Superior gastrointestinal visualization and safety of detachable string magnetically controlled capsule endoscopy in patients on antithrombotic agents

Wireless magnetically controlled capsule endoscopy (WMCCE) offers a non-invasive alternative for patients on antithrombotic therapy, but it has limitations in esophageal visualization and carries risks of capsule retention. We aim to explore the safety and feasibility of detachable string magnetically controlled capsule endoscopy (ds-MCE) for patients on antithrombotic agents. This single-center, retrospective study included 387 patients on antithrombotic therapy who underwent magnetically controlled capsule endoscopy between October 2023 and October 2024: 86 with ds-MCE and 301 with WMCCE. Differences in the visualization of the esophagus and stomach, lesions detection and examination time of the esophagus, stomach and small intestine between the two groups were compared, and the safety of ds-MCE was assessed based on string-related discomfort and adverse events. The primary outcome was visualization of the oesophagus. The key secondary outcome was the safety of ds-MCE. The ds-MCE group achieved significantly higher rates of complete visualization of the esophageal Z-line (52.3% vs. 6.3%, p < 0.001) and esophageal mucosa (upper: 87.2% vs. 38.2%; middle: 97.7% vs. 38.9%; lower: 98.8% vs. 53.5%, p < 0.001). Detection rates of esophageal lesions, including cancer and varices, were higher in the ds-MCE group (p < 0.001). No capsule retention occurred in the ds-MCE group, and 94.2% reported no or mild discomfort. The ds-MCE improved esophageal visualization and lesion detection compared to WMCCE, offering a safer and less invasive alternative to esophagogastroduodenoscopy for patients on antithrombotic agents with excellent safety and tolerability.