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

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.

Efficacy and timing of gastrografin administration after ileus tube insertion in patients with adhesive small bowel obstruction

“…However, there have conventionally been clinical concerns with regard to the technical difficulty associated with the insertion of a long intestinal tube under radiography, which requires a long time and involves a high radiation dose. Recently, many types of useful tube insertion methods have been reported, and they allow easy insertion of an ileus tube in patients with small bowel obstruction [13][14][15][16][17][18]. Treatment using an ileus tube should be selected in patients with small bowel obstruction owing to its usefulness and high effectiveness.…”

“…3 [2][3][4] vs. 3 [2][3] days, P = 0.51; median period of hospital admission: 12.5 [9.25-14] vs. 11 [9][10][11][12][13][14][15] days, P = 0.14). However, the median period of ileus tube intubation was significantly shorter in the NEGA group than in the EGA group (7 [5-8] vs. 5 [4][5][6][7] days, P = 0.007).…”

Early gastrografin administration after ileus tube insertion does not improve the clinical outcomes in patients with adhesive small bowel obstruction

“…Recently, many types of useful tube insertion methods have been reported, and they allow easy insertion of an ileus tube in patients with small bowel obstruction [12][13][14][15][16]. Treatment using an ileus tube should be selected in patients with small bowel obstruction owing to its usefulness and high effectiveness.…”

“…In the NEGA group, 5.9% (5/85) of patients were successfully treated without gastrografin administration. The median period until the first stool and median period of hospital admission were not significantly different between the EGA and NEGA groups (median period until the first stool: 3 [IQR, 2-4] vs. 3 [IQR, 2-3] days, P = 0.51; median period of hospital admission: 12.5 [IQR, 9.25-14] vs. 11 [IQR, [9][10][11][12][13][14][15] days, P = 0.14). However, the median period of ileus tube intubation was significantly shorter in the NEGA group than in the EGA group (7 [IQR, [5][6][7][8] vs. 5 [IQR, 4-7] days, P = 0.007).…”

“…The P-value is calculated using the Mann-Whitney U test for continuous data distributed abnormally. Period of hospital admission, median (days) [IQR] 11 [9][10][11][12][13][14] 12.5 [9.25-14] 11 [9][10][11][12][13][14][15] EGA, early gastrografin administration; NEGA, non-early gastrografin administration; IQR, interquartile range The P-value is calculated using Fisher's exact test for categorical data.…”