reported upper gastrointestinal symptoms who would require a conventional EGD
• Patients currently participating in other clinical studies
• Patients who do not speak English