Transnasal ultrathin endoscopy for placement of a long intestinal tube in patients with intestinal obstruction.
BACKGROUND
The technical difficulties related to the insertion of a long intestinal tube into the jejunum under fluoroscopy present a considerable problem in patients with an intestinal obstruction.


OBJECTIVE
To evaluate the usefulness of endoscopic long intestinal-tube placement with the ultrathin esophagogastroduodenoscope (UT-EGD).


METHODS
A prospective randomized clinical trial was conducted.


METHODS
Twenty-eight consecutive patients who presented with an intestinal obstruction were included in the study.


METHODS
The UT-EGD was inserted nasally into at least the second portion of the duodenum or beyond. After a guidewire was introduced through the working channel, with fluoroscopic guidance, the UT-EGD itself was carefully removed with the guidewire left in place. Next, a hydrophilic intestinal tube was advanced over the guidewire into the jejunum, and then the guidewire was removed.


METHODS
Primary end points are the total procedure time, the radiation exposure time, and the rate of complications, all compared with the conventional method.


RESULTS
The mean (+/-SD) total procedure time was 18.7 +/- 8.4 minutes for the UT-EGD method and 39.5 +/- 15.0 minutes for the conventional method, with a significant time difference between the 2 methods (P < .0005). The mean (+/-SD) radiation exposure time was also shorter with the UT-EGD method (11.1 +/- 6.0 minutes) than with the conventional method (30.3 +/- 13.7 minutes) (P < .0005). There were no complications, except for mild nasal bleeding with each method.


CONCLUSIONS
The UT-EGD method has definite advantages in the placement of a long intestinal tube for patients with an intestinal obstruction in comparison with the conventional method.
Sato
Ryu
R
Division of Endoscopy, Asahikawa Medical College, Asahikawa, Japan.
Watari
Jiro
J
Tanabe
Hiroki
H
Fujiya
Mikihiro
M
Ueno
Nobuhiro
N
Konno
Youkou
Y
Ishikawa
Chisato
C
Ito
Takahiro
T
Moriichi
Kentaro
K
Okamoto
Kotaro
K
Maemoto
Atsuo
A
Chisaka
Kenji
K
Kitano
Yohei
Y
Matsumoto
Kakuya
K
Ashida
Toshifumi
T
Kono
Toru
T
Kohgo
Yutaka
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000628:therapy*; D007421:Intestine, Small; D007441:Intubation, Gastrointestinal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D008904:Miniaturization / Q000295:instrumentation*; D009666:Nose; D011446:Prospective Studies