TY - JOUR
T1 - Head or tail
T2 - The orientation of the small bowel capsule endoscope movement in the small bowel
AU - Kopylov, Uri
AU - Papageorgiou, Neofytos P.
AU - Nadler, Moshe
AU - Eliakim, Rami
AU - Ben-Horin, Shomron
PY - 2012/3
Y1 - 2012/3
N2 - Background and Aims The diagnostic accuracy of capsule endoscopy has been suggested to be influenced by the direction of the passage in the intestine. It is currently unknown if a head-first or a tail-first orientation are equally common during the descent through the small bowel. The aim of the study was to identify the orientation of the capsule along the migration through the small bowel. Methods Thirty capsule endoscopies were reviewed by an experienced observer. The direction of the passage through the pylorus and the ileoceccal valve was recorded for all the examinations. In addition, detailed review of the passage of the capsule in different segments of the small bowel was undertaken for all the capsules. Results The capsule was significantly more likely to pass the pylorus head-first compared to tail-first (25 and 5 out of 30, respectively, OR 5, 95% CI 65-94%, P<0.001). In 28/30 studies, the capsule exited the ileoceccal valve headfirst (OR-14, 95% CI 77-99%, P<0.001). In an immersion experiment, uneven distribution of weight of the capsule body was demonstrated with the head part (camera tip) being lighter than the tail part. Conclusions The capsule endoscope usually passes through the pylorus and subsequent segments of the small bowel head-first. This observation suggests that the intestinal peristaltic physiology drives symmetrical bodies with their light part first. The principle of intestinal orientation by weight distribution may bear implications for capsules' design in the future.
AB - Background and Aims The diagnostic accuracy of capsule endoscopy has been suggested to be influenced by the direction of the passage in the intestine. It is currently unknown if a head-first or a tail-first orientation are equally common during the descent through the small bowel. The aim of the study was to identify the orientation of the capsule along the migration through the small bowel. Methods Thirty capsule endoscopies were reviewed by an experienced observer. The direction of the passage through the pylorus and the ileoceccal valve was recorded for all the examinations. In addition, detailed review of the passage of the capsule in different segments of the small bowel was undertaken for all the capsules. Results The capsule was significantly more likely to pass the pylorus head-first compared to tail-first (25 and 5 out of 30, respectively, OR 5, 95% CI 65-94%, P<0.001). In 28/30 studies, the capsule exited the ileoceccal valve headfirst (OR-14, 95% CI 77-99%, P<0.001). In an immersion experiment, uneven distribution of weight of the capsule body was demonstrated with the head part (camera tip) being lighter than the tail part. Conclusions The capsule endoscope usually passes through the pylorus and subsequent segments of the small bowel head-first. This observation suggests that the intestinal peristaltic physiology drives symmetrical bodies with their light part first. The principle of intestinal orientation by weight distribution may bear implications for capsules' design in the future.
KW - Capsule endoscopy
KW - Motility
KW - Small bowel
UR - http://www.scopus.com/inward/record.url?scp=84859496652&partnerID=8YFLogxK
U2 - 10.1007/s10620-011-1913-6
DO - 10.1007/s10620-011-1913-6
M3 - מאמר
AN - SCOPUS:84859496652
VL - 57
SP - 694
EP - 698
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
SN - 0163-2116
IS - 3
ER -