Decompression Tube Placement Research Articles

Observational study of colonoscopy techniques used for acute colorectal obstruction: A single-center experience.

The prevalence of acute colorectal obstruction at the hospital setting is high. There is need for improvement in the quality of colonoscopy for relieving obstruction. A retrospective, uncontrolled, open-label study was conducted, with the aim of documenting the causes of acute colorectal obstruction and the quality of colonoscopy practice in managing obstruction at a university hospital in China. A total of 61 adult patients with acute colorectal obstruction treated with urgent colonoscopy between February, 2011 and January, 2016 were identified at the Endoscopic Unit of Tongji Hospital (Wuhan, China). The technique success rate was the primary outcome. The etiology was mainly related to malignant diseases, including colorectal cancer in 53 patients (86.9%) and advanced peritoneal serous carcinoma leading to extrinsic colonic compression in 1 patient (1.6%). Benign causes of obstruction included foreign bodies in 3 patients (4.9%) and fecal impaction in 2 patients (3.3%); furthermore, anastomotic strictures were found in 2 patients (3.3%). The technique success rate was 98.4% (60/61). All colorectal cancer patients who underwent urgent colonoscopy were admitted to the Department of Surgery for placement of a self-expanding metallic stent; 1 patient who had an extracolonic malignancy underwent placement of a transanal colonoscopic decompression tube as palliative therapy and 2 patients with anastomotic strictures underwent endoscopic balloon dilation. Furthermore, colonoscopy was used for extracting the foreign body, as well as removing fecal stones in all the patients. In conclusion, urgent colonoscopy as a minimal invasive approach is associated with certain advantages for diagnosing and managing acute colorectal obstruction. Furthermore, experienced operators achieved a better outcome when managing colorectal obstruction.

Computerized tomography attenuation values can be used to differentiate hydronephrosis from pyonephrosis.

To determine the diagnostic value of computerized tomography (CT) in differentiating pyonephrosis from hydronephrosis on the basis of attenuation values (Hounsfield unit-HU). Data of the patients with grades 1-3 hydronephrosis on abdominopelvic CT, who underwent nephrostomy tube placement for decompression of the collecting system, were retrospectively analyzed. Patient demographics and CT findings were recorded along with the first access urine culture results. Three physicians calculated the surface areas and the attenuation values of the dilated collecting systems using the system software. Mean HU of pyonephrosis and hydronephrosis cases was compared. A total of 105 patients with the mean age of 47.7±15.5 (range 20-80) were included. The interclass correlation coefficient of three physicians was 0.981 for HU measurement and 0.999 for calculation of collecting system surface area. Of the patients, 47 (44.8%) had pyonephrosis. Mean surface areas of the collecting system were similar in patients with pyonephrosis and hydronephrosis (1481.13±1562.94 vs. 1612.94±2261.4mm2, p=0.735). Urine cultures were positive in all patients with pyonephrosis, whereas 12.7% of hydronephrosis cases had bacterial in first access urine culture. The HU of the patients with pyonephrosis was significantly higher that that of patients with hydronephrosis (13.51±13.29 vs. 4.67±5.37, p=0.0001). Having a HU of 9.21 or over diagnosed pyonephrosis accurately with 65.96% sensitivity and 87.93% specificity. Measuring attenuation values of the collecting system may be useful to differentiate pyonephrosis from hydronephrosis. Diagnosing pyonephrosis accurately may avoid septic complications.

Placement of the Decompression Tube as a Bridge to Surgery for Acute Malignant Left-Sided Colonic Obstruction

