Long-tube insertion with the ropeway method facilitated by a guidewire placed by transnasal ultrathin endoscopy for bowel obstruction: a prospective, randomized, controlled trial - 23/08/11

Doi : 10.1016/j.gie.2009.01.044

Yoshihide Kanno, MD ^⁎, Dai Hirasawa, MD, Naotaka Fujita, MD, Yutaka Noda, MD, Go Kobayashi, MD, Kazuhiko Ishida, MD, Kei Ito, MD, Takashi Obana, MD, Takashi Suzuki, MD, Toshiki Sugawara, MD, Jun Horaguchi, MD, Osamu Takasawa, MD, Kazunari Nakahara, MD, Tetsuya Ohira, MD, Kengo Onochi, MD, Yoshihiro Harada, MD, Wataru Iwai, MD, Masatake Kuroha, MD
Current affiliations: Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan

Reprints: Yoshihide Kanno, MD, 5-22-1, Tsurugaya, Miyagino-ku, Sendai 983-0824, Japan.

Sendai, Japan

Abstract

Background

It is often difficult to insert a long intestinal tube in the small bowel of patients with bowel obstruction, and it often results in long procedure time and severe patient distress.

Objective

To assess the usefulness of the ropeway method by using a guidewire placed with the assistance of transnasal ultrathin endoscopy in long-tube insertion for patients with bowel obstruction.

Design

Prospective, randomized, controlled, single-center study.

Patients and Interventions

Thirty-four consecutive patients with bowel obstruction requiring decompression participated in the study and were randomized to the insertion of a long tube with the ropeway method (ILTR) group (ie, insertion along an endoscopically placed guidewire that was passed through only the distal 4 cm of the tube) or insertion by a conventional method group (C group).

Main Outcome Measurements

The time required for the procedure (main), success rate, x-ray exposure time, and intensity of patient distress measured with a visual analog scale of 1 to 5 (better to worse).

Results

The mean (± standard deviation) duration of the procedure in the successful cases in the ILTR group and the C group was 16.1 ± 5.6 minutes and 26.4 ± 13.8 minutes, respectively (P = .010). The success rate was 100% in the ILTR group and 88% in the C group (P = .48). The mean (± standard deviation) x-ray exposure time and intensity of patient distress were, respectively, 16.4 ± 8.7 minutes and 33.2 ± 12.3 minutes (P < .001) and 2.6 ± 0.7 and 3.7 ± 1.2 (P = .016).

Limitations

Single-center study and small sample size to evaluate overall safety.

Conclusions

Long-tube insertion for bowel obstruction with the ropeway method facilitated by transnasal ultrathin endoscopy was superior to conventional fluoroscopic placement with regard to overall procedure success, time required, and patient comfort.

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Abbreviations : ILTR, SD

Plan

Sample size calculation

Statistical analysis

Results

Discussion

	DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
	If you want to chat with an author of this article, you may contact him at yoshi-hk@openhp.or.jp.