Purpose Postoperative recovery following colorectal surgery remains impaired by severe complications including postoperative ileus (POI). Human studies of POI have been limited by a lack of safe and easy-to-use objective methods. Motilis 3D-transit is a completely ambulatory, minimally invasive system whereby electromagnetic capsules are followed by external sensors during their passage of the gastrointestinal (GI) tract. The aim of this study was to evaluate the applicability of the 3D-transit system in a surgical setting.
Method We included 12 patients as a substudy of the randomised double blind controlled Stimulation of the Autonomic Nervous System In Colorectal Surgery by perioperative nutrition (SANICS)-II trial undergoing elective segmental colonic resection with primary anastomosis at Aarhus University Hospital and Randers Regional Hospital, Denmark. To study region-specific motility, three electromagnetic capsules were administered. One was taken 3 hours before surgery, the next was taken 1 hour before surgery, while the third was placed distal to the anastomosis during surgery. Total and regional GI transit times as well as time until first propulsive colonic contraction were determined.
Results All patients tolerated the setup well with no adverse events related to the 3D-transit system. Large variations were found in total GI transit time (26.7–127.6 hours), gastric emptying (0.07–>106.9 hours), small intestinal (1.2–58.4 hours) and colorectal transit time (14.3–>118.1 hours). Time from end of surgery to first propulsive movement in the colon varied from 3.9 to 85 hours. No correlation was found between parameters of GI motility and tolerance of an oral diet or recovery of bowel function.
Conclusion The 3D-transit system allows safe assessment of GI motility in patients operated with segmental colonic resections and primary anastomosis for colorectal cancer. Postsurgical motility varies significantly between patients.
- colorectal cancer
- postoperative ileus
- gastrointestinal motility
- gastrointestinal transit
- pilot study
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Contributors JN, MWK, JAF, TS, KK and SL designed and conceived the study. JN collected the data, completed case report forms and analysed the data. JN, JAF, TS, KK and SL interpreted the data. MWK validated the data. JN and JAF wrote the manuscript. JN submitted the study. All authors critically revised and agreed on the final version of the manuscript and are responsible for its content.
Funding JN received a Research Year Scholarship from Randers Regional Hospital (17 932–21201) and funding from the A.P. Møller Foundation (Proj.827). As a part of the SANICS-II-trial, this study received funding by research grants from the Netherlands Organisation for Health Research and Development (ZonMW, 837001505), Fonds NutsOhra (1403–057) and Danone Research.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was performed in accordance with the declaration of Helsinki and with approval from the Danish Ethical Committee (approval number 1-10-72-245-15). The project was reported to the Danish Data Protection Agency through joint notification from Region Midtjylland. Approval for authorisation for clinical investigations of medical devices carried out in human subjects was obtained from the Danish Medicines Agency (case number 2016021313).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.