J Neurogastroenterol Motil  
Detecting the Non-physiological, Surgically Tailored Ileocolic Anastomosis Using the Wireless Motility Capsule. A Pre- and Post-operative, Prospective, Within Subject Trial
Yngve Thorsen,1,2* Bojan V Stimec,3 Jens M Nesgaard,4 and Dejan Ignjatovic1,2
1Department of Digestive Surgery, Akershus University Hospital, Lorenskog, Norway; 2Institute of Clinical Medicine, University of Oslo, Oslo, Norway; 3Faculty of Medicine, Department of Cellular Physiology and Metabolism, Anatomy Sector, University of Geneva, Geneva, Switzerland; and 4Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tonsberg, Norway
Correspondence to: Yngve Thorsen, MD
Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Norway
Tel: +47-67969794, Fax: +47-67969040, E-mail: yngve.thorsen@gmail.com
Received: November 5, 2016; Revised: January 31, 2017; Accepted: March 12, 2017; Published online: June 1, 2017.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims
Wireless motility capsule (WMC) detects the ileocolic junction (ICJ) in most non-operated patients. We find no data concerning this examination in patients where the ileocolic valve is replaced by a per definition incompetent, surgically created ICJ. We wanted to see if WMC could detect the ICJ after a right colectomy and assess the competency.
Methods
Prospective cohort study using a within-subject design to eliminate subject-subject variability. Selected patients operated with right colectomy underwent 3 WMC examinations (pre-operatively, 3 weeks, and 6 months after surgery).
Results
Twenty patients (8 men) included, 7 (4 men) excluded due to poor recordings (4) and unforeseen events (3). Thirteen patients (4 men), median age 63 years completed 3 tests. Median bowel lengths removed 11.0 cm ileum and 21.0 cm colon. Thirty-nine examinations analyzed by 2 physicians who found all 13 ICJs at 3 examinations with high inter-rater reliability (intra-class correlation coefficient: 0.99, 0.91, and 0.99 respectively), whereas the computer found 9, 8, and 10 out of the 13 ICJs, respectively. Computed values significantly more often deviated from the 2 raters. Mean magnitude and duration of pH-drop at the ICJ (3 examinations) was 1.16-1.02-1.13 pH units and 3.15-4.78-3.75 minutes, respectively. pH-drop was smaller and duration longer at 3 weeks. We found no differences between the pre-operative (competent ICJ) and post-operative 6-month examinations (incompetent ICJ). Highest pressure immediately prior to ICJ was equal before and after surgery.
Conclusions
WMC can identify the non-physiological ICJ after right colectomy. Ileocolic competence cannot be assessed.
Keywords: Anastomosis, surgical; Colectomy; Gastrointestinal motility; Gastrointestinal transit; Ileocolic valve


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