Digestive Diseases and Sciences

, Volume 57, Issue 3, pp 694–698 | Cite as

Head or Tail: The Orientation of the Small Bowel Capsule Endoscope Movement in the Small Bowel

  • Uri KopylovEmail author
  • Neofytos P. Papageorgiou
  • Moshe Nadler
  • Rami Eliakim
  • Shomron Ben-Horin
Original Article


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.


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.


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 head-first (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.


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.


Capsule endoscopy Small bowel Motility 

Supplementary material

10620_2011_1913_MOESM1_ESM.mpg (3.2 mb)
Video 1: Forward motion of the small bowel capsule. Supplementary material 1 (MPG 3300 kb)

Video 2: Backward motion of the small bowel capsule. Supplementary material 2 (MPG 256 kb)


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Uri Kopylov
    • 1
    Email author
  • Neofytos P. Papageorgiou
    • 1
  • Moshe Nadler
    • 1
  • Rami Eliakim
    • 1
  • Shomron Ben-Horin
    • 1
  1. 1.Department of GastroenterologyChaim Sheba Medical CenterTel HashomerIsrael

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