title: Transnasal ultrathin endoscopy for placement of a long intestinal tube in patients with intestinal obstruction.
abstract: 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.
authors.affiliation: Division of Endoscopy, Asahikawa Medical College, Asahikawa, Japan.
authors.forename: Ryu
authors.initials: R
authors.lastname: Sato
authors.forename: Jiro
authors.initials: J
authors.lastname: Watari
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tanabe
authors.forename: Mikihiro
authors.initials: M
authors.lastname: Fujiya
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ueno
authors.forename: Youkou
authors.initials: Y
authors.lastname: Konno
authors.forename: Chisato
authors.initials: C
authors.lastname: Ishikawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ito
authors.forename: Kentaro
authors.initials: K
authors.lastname: Moriichi
authors.forename: Kotaro
authors.initials: K
authors.lastname: Okamoto
authors.forename: Atsuo
authors.initials: A
authors.lastname: Maemoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Chisaka
authors.forename: Yohei
authors.initials: Y
authors.lastname: Kitano
authors.forename: Kakuya
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Ashida
authors.forename: Toru
authors.initials: T
authors.lastname: Kono
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kohgo
mesh_terms: 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