Abstract
Many patients with acute intestinal obstruction due to postoperative adhesions can be safely and effectively treated with non-operative treatment through a short gastric tube or long intestinal tube, by hyperbaric oxygen therapy, or by other conventional measures. Total parenteral nutrition combined with these decompression therapies has made it possible to support patients with long persisting intestinal obstruction, providing them with a good state of nutrition. Although the role of the long intestinal tube has been important, the passage of the tube through the pyrolus has sometimes been difficult. Various procedures for the institution of the long tube have been proposed, among which endoscopic insertion of the long tube seems to be best suited to the purpose. We therefore, developed a small caliber fibro-optic duodenoscope (DUO-CM), the diameter of the shaft of which is 6.4mm. We apply this fiberscope as follows: after topical anesthesia, this endoscope is advanced through a nostril down to the duodenum. After the tip of the scope reaches the duodenum, a Teflon-coated guidewire with a flexible tip is inserted to the duodenum through the biopsy channel. Then the scope is withdrawn, leaving the guidewire in the duodenum. The long tube (Dennis tube) is inserted over the guidewire, and is placed at the desired position.
This procedure is superior in terms of rapid and accurate placement of the long intestinal tube.
