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). Design: A prospective randomized clinical trial was conducted. Patients: Twenty-eight consecutive patients who presented with an intestinal obstruction were included in the study. Intervention: 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. Main Outcome Measurements: 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 18.71 +/- 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.