title: Long-tube insertion with the ropeway method facilitated by a guidewire placed by transnasal ultrathin endoscopy for bowel obstruction: a prospective, randomized, controlled trial.
abstract: BACKGROUND
  It is often difficult to insert a long intestinal tube in the small bowel of patients with bowel obstruction, and it often results in long procedure time and severe patient distress.
  
  
  OBJECTIVE
  To assess the usefulness of the ropeway method by using a guidewire placed with the assistance of transnasal ultrathin endoscopy in long-tube insertion for patients with bowel obstruction.
  
  
  METHODS
  Prospective, randomized, controlled, single-center study.
  
  
  METHODS
  Thirty-four consecutive patients with bowel obstruction requiring decompression participated in the study and were randomized to the insertion of a long tube with the ropeway method (ILTR) group (ie, insertion along an endoscopically placed guidewire that was passed through only the distal 4 cm of the tube) or insertion by a conventional method group (C group).
  
  
  METHODS
  The time required for the procedure (main), success rate, x-ray exposure time, and intensity of patient distress measured with a visual analog scale of 1 to 5 (better to worse).
  
  
  RESULTS
  The mean (+/- standard deviation) duration of the procedure in the successful cases in the ILTR group and the C group was 16.1 +/- 5.6 minutes and 26.4 +/- 13.8 minutes, respectively (P = .010). The success rate was 100% in the ILTR group and 88% in the C group (P = .48). The mean (+/- standard deviation) x-ray exposure time and intensity of patient distress were, respectively, 16.4 +/- 8.7 minutes and 33.2 +/- 12.3 minutes (P < .001) and 2.6 +/- 0.7 and 3.7 +/- 1.2 (P = .016).
  
  
  CONCLUSIONS
  Single-center study and small sample size to evaluate overall safety.
  
  
  CONCLUSIONS
  Long-tube insertion for bowel obstruction with the ropeway method facilitated by transnasal ultrathin endoscopy was superior to conventional fluoroscopic placement with regard to overall procedure success, time required, and patient comfort.
authors.affiliation: Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan. yoshi-hk@openhp.or.jp
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Kanno
authors.forename: Dai
authors.initials: D
authors.lastname: Hirasawa
authors.forename: Naotaka
authors.initials: N
authors.lastname: Fujita
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Noda
authors.forename: Go
authors.initials: G
authors.lastname: Kobayashi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ishida
authors.forename: Kei
authors.initials: K
authors.lastname: Ito
authors.forename: Takashi
authors.initials: T
authors.lastname: Obana
authors.forename: Takashi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Toshiki
authors.initials: T
authors.lastname: Sugawara
authors.forename: Jun
authors.initials: J
authors.lastname: Horaguchi
authors.forename: Osamu
authors.initials: O
authors.lastname: Takasawa
authors.forename: Kazunari
authors.initials: K
authors.lastname: Nakahara
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ohira
authors.forename: Kengo
authors.initials: K
authors.lastname: Onochi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Harada
authors.forename: Wataru
authors.initials: W
authors.lastname: Iwai
authors.forename: Masatake
authors.initials: M
authors.lastname: Kuroha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000628:therapy*; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies