A study of human colonic motility in healthy and constipated subjects using the wireless capsule

A Flexible Implant for Multi-Day Monitoring of Colon Segment Activity

Monitoring of colon activity is currently limited to tethered systems like anorectal manometry. These systems have significant drawbacks, but fundamentally limit the observation time of colon activity, reducing the likelihood of detecting specific clinical events. While significant technological advancement has been directed to mobile sensor capsules, this work describes the development and feasibility of a stationary sensor for describing the coordinated activity between neighboring segments of the colon. Unlike wireless capsules, this device remains in position and measures propagating pressure waves and impedances between colon segments to describe activity and motility. This low-power, flexible, wireless sensor-the colon monitor to capture activity (ColoMOCA) was validated in situ and in vivo over seven days of implantation. The ColoMOCA diameter was similar to common endoscopes to allow for minimally invasive diagnostic placement. The ColoMOCA included two pressure sensors, and three impedance-sensing electrodes arranged to describe the differential pressures and motility between adjacent colon segments. To prevent damage after placement in the colon, the ColoMOCA was fabricated with a flexible polyimide circuit board and a silicone rubber housing. The resulting device was highly flexible and suitable for surgical attachment to the colon wall. In vivo testing performed in eleven animals demonstrated suitability of both short term (less than 3 hours) and 7-day implantations. Data collected wirelessly from animal experiments demonstrated the ColoMOCA described colon activity similarly to wired catheters and allowed untethered, conscious monitoring of organ behavior.

Minimally invasive wireless motility capsule to study canine gastrointestinal motility and pH

The aim of this study was to describe the feasibility of using a gastrointestinal tract wireless motility capsule (WMC) that measured intraluminal pressure, pH and transit time through the gastrointestinal tract, in dogs in their home environment. Forty-four adult healthy dogs, eating a standard diet, were prospectively enrolled. The WMC was well tolerated by all dogs and provided data from the different sections of the gastrointestinal tract. Median gastric emptying time was 20h (range, 6.3-119h), demonstrating a large range. The gastric pressure pattern and pH depended on the phase of food consumption. The small bowel transit time was 3.1h (range, 1.6-5.4h) with average contraction pressures of 6.5mmHg (range, 1.1-21.4mmHg) and pH 7.8 (range, 7-8.9). The large bowel transit time was 21h (range, 1-69h) with average contractions pressures of 0.9mmHg (range, 0.3-2.7mmHg) and pH 6.4 (range, 5.3-8.2). There was considerable individual variation in motility patterns and transit times between dogs. No difference was observed between the sexes. No relationships between any transit time, bowel pH or pressure pattern and bodyweights were identified. The WMC likely represents movement of a large non-digestible particle rather than normal ingesta. Due to its large size, the WMC should not be use in smaller dogs. The WMC is a promising minimally invasive tool to assess GIT solid phase transit times, pressures and pH. However, further studies are necessary due to the current limitations observed.

Functional Disorders: Slow-Transit Constipation

Constipation is a very common complaint, with slow-transit constipation (STC) accounting for a significant proportion of cases. Old age, female gender, psychiatric illness, and history of sexual abuse are all associated with STC. The exact cause of STC remains elusive; however, multiple immune and cellular changes have been demonstrated. Diagnosis requires evidence of slowed colonic transit which may be achieved via numerous modalities. While a variety of medical therapies exist, these are often met with limited success and a minority of patients ultimately require operative intervention. When evaluating a patient with STC, it is important to determine the presence of concomitant obstructed defecation or other forms of enteric dysmotility, as this may affect treatment decisions. Although a variety of surgical procedures have been reported, subtotal colectomy with ileorectal anastomosis is the most commonly performed and well-studied procedure, with the best track record of success.