title: Sigmoid stiffener for decompression tube placement in colonic pseudo-obstruction.
abstract: OBJECTIVE
  Decompression tube placement improves outcome in colonic pseudo-obstruction (CP) which is refractory to conservative measures, especially if the decompression tube is placed proximal to the hepatic flexure. We evaluate the ability of a sigmoid stiffener to facilitate more proximal colonoscopy and decompression tube placement.
  
  
  METHODS
  A sigmoid stiffener is used in the standard fashion during colonoscopic decompression for pseudo-obstruction. After cecal wire placement, the colonoscope is withdrawn, leaving the stiffener and wire in place. By passing through the stiffener, an over-wire decompression tube can avoid sigmoid looping. We compared proximal extent of colonoscopy, tube position, endoscopy time, and patient outcomes using a sigmoid stiffener, with a control group of patients treated previously. Patients with colonic ischemia were excluded.
  
  
  RESULTS
  Using this technique, nine consecutive colonoscopies and decompression tube placements reached the right colon. Significantly, only three of seven control colonoscopies and two control decompression tubes did so. However, improvements in procedural time and patient outcome did not reach statistical significance. No complications occurred.
  
  
  CONCLUSIONS
  The use of a sigmoid stiffener during colonic decompression allows more proximal colonoscopy and decompression tube placement, with possible clinical benefit. We do not use this technique in the setting of left colon ischemia.
authors.affiliation: Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee 53226, USA. wberger@mcw.edu
authors.forename: W L
authors.initials: WL
authors.lastname: Berger
authors.forename: K
authors.initials: K
authors.lastname: Saeian
mesh_terms: D000328:Adult; D000368:Aged; D003112:Colonic Pseudo-Obstruction / Q000209:etiology / Q000628:therapy*; D019299:Decompression, Surgical / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D020694:Sigmoidoscopes