PurposeThe aim of this study is to investigate the feasibility, safety, and effectiveness of placing the decompression tube as a bridge to surgery for acute malignant left-sided colonic obstruction. MethodsFrom January 2009 to August 2014, consecutive patients with acute malignant left-side colonic obstruction underwent placement of the decompression tube as a bridge to surgery in our center. The technical and clinical success of placing the decompression tube was evaluated. Clinical success was defined as relief of obstructive symptoms within 48 h after placing the decompression tube. Elective tumor resection was performed 7–9 days after colonic decompression. The types of surgery, primary anastomosis rate, and follow-up findings were analyzed. ResultsTwenty patients with acute malignant left-side colonic obstruction underwent placement of the decompression tube as a bridge to surgery. Placement of decompression tube was technically successful in all patients. No procedure-related complication occurred. Clinical success was achieved in 19 patients. Elective tumor resection and primary anastomosis were successfully performed in all 19 patients. The postoperative complications included wound infection (n = 2) and anastomotic stenosis (n = 1). ConclusionDecompression tube can serve as an easy, safe, and effective bridge to subsequent surgery for patients with acute malignant left-sided colonic obstruction.

Endoscopic Decompression, Detorsion, and Reduction of Sigmoid Volvulus

BackgroundColonic volvulus is a loop of bowel twisted around the site of mesenteric attachment leading to bowel obstruction. The sigmoid colon is involved in a majority of these cases. If untreated, sigmoid volvulus leads to bowel ischemia, perforation, sepsis, and potential death. Patients and methodsIn this video manuscript, we present two patients with uncomplicated sigmoid volvulus that were successfully managed by emergent endoscopic decompression, detorsion, and reduction (EDDR) and temporary colon decompression tube placement as a bridge therapy to elective and definitive surgical interventions. Detailed endoscopic evaluation and techniques are described. In addition, classic radiological findings such as the “coffee bean” sign on plain radiograph and the “whirl” sign on computed tomography are shown. ResultsAfter successful EDDR with subsequent bowel preparation and medical resuscitation, both patients underwent elective surgical resection of the sigmoid colon with primary anastomosis without post-operative complications. ConclusionsSigmoid volvulus is a medical emergency and diagnosis requires a high index of suspicion. Emergent EDDR and decompression tube placement should be utilized as a first line treatment for patients with uncomplicated sigmoid volvulus.

The Effectiveness of Self-Expandable Metallic Stent Insertion in Treating Right-Sided Colonic Obstruction: A Comparison between SEMS and Decompression Tube Placement and an Investigation of the Safety and Difficulties of SEMS Insertion in Right Colons.

Objectives. Self-expandable metallic stent (SEMS) is widely used to treat malignant colonic obstruction. However, most reports about SEMS insertion have concentrated on the left colon. This study aimed to (1) investigate the effectiveness of SEMS insertion compared with conventional decompression tube for right-sided colonic obstruction and (2) compare the safety and technical success of SEMS insertion between left- and right-sided colonic obstructions. Methods. The data from thirty-seven patients who underwent SEMS or conventional decompression tube placement for malignant colonic obstruction in our hospital were analyzed retrospectively. Technical and clinical success, complications, and technical difficulties were analyzed. We compared the results between SEMS insertion and decompression tube placement in right colons and the outcomes of SEMS insertion between right- and left-sided colonic obstructions. Results. For right colons, the clinical success rate of SEMS insertion (100%) was significantly higher than that of decompression tube placement (55.9%). Concerning SEMS insertion, the technical difficulty and safety of SEMS insertion were similar between right- and left-sided colonic obstructions. Conclusion. SEMS insertion for right-sided colon is significantly more effective than conventional decompression tube placement, and this procedure was safer and less technically challenging than expected. SEMS insertion should be considered for treating right-sided malignant colonic obstruction.

Postpyloric decompression tube placement through a gastrostomy for malignant bowel obstruction

BackgroundMalignant bowel obstruction affect a patient’s quality of life, but, management of MBO is controversial.Case presentationA 51-year-old woman who had been diagnosed as uterine cervix cancer 2 years ago and had undergone surgery, chemotherapy and radiotherapy, was admitted to our hospital. She was diagnosed as having a recurrence of peritoneal metastasis and bowel obstruction. For her nasal pain, we considered insertion of a postpyloric decompression tube through the gastrostomy instead of via the nasal cavity. After insertion of a percutaneous gastrostomy tube was performed endoscopically, we introduced a postpyloric decompression tube through her gastrostomy. She could be discharged home, and 91 days later, she died in her home under hospice care, as she had wished.ConclusionsInsertion of a postpyloric decompression tube through a gastrostomy might be useful in the management of advanced cancer patients with bowel obstruction.

Percutaneous endoscopic gastrostomy tube occlusion in malignant peritoneal carcinomatosis-induced bowel obstruction

Percutaneous endoscopic gastrostomy (PEG) tube placement for decompression in advanced peritoneal carcinomatosis with bowel obstruction is a safe and feasible palliative procedure. We describe a rare, previously unreported phenomenon of PEG tube occlusion by gastric mucosal herniation. A consecutive case series of 73 patients with advanced abdominal carcinomatosis-induced bowel obstruction from January 2007 to June 2010. All patients had a 28 Fr (Bard) PEG tube placed for drainage. None of them were surgical candidates due to extensive peritoneal involvement. Patients with PEG tube occlusion as a result of gastric mucosal herniation were further evaluated. Nineteen patients were men and 54 were women. The mean age was 53.3 years. The most common cancer types were ovary, pancreas, colon, and stomach. All patients had PEG tube functioning well after the procedure with immediate relief of obstructive symptoms. Subsequently, 10 patients developed acute occlusion of PEG tubes with reoccurrence of obstructive symptoms. The time between the placement of the PEG tube and its occlusion ranged from 5 to 129 days. Repeat endoscopy showed the PEG tube occluded with gastric mucosa from the opposite wall. PEG tube was replaced with a 28 Fr balloon replacement tube leading to symptom improvement in all 10 patients. This rare but correctable phenomenon of obliteration of PEG tube from the gastric mucosa should be considered in any patient who develops intermittent occlusive symptoms. This phenomenon can be corrected by replacing the PEG tube with a ballooned replacement tube as well as occasional manipulation of the tube.

Clinical significance of rapid recovery nursing following minimally-invasive laparoscopic surgery

Objective To investigate the effect of rapid recovery nursing without the use of gastrointestinal decompression tube and with early food intake on patients with minimally-invasive laparoscopic surgery. Methods Two hundred and twenty patients with resection of the stomach, intestine, gallbladder and uterus using minimally-invasive laparoscopic surgery were enrolled in this study, with an observation group (120patients) and a control group (100 patients) established. The control group was treated with the placement of gastrointestinal decompression tube during surgery and regular nursing following surgery, whereas the observation group had no placement of gastrointestinal tube during surgery and were treated with rapid recovery nursing and early food intake for comparison with the control group. Results The recovery times of both the bowel sound and the passage of gas by anus in the observation group were earlier than the control group (P ＜0. 01). Cases with sore throat, nausea and vomiting were significantly reduced (P ＜ 0. 01), and the hospital stay was also significantly reduced in the observation group (P ＜0. 01) compared with the control group. Furthermore, no significant difference existed in the complication rate in both groups (P ＞ 0. 05). Conclusions Rapid recovery nursing is feasible and safe, and can reduce the pain and enable a quick recovery following laparoscopic surgery. Key words: Minimally-invasive laparoscopic surgery; Gastrointestinal decompression tube; Early food intake; Rapid recovery nursing

Transanal placement of ileus decompression tube for left colon carcinoma with obstruction

Objective To explore the value of transanal placement of ileus decompression tube in left colon carcinoma with obstruction. Methods Data of 35 patients with complete malignant colon obstruction, who underwent placement of ileus decompression tube by colonoseopy and fluoroscopy with guidewire from January 2007 to December 2009, were retrospectively studied. Results Tube placement was successfully performed with one procedure in all 35 patients. Phase I surgery was achieved in 34 patients at 7 - 10 days after decompression. The tube desquamated in 1 case 2 days after the placement, and was replaced successfully, and the patient received phase I resection 8 days after. No perforation or other complications occurred in any cases. Conclusion Placement of ileus decompression tube, assisted with colonoscopy and fluoroscopy, simple and safe, can immediately relieve the symptoms of intestinal obstruction, decrease the risk of emergency operation and help to avoid colonostomy and phase U radical operation. Key words: Transanal placement of ileus depressed tube; Left hemicolon carcinoma, Intestinal Obstruction

Pharyngostomy tubes for gastric conduit decompression

This article illustrates our operative technique for pharyngostomy tube placement and describes our clinical experience with pharyngostomy use for gastric conduit decompression after esophagectomy. We retrospectively reviewed patients undergoing pharyngostomy tube placement for gastric conduit decompression after esophagectomy from January 2008 to August 2009. Patients were included if they had a pharyngostomy tube placed at esophagectomy (prophylactic placement) or as a means of decompression after postesophagectomy anastomotic leak (therapeutic placement). We collected operative and clinical data and performed a descriptive statistical analysis. We placed 25 pharyngostomy tubes for gastric conduit decompression after esophagectomy. Eleven were placed prophylactically (44%); the remaining 14 were placed therapeutically (56%) after anastomotic leak. Prophylactic pharyngostomy tubes remained in place a median of 8 days (range 4-17 days), whereas therapeutic pharyngostomy tubes were left in place a median of 15 days (range 7-125 days). There were 4 infectious complications (16%) unrelated to length of pharyngostomy use: 2 cases of cellulitis (resolved with antibiotics, tube remaining in place) and 2 superficial abscesses after tube removal requiring bedside débridement. Seventy-two percent of patients underwent swallow evaluation; 22% of these patients had radiographic evidence of aspiration. Pharyngostomy tube placement for gastric conduit decompression after esophagectomy is simple, and tubes can stay in place for prolonged periods. Our experience suggests that pharyngostomy tubes are a safe alternative to nasogastric drainage.

Percutaneous transesophageal gastrostomy tube placement: an alternative to percutaneous endoscopic gastrostomy in patients with intra-abdominal metastasis

PEG/jejunostomy (PEG/J) is often placed in patients with metastatic gastric cancer for palliating bowel obstruction or for feeding. However, PEG/J placement may not always be possible for many reasons. We wish to bring attention to the percutaneous transesophageal gastrostomy/jejunostomy (PTEG/J) as a viable alternative to nasogastric decompression in patients who are not candidates for PEG/J. PTEG/J is a largely unknown technique in the United States that designed to gain access to the stomach and proximal small bowel in these patients. We describe the use of PTEG/J in 3 patients with metastatic gastric cancer by using resources and techniques readily available in a well-stocked interventional radiology suite. In the first case, percutaneous transesophageal gastrostomy (PTEG) was placed for palliation of intractable nausea and vomiting in a 37-year-woman with diffuse gastric cancer and peritoneal carcinomatosis. In the second case, PTEG was extended into the jejunum for feeding a 60-year-old woman with metastatic gastric cancer. In the third case, PTEG extending into the jejunum was placed in a 69-year-old man for palliation of bowel obstruction caused by metastatic gastric cancer and peritoneal carcinomatosis. After adequate sedation is administered, a 22 x 4-mm balloon catheter is passed into the esophagus over a guidewire just below the thoracic inlet. The balloon is ruptured with a needle passed through the neck under US guidance. A guidewire is then passed through the needle into the balloon and carried into the stomach or proximal small bowel by advancing the balloon catheter. The track is then dilated over the guidewire and a pigtail 45-cm-long 14F nephrostomy tube then passed into the stomach or into the proximal small bowel over the guidewire. The catheter is secured by suturing to the skin of the neck. PTEG/J was effective in achieving palliation or feeding in our patients. No complications occurred. PTEG/J is a safe and effective alternative to standard percutaneous gastrostomy/jejunostomy tube placement for decompression of bowel obstruction or feeding in appropriately selected patients.

Percutaneous Transesophageal Gastrostomy Tube Placement — An Alternative to Percutaneous Endoscopic Gastrostomy in Patients with Intraabdominal Metastasis

Purpose: Percutaneous Endoscopic Gastrostomy/Jejunostomy (PEG/J) is often placed in patients with metastatic gastric cancer for palliating bowel obstruction or for feeding. However, PEG/J placement may not always be possible due to altered anatomy after surgery, tese ascites, rechnical failure, or diffuse intra-abdominal metastatic disease. Percutaneous Transesophageal Gastrostomy/Jejunostomy (PTEG/J), largely unknown in the United States, is a viable alternative to naso-gastric decompression in patients not candidates for PEG/J. We describe the use of PTEG/J in three patients with metastatic gastric cancer utilizing resources and techniques readily available in a well stocked Interventional Radiology suite. Methods: After adequate sedation, a 22 mm X 4 mm balloon catheter is passed into the esophagus over a guidewire just below the thoracic inlet. The balloon is ruptured with a needle passed through the neck under ultrasound guidance. A guidewire is then passed through the needle into the balloon and carried into the stomach or proximal small bowel by advancing the balloon catheter. The track is then dilated over the guidewire and a pig tail 45 cm long 14F nephrostomy tube then passed into the stomach or into the proximal small bowel over the guidewire. The catheter is secured by suturing to the skin of the neck.FigureResults: In the first case, PTEG was placed for palliation of intractable nausea and vomiting in a 37 year woman with diffuse gastric cancer and peritoneal carcinomatosis. In the second case, PTEG was extended into the jejunum (PTE-J) for feeding a 60 year old woman with metastatic gastric cancer. In the third case, PTE-J was placed in a 69 year old man for palliation of bowel obstruction due to metastatic gastric cancer and peritoneal carcinomatosis. PTEG/J was effective in achieving palliation or feeding in our patients. No complications occurred. Conclusion: PTEG/J is a safe and effective alternative to standard percutaneous gastrostomy/jejunostomy tube placement for decompression of bowel obstruction or feeding in appropriately selected patients.

Acute Pancreatitis and Ileus Postcolonoscopy

Postpolypectomy bleeding and perforation are the most common complications of colonoscopy. A case of acute pancreatitis and ileus after colonoscopy is described. A 60-year-old woman underwent a gastroscopy and colonoscopy for investigation of iron deficiency anemia. Gastroscopy was normal; however, the colonoscope could not be advanced beyond the splenic flexure due to a tight angulation. Two polypectomies were performed in the descending colon. After the procedure, the patient developed a distended, tender abdomen. Bloodwork was remarkable for an elevated amylase level. An abdominal x-ray and computed tomography scan showed pancreatitis (particularly of the tail), a dilated cecum and a few air-fluid levels. The patient improved within 24 h of a repeat colonoscopy and decompression tube placement. The patient had no risk factors for pancreatitis. The causal mechanism of pancreatitis was uncertain but likely involved trauma to the tail of the pancreas during the procedure. Our patient developed ileus, likely secondary to pancreatitis. The present case is the first report of clinical pancreatitis and ileus associated with colonoscopy.

Sigmoid stiffener for decompression tube placement in colonic pseudo-obstruction.

Decompression tube placement improves outcome in colonic pseudo-obstruction (CP) which is refractory to conservative measures, especially if the decompression tube is placed proximal to the hepatic flexure. We evaluate the ability of a sigmoid stiffener to facilitate more proximal colonoscopy and decompression tube placement. A sigmoid stiffener is used in the standard fashion during colonoscopic decompression for pseudo-obstruction. After cecal wire placement, the colonoscope is withdrawn, leaving the stiffener and wire in place. By passing through the stiffener, an over-wire decompression tube can avoid sigmoid looping. We compared proximal extent of colonoscopy, tube position, endoscopy time, and patient outcomes using a sigmoid stiffener, with a control group of patients treated previously. Patients with colonic ischemia were excluded. Using this technique, nine consecutive colonoscopies and decompression tube placements reached the right colon. Significantly, only three of seven control colonoscopies and two control decompression tubes did so. However, improvements in procedural time and patient outcome did not reach statistical significance. No complications occurred. The use of a sigmoid stiffener during colonic decompression allows more proximal colonoscopy and decompression tube placement, with possible clinical benefit. We do not use this technique in the setting of left colon ischemia.

Randomized controlled trial of rectal tube placement for the management of abdominal distension following colonoscopy

Background: Traditionally, endoscopists have sought to provide maximum comfort for patients undergoing colonoscopy but may have been less concerned with the level of patient discomfort following the procedure. The aim of this study was to examine the effectiveness of rectal tube placement for abdominal decompression following colonoscopy in an effort to limit patient discomfort. Methods: We conducted a prospective, single-blind, randomized controlled trial in 67 consecutive men undergoing elective colonoscopy. At the end of the procedure, patients were randomized to rectal tube placement or standard management without tube placement. Patients were evaluated by standardized criteria 30 minutes after completion of colonoscopy, and again 24 hours later. Results: Thirty patients were randomized to rectal tube placement and 37 served as controls. The two groups were well matched with respect to age, duration of colonoscopy, quality of bowel preparation, prevalence of diverticulosis, frequency of polypectomy, and degree of difficulty in colonoscopy. At 30 minutes after colonoscopy, patients' overall satisfaction rating (mean ± SD) from a 10-point scale was 9.1 ± 3.2 in treated patients and 5.7 ± 3.9 in controls ( p < 0.05; 2-tailed unpaired t test). Conclusion: Placement of a rectal tube at the conclusion of colonoscopy reduces patient discomfort, and improves satisfaction. (Gastrointest Endosc 1997;46:444-6.)

Acute colonic pseudo-obstruction: Treatment by endoscopic decompression and proximal colonic tube placement

Acute colonic pseudo-obstruction: Treatment by endoscopic decompression and proximal colonic tube placement

New technique: Sigmoid stiffener for endoscopic decompression tube placement in ogil vie's

New technique: Sigmoid stiffener for endoscopic decompression tube placement in ogil vie's

Endoscopic decompression for acute colonic pseudo-obstruction

Background: Acute colonic pseudo-obstruction is often treated by colonoscopic decompression. Efficacy, safety, and outcome of endoscopic decompression was assessed. Methods: Colonoscopic decompressions from 1988 to 1994 were reviewed. Resolution without further endoscopic intervention was defined as clinical success. Results: Acute colonic pseudo-obstruction was diagnosed in 50 patients. Thirty-three cases followed surgery or trauma and 17 developed during severe medical illness. Orthopedic joint surgery was most common. Nineteen of 50 patients (38%) had severe underlying medical disease. Forty-one patients (82%) had one colonoscopic decompression with clinical success in 39 (95%). Nine patients (18%) required multiple (2 to 4) colonoscopic decompressions with clinical success in 5 (56%). A decompression tube positioned in the right colon (57%) and in the transverse colon (33%) had similar clinical success. In 8 procedures a decompression tube was not placed, with poor clinical success (25%). The overall clinical success of colonoscopic decompression was 88% (44 of 50). An endoscopic perforation occurred in 1 patient (2%). Overall hospital mortality was 30%. Conclusions: Colonoscopic decompression is effective and safe for acute colonic pseudo-obstruction that does not respond to conservative therapy. Most patients will respond to one colonoscopic decompression with decompression tube placement. Complete colonoscopy and cecal tube placement is unnecessary. (Gastrointest Endosc 1996;44:144-50.)

Treatment of acute nontoxic megacolon during colonoscopy: tube placement versus simple decompression

The study compares the efficacy of colonoscopic decompression versus decompression and tube placement in the treatment of Ogilvie’s syndrome. Nine patients were treated with a single colonoscopic decompression which resulted in four recurrences. In contrast, there were no recurrences observed in 11 patients who underwent decompression and subsequent tube placement (p < 0.05). There was no morbidity observed from either decompression or tube placement. Tube placement added less than 10 min of additional procedure time to the colonoscopy. The tube utilized in this study was an enteroclysis tube with sideholes cut in the distal 20 cm. The tube was easily inserted over a Teflon-coated flexible guide wire inserted through the colonoscope into the cecum following decompression. This study demonstrates that colonoscopic decompression followed by tube placement is the preferred treatment modality for acute nontoxic megacolon.