Abstract
It has been difficult to intubate the small intestinal fiberscope (SIF-B) into the deep jejunum because the fiberscope usually makes a loop in the stomach. Only the monorail tech-nique over a transintestinal probe, which is known as rope-way procedure, has been a method to pass the instrument into the lower portion of the small intestine and to take biopsy specimens, even though the trouble is that it takes 2 to 3 days to pass the transintestinal intubation. It is therefore advisable to use an active maneuver of peroral instrument, if only the intubation into the deep jejunum becomes possible. A new technique for intubation of the instrument into the lower portion of the intestine was successfully developed. The procedure in which the sliding tube is intubated into the descending portion of the duodenum is shown in Fig. 3 or Fig. 4 to 9, and the results in Fig. 13. In cases in which the instrument was intubated into the jejunal loop with counterclockwise rotation, the examination was done successfully in the mean extent of 80 cm (116 cm in the maximum) distal part from the duodenojejunal flexure, whereas 40 cm with clockwise rotation. The time required in intubation was only 25 minutes in average. Failure or complication has not been experienced. An advantage of this method is that reintubation or exchange of SIF-B for other more soft and long instrument as SIF-B long shown in Table 1 can be done easily.
