P4171 - Magnetically-Guided Capsule Endoscopy Equals Gastroscopy for Clinically Significant Gastric Lesion Detection: A Systematic Review and Meta-Analysis of 3 Randomized Trials

Ashesh Das, MBBS¹, Umama Alam, ², Alisha Ahmed, MBBS³, Venkata Dileep Kumar Veldi, MBBS⁴, Noorul Hidhaya, MBBS⁵, Saketh S. Mandiga, MBBS⁶, Naga Sai Akhil Reddy Gogula, MBBS⁷, Freya R. Thummar, MBBS⁸, Vineet R. Chandak, MBBS⁹, Nisha S. Gowda, MBBS¹⁰, Gadila Sindhu Reddy, ¹¹, Vinod Kumar Reddy Murukuti, MBBS¹², Siddharth P. Modi, ¹³
1KPC Medical College and Hospital , Kolkata, India, Kolkata, West Bengal, India; 2Khyber medical college, Peshawar, North-West Frontier, Pakistan; 3Jinnah Sindh medical university, Karachi, Sindh, Pakistan; 4Gayatri Vidya Parishad Institute of Health care and Medical Technology, Visakhapatnam, Andhra Pradesh, India; 5Stanley Medical College, Chennai, Tamil Nadu, India; 6Osmania General Hospital and Medical College, Hyderabad, Telangana, India; 7Duke University, Durham, NC; 8C.U. Shah Medical Collage, Surat, Gujarat, India; 9Seth Gordhandas Sundardas Medical College and KEM Hospital, Mumbai, Maharashtra, India; 10Gadag institute of medical science, Mysore, Karnataka, India; 11Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, Puducherry, India; 12ACSR GOVERNMENT MEDICAL COLLEGE, Proddatur, Andhra Pradesh, India; 13BJ Medical College, Gandhinagar, Gujarat, India

Introduction: Early detection of gastric neoplasia hinges on high-quality visual inspection, yet uptake of conventional esophagogastroduodenoscopy (EGD) is constrained by sedation, cost, and limited endoscopy capacity. Magnetically guided capsule endoscopy (MGCE) offers a non-sedated, office-based alternative that could widen access, but its diagnostic equivalence to EGD remains uncertain. We therefore synthesized all randomized evidence to determine whether second-generation MGCE matches EGD for clinically significant gastric lesion detection and to map lesion-specific concordance.

Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified RCTs MGCE vs Conventional EGD in managing UC through May 2025. Data were analysed using RevMan 4.2.1. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at p < 0.05. Risk of bias was assessed using RoB 2.0.

Results: Across three randomised trials (n = 462 gastric examinations) magnetically controlled capsule/standing-type capsule endoscopy detected gastric lesions as reliably as conventional gastroscopy (RR 1.05, 95 % CI 0.96–1.16; I² = 0). Leave-one-out sensitivity checks held the estimate within 1.02–1.06 and all CIs crossed unity. Lesion-level concordance in the largest trial was 78 % (50/64); MGCE missed 11 % and gastroscopy 11 %. Agreement for polyps reached 94 %, while MGCE captured five extra superficial erosions and gastroscopy detected more submucosal nodules. Thus, MGCE delivers patient-level yield equivalent to gastroscopy with complementary lesion-specific strengths.

Discussion: Pooled data show MGCE achieves patient-level detection rates indistinguishable from EGD, with robust sensitivity analyses and no heterogeneity. Lesion-level review reveals 78 % concordance, MGCE’s advantage for superficial erosions, and EGD’s edge for submucosal nodules—suggesting complementary strengths rather than outright superiority. These results position MGCE as a viable, sedation-free option for gastric surveillance and triage, warranting larger histology-driven trials to confirm long-term clinical impact.


Figure: Forest showing Gastric Lesions Detected

Disclosures:
Ashesh Das indicated no relevant financial relationships.
Umama Alam indicated no relevant financial relationships.
Alisha Ahmed indicated no relevant financial relationships.
Venkata Dileep Kumar Veldi indicated no relevant financial relationships.
Noorul Hidhaya indicated no relevant financial relationships.
Saketh S. Mandiga indicated no relevant financial relationships.
Naga Sai Akhil Reddy Gogula indicated no relevant financial relationships.
Freya Thummar indicated no relevant financial relationships.
Vineet Chandak indicated no relevant financial relationships.
Nisha Gowda indicated no relevant financial relationships.
Gadila Sindhu Reddy indicated no relevant financial relationships.
Vinod Kumar Reddy Murukuti indicated no relevant financial relationships.
Siddharth Modi indicated no relevant financial relationships.

Ashesh Das, MBBS¹, Umama Alam, ², Alisha Ahmed, MBBS³, Venkata Dileep Kumar Veldi, MBBS⁴, Noorul Hidhaya, MBBS⁵, Saketh S. Mandiga, MBBS⁶, Naga Sai Akhil Reddy Gogula, MBBS⁷, Freya R. Thummar, MBBS⁸, Vineet R. Chandak, MBBS⁹, Nisha S. Gowda, MBBS¹⁰, Gadila Sindhu Reddy, ¹¹, Vinod Kumar Reddy Murukuti, MBBS¹², Siddharth P. Modi, ¹³. P4171 - Magnetically-Guided Capsule Endoscopy Equals Gastroscopy for Clinically Significant Gastric Lesion Detection: A Systematic Review and Meta-Analysis of 3 Randomized Trials, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.