Robotic Capsule Endoscopy: Simultaneous Gastric and Enteric Evaluation in Real-World Practice

<b>Background/Objectives</b>: Robotic capsule endoscopy (RCE) is an emerging technology that combines magnetically controlled gastric navigation with conventional capsule enteroscopy (CE), enabling a minimally invasive, comprehensive evaluation of the upper- and mid-gastrointestinal tract. This study aimed to characterize the real-world implementation and diagnostic performance of RCE in a European tertiary referral center. <b>Methods</b>: A retrospective, single-center analysis was conducted on adult patients (≥18 years) who underwent RCE (Omom RC) between June 2023 and July 2025. Eligible patients had a clinical indication for small bowel CE and a concurrent requirement for diagnostic gastroscopy or reassessment of known gastric lesions. The RCE protocol comprised an initial robotic-guided gastric examination followed by passive transit through the small bowel. <b>Results</b>: A total of 85 patients were included (52% female), with a median age of 49 years (IQR 40-64). The most common indications were suspected or established inflammatory bowel disease (57%) and iron deficiency anemia (31%). Gastric preparation was rated at least fair in 98% of cases, with good preparation in 38%. Median gastric transit time was 74 min (IQR 35-106). Relevant gastric findings were identified in 39 cases (46%), namely polyps (18%) and angiectasias (8%, including one with active bleeding), in addition to signs of chronic gastritis. Thirteen patients underwent subsequent endoscopy, resulting in seven therapeutic procedures. Small bowel findings were present in 60 patients (71%), including P3 (active bleeding) in 3% and P2 lesions (angiectasias, ulcers, tumors, varices) in 39%. One moderate adverse event occurred: small bowel capsule retention in a patient with multifocal neuroendocrine tumor and ileostomy, requiring endoscopic intervention. <b>Conclusions</b>: Robotic capsule endoscopy is a feasible tool for dual-region gastrointestinal evaluation. It enables high-quality gastric visualization, facilitates early detection of clinically actionable lesions, and maintains the diagnostic yield expected from standard small bowel CE. These findings support the integration of RCE into diagnostic pathways for patients requiring simultaneous gastric and small bowel assessment.