Intestinal Tube Placement Research Articles

Percutaneous Image-Guided Transesophageal Long Intestinal Tube Placement for Palliative Decompression in Advanced Cancer Patients with Unresectable Malignant Small Bowel Obstruction.

To assess the safety and efficacy of long intestinal tube placement following percutaneous image-guided esophagostomy for palliative decompression of incurable malignant small bowel obstruction. Between January 2013 and June 2022, a single-institution retrospective study was conducted to examine patients undergoing percutaneous transesophageal intestinal intubation for an occluded intestinal segment. Patients' baseline characteristics, procedural details, and clinical courses were reviewed. Severe complications were defined as those with ≥ 4 grade according to the CIRSE classification. This study included 73 patients (mean age, 57.7years) who underwent 75 procedures. All bowel obstructions were caused by peritoneal carcinomatosis or similar disease, which precluded transgastric access in almost 50% of the patients due to massive cancerous ascites (n = 28), diffuse gastric involvement (n = 5), or omental dissemination in front of the stomach (n = 3). Technical success (appropriate tube positioning) was achieved in 98.7% (74/75) of procedures. The cumulative 1-month overall survival and sustained clinical success (adequate bowel decompression) rates were estimated at 86.8% and 88%, respectively, using Kaplan-Meier analysis. At the median survival of 70days, the disease progression required other gastrointestinal interventions, including additional tube insertion, repositioning, or venting enterostomy in 16 patients (21.9%). The severe complication rate was 4% (3/75); one patient aspirated to death due to tube clogging and two encountered fatal perforation of isolated intestinal loops developing far beyond the tip of the indwelling tube. Percutaneous image-guided transesophageal intestinal intubation achieves feasible bowel decompression as palliative care in advanced cancer patients. Level 4, Case Series.

Successful Retrocecal Hernia Diagnosis and Treatment: A Case Report

Introduction A retrocecal hernia is a rare type of internal hernia that occasionally causes small bowel obstruction and strangulation ileus. We report a case of retrocecal hernia that was preoperatively diagnosed using multidetector raw computed tomography and successfully treated by emergency surgery. Case Presentation A 97-year-old woman presented at another hospital with abdominal distension and nausea. She was diagnosed with ileus and was conservatively treated with long intestinal tube placement. However, the symptoms had not improved after 7 days in the hospital. The patient was then referred to our hospital, where a pericecal hernia was diagnosed using multidetector raw computed tomography. We performed emergency surgery and intraoperatively confirmed the presence of a retrocecal hernia. A 30-cm nonviable section of small intestine was resected, and the hernia orifice was closed routinely. Postoperative recovery was uneventful. Conclusions Patients with pericecal hernia usually require surgical treatment. Multidetector raw computed tomography is useful for precise diagnosis of this type of hernia. Precise diagnosis is necessary to select prompt operative intervention for internal hernia.

Fluoroscopy‑guided long intestinal tube placement for the treatment of malignant bowel obstruction

The aim of the present study was to investigate the safety and efficacy of long intestinal tube placement under fluoroscopic guidance for the treatment of malignant bowel obstruction (MBO). The cases of 74 patients with MBO who underwent long intestinal tube placement under fluoroscopic guidance during the period between June 2015 and October 2017 were reviewed. The clinical characteristics were retrospectively analysed with respect to efficacy, safety and outcome. Long intestinal tube placement was successfully completed in all 74 patients. The mean time required for tube placement was 31.09±16.25 min and the mean insertion depth of the tube was 153±39 cm. In 58 cases, the symptoms of abdominal pain, abdominal bloating and vomiting were greatly improved following 1-3 days of tube decompression. The symptoms of the remaining 16 patients were not effectively relieved following decompression. No serious complications were observed in any patients. Overall, for patients with severe MBO, long intestinal tube placement under fluoroscopic guidance appears to be an effective and safe treatment, and it may improve quality of life.

