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A new method for insertion of long intestinal tube for small bowel obstruction

View Article: PubMed Central - PubMed

ABSTRACT

It is often difficult to insert a long intestinal tube (LT) in patients with small bowel obstruction (SBO). We developed a novel technique for inserting an LT without endoscopy called nonendoscopic over-the-wire method via short nasogastric tube (NEWSt). We evaluated the efficacy and safety of NEWSt.

We performed a retrospective study of patients who underwent LT insertion for SBO without any indications of strangulation with either NEWSt (n = 16) or endoscopy (n = 17) between November 2011 and February 2015 at our hospital. Univariate analysis was used to assess the success rate of LT placement beyond the duodenojejunal flexure, time required for the procedure, clinical outcomes, and adverse events.

The success rate was 100% in both groups. Procedure time was numerically, but not statistically, shorter in the NEWSt group compared with the endoscopy group (24 ± 13 vs 30 ± 13 min; P = 0.174). There were no statistically significant differences between the 2 groups in terms of surgery rate (31% vs 12%; P = 0.225), fasting period (11.3 ± 6.3 vs 9.9 ± 4.5 days; P = 0.482), hospital stay (26.4 ± 22.1 vs 18.7 ± 7.0 days; P = 0.194), and recurrence rate (19% vs 24%; P = 1.0). No serious adverse event was observed in the NEWSt group, whereas serious aspiration pneumonia was observed in 2 patients after LT insertion in the endoscopy group.

Without endoscopy, NEWSt enabled the high success rate and the short procedure time for the LT insertion. Prospective, randomized controlled trials are needed.

No MeSH data available.


Related in: MedlinePlus

Procedure of LT insertion using nonendoscopic over-the-wire method via short nasogastric tube (NEWSt). (A) A short nasogastric tube (NGT) is placed in the stomach before NEWSt. (B) A Dennis guidewire (1.32 mm, 500 cm long; Covidien, Tokyo, Japan) is inserted via NGT as distally as possible beyond the duodenojejunal flexure under fluoroscopy guidance. (C) The NGT is withdrawn while the guidewire is kept in place. (D) A hydrophilic long tube (16 Fr, 300 cm; Argyle Super Dennis Tube; Covidien, Tokyo, Japan) is inserted along the guidewire. (E) The guidewire is withdrawn. LT = long intestinal tube.
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Figure 1: Procedure of LT insertion using nonendoscopic over-the-wire method via short nasogastric tube (NEWSt). (A) A short nasogastric tube (NGT) is placed in the stomach before NEWSt. (B) A Dennis guidewire (1.32 mm, 500 cm long; Covidien, Tokyo, Japan) is inserted via NGT as distally as possible beyond the duodenojejunal flexure under fluoroscopy guidance. (C) The NGT is withdrawn while the guidewire is kept in place. (D) A hydrophilic long tube (16 Fr, 300 cm; Argyle Super Dennis Tube; Covidien, Tokyo, Japan) is inserted along the guidewire. (E) The guidewire is withdrawn. LT = long intestinal tube.

Mentions: For local anesthesia, 8% lidocaine was sprayed in the pharynx and a small amount of 2% lidocaine jelly was applied to the nostrils. A 1.32-mm wide, 500-cm long Dennis guidewire (Covidien, Tokyo, Japan) was inserted via NGT with the patient in the supine position. The guidewire was advanced beyond the duodenojejunal flexure under fluoroscopy guidance. NGT was then withdrawn while the guidewire was kept in place. Subsequently, a 16-Fr, 300-cm hydrophilic long tube (Argyle Super Dennis Tube; Covidien, Tokyo, Japan) was gently inserted along the guidewire. The tube was advanced as distally as possible beyond the duodenojejunal flexure. Finally, the positioning balloon was inflated, and the guidewire was withdrawn (Figs. 1 and 2).


A new method for insertion of long intestinal tube for small bowel obstruction
Procedure of LT insertion using nonendoscopic over-the-wire method via short nasogastric tube (NEWSt). (A) A short nasogastric tube (NGT) is placed in the stomach before NEWSt. (B) A Dennis guidewire (1.32 mm, 500 cm long; Covidien, Tokyo, Japan) is inserted via NGT as distally as possible beyond the duodenojejunal flexure under fluoroscopy guidance. (C) The NGT is withdrawn while the guidewire is kept in place. (D) A hydrophilic long tube (16 Fr, 300 cm; Argyle Super Dennis Tube; Covidien, Tokyo, Japan) is inserted along the guidewire. (E) The guidewire is withdrawn. LT = long intestinal tube.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5134882&req=5

Figure 1: Procedure of LT insertion using nonendoscopic over-the-wire method via short nasogastric tube (NEWSt). (A) A short nasogastric tube (NGT) is placed in the stomach before NEWSt. (B) A Dennis guidewire (1.32 mm, 500 cm long; Covidien, Tokyo, Japan) is inserted via NGT as distally as possible beyond the duodenojejunal flexure under fluoroscopy guidance. (C) The NGT is withdrawn while the guidewire is kept in place. (D) A hydrophilic long tube (16 Fr, 300 cm; Argyle Super Dennis Tube; Covidien, Tokyo, Japan) is inserted along the guidewire. (E) The guidewire is withdrawn. LT = long intestinal tube.
Mentions: For local anesthesia, 8% lidocaine was sprayed in the pharynx and a small amount of 2% lidocaine jelly was applied to the nostrils. A 1.32-mm wide, 500-cm long Dennis guidewire (Covidien, Tokyo, Japan) was inserted via NGT with the patient in the supine position. The guidewire was advanced beyond the duodenojejunal flexure under fluoroscopy guidance. NGT was then withdrawn while the guidewire was kept in place. Subsequently, a 16-Fr, 300-cm hydrophilic long tube (Argyle Super Dennis Tube; Covidien, Tokyo, Japan) was gently inserted along the guidewire. The tube was advanced as distally as possible beyond the duodenojejunal flexure. Finally, the positioning balloon was inflated, and the guidewire was withdrawn (Figs. 1 and 2).

View Article: PubMed Central - PubMed

ABSTRACT

It is often difficult to insert a long intestinal tube (LT) in patients with small bowel obstruction (SBO). We developed a novel technique for inserting an LT without endoscopy called nonendoscopic over-the-wire method via short nasogastric tube (NEWSt). We evaluated the efficacy and safety of NEWSt.

We performed a retrospective study of patients who underwent LT insertion for SBO without any indications of strangulation with either NEWSt (n = 16) or endoscopy (n = 17) between November 2011 and February 2015 at our hospital. Univariate analysis was used to assess the success rate of LT placement beyond the duodenojejunal flexure, time required for the procedure, clinical outcomes, and adverse events.

The success rate was 100% in both groups. Procedure time was numerically, but not statistically, shorter in the NEWSt group compared with the endoscopy group (24 ± 13 vs 30 ± 13 min; P = 0.174). There were no statistically significant differences between the 2 groups in terms of surgery rate (31% vs 12%; P = 0.225), fasting period (11.3 ± 6.3 vs 9.9 ± 4.5 days; P = 0.482), hospital stay (26.4 ± 22.1 vs 18.7 ± 7.0 days; P = 0.194), and recurrence rate (19% vs 24%; P = 1.0). No serious adverse event was observed in the NEWSt group, whereas serious aspiration pneumonia was observed in 2 patients after LT insertion in the endoscopy group.

Without endoscopy, NEWSt enabled the high success rate and the short procedure time for the LT insertion. Prospective, randomized controlled trials are needed.

No MeSH data available.


Related in: MedlinePlus