Magnetically controlled capsule endoscopy: Innovations, standardized practice, and emerging clinical roles

ABSTRACT: Capsule endoscopy has transformed small bowel evaluation but remains limited for gastric examination because of passive, peristalsis dependent movement. Magnetically controlled capsule endoscopy (MCE) addresses this limitation by enabling real time external steering of the capsule, allowing systematic visualization of the spacious gastric cavity without sedation or intubation. Since the first human application in 2010, multiple MCE platforms have been developed and validated, including handheld, magnetic resonance based, and robotic arm systems, with the latter now representing the dominant clinical platform. Clinical trials have demonstrated that robotic arm MCE achieves diagnostic accuracy comparable to conventional esophagogastroduodenoscopy for the detection of gastric lesions, while offering superior patient tolerance. In parallel, standardized examination protocols have been established, ensuring reproducible gastric preparation, complete mucosal coverage, and structured reporting. Recent technological advances, including higher resolution imaging, detachable string technology for combined esophageal and gastric examination, improved magnetic steering, and artificial intelligence assisted image analysis, have further expanded the diagnostic capability and efficiency of MCE. Importantly, the noninvasive and well tolerated nature of MCE supports its use in populations at increased risk from conventional endoscopy, including children, elderly patients, individuals with liver cirrhosis, and those receiving antiplatelet therapy. This review summarizes current MCE technologies, standardized clinical practice, and diagnostic performance, and discusses emerging clinical roles and future challenges. MCE is evolving from a novel diagnostic tool into a practical and well-tolerated noninvasive modality for upper gastrointestinal evaluation.