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J Neurogastroenterol Motil. 2017 Oct;23(4):585-591. English. Original Article. https://doi.org/10.5056/jnm16190
Thorsen Y , Stimec BV , Nesgaard JM , Ignjatovic D .
Department of Digestive Surgery, Akershus University Hospital, Lorenskog, Norway. yngve.thorsen@gmail.com
Institute of Clinical Medicine, University of Oslo, Norway.
Faculty of Medicine, Department of Cellular Physiology and Metabolism, Anatomy Sector, University of Geneva, Switzerland.
Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tonsberg, Norway.
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 were 11 cm for ileum and 21 cm for 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.

Conclusion

WMC can identify the non-physiological ICJ after right colectomy. Ileocolic competence cannot be assessed.

Copyright © 2019. Korean Association of Medical Journal Editors.