Methods of naso intestinal tube placement in 9 patients with severe brain injury accompanied by gastric retention

Objective The causes of unsuccessful nasointestinal tube placement in 9 patients with severe brain injury and gastric retention were analyzed and corrected. Methods The 9 cases of unsuccessful nasointestinal tube placement were analyzed from the aspects of disease, sedative drug use, mechanical ventilation, weakened bowel sounds and so on. Blind intubation was used to correct the defect, and the depth and time consumed of blind intubation and ultrasonic catheterization were compared. Results All 9 patients had gastric emptying disorders, decreased gastrointestinal peristalsis, and increased gastric residue, which affected the entrance of the catheter to the pylorus. Among them, 5 patients were given 3 or more sedative drugs in the state of drug sedation, and 2 patients had gastric emptying disorder due to the location of the disease damage. Therefore, ultrasound-guided nasointestinal tube placement was unsuccessful. Finally the 9 patients are successful to be inserted nasointestinal tubes by the blind placement plus air injection method. The average time of blind intubation was (28.89±13.80) min, which was lower than that of ultrasonic catheterization (84.44±20.07) min, and the difference was statistically significant (t=6.842, P<0.01) . Conclusions The failure of ultrasound-guided nasointestinal tube placement in patients with severe brain injury and gastric retention is related to the severity of the patient, the use of sedatives, mechanical ventilation, gastric retention and other causes of gastrointestinal peristalsis weakened or disappeared. Clinical nurses are required to give accurate assessment. Patients with severe brain injury and massive gastric retention are advised to use the blind placement plus air injection method for nasointestinal tube placement. In the case of ultrasound-guided nasointestinal tube placement, gastric motility drugs need to be used in advance. Key words: Nursing care; Brain injury; Gastroparesis; Nasointestinal tube placement; Ultrasound-guided; Blind placement plus air injection

Transnasal Route: New Approach to Endoscopy

Transnasal esophagogastroduodenoscopy (TN-EGD) has recently become one of the frequently used methods of upper gastrointestinal endoscopy in some countries. Changes in blood pressure, heart rate, and oxygen saturation are smaller for TN-EGD than for conventional transoral esophagogastroduodenoscopy, making it a safer procedure. Lower pain and gag reflex enable TN-EGD to be performed without conscious sedation. TN-EGD is applied in various gastrointestinal (GI) procedures such as percutaneous endoscopic gastrostomy, nasoenteric feeding tube placement, endoscopic retrograde cholangiopancreaticography with nasobiliary drainage and lithotripsy, long intestinal tube placement in small-bowel obstruction, esophageal manometry, foreign body removal, botulinum toxin injection for achalasia, esophageal varix evaluation with the aid of endoscopic ultrasonography, and the double-scope technique for endoscopic submucosal dissection. The establishment of standard training programs and nationwide guidelines, the dissemination of educational information, the improvement in endoscopy devices and accessories, and the availability of insurance coverage for the procedure will obviously further widen the adoption of TN-EGD.

Transnasal ultrathin endoscopy for placement of a long intestinal tube in patients with intestinal obstruction

The technical difficulties related to the insertion of a long intestinal tube into the jejunum under fluoroscopy present a considerable problem in patients with an intestinal obstruction. To evaluate the usefulness of endoscopic long intestinal-tube placement with the ultrathin esophagogastroduodenoscope (UT-EGD). A prospective randomized clinical trial was conducted. Twenty-eight consecutive patients who presented with an intestinal obstruction were included in the study. The UT-EGD was inserted nasally into at least the second portion of the duodenum or beyond. After a guidewire was introduced through the working channel, with fluoroscopic guidance, the UT-EGD itself was carefully removed with the guidewire left in place. Next, a hydrophilic intestinal tube was advanced over the guidewire into the jejunum, and then the guidewire was removed. Primary end points are the total procedure time, the radiation exposure time, and the rate of complications, all compared with the conventional method. The mean (+/-SD) total procedure time was 18.7 +/- 8.4 minutes for the UT-EGD method and 39.5 +/- 15.0 minutes for the conventional method, with a significant time difference between the 2 methods (P < .0005). The mean (+/-SD) radiation exposure time was also shorter with the UT-EGD method (11.1 +/- 6.0 minutes) than with the conventional method (30.3 +/- 13.7 minutes) (P < .0005). There were no complications, except for mild nasal bleeding with each method. The UT-EGD method has definite advantages in the placement of a long intestinal tube for patients with an intestinal obstruction in comparison with the conventional method.

Determining Feeding Tube Location by Gastric and Intestinal pH Values

The purpose of this study was to evaluate a series of pH values of aspirates from feeding tubes to differentiate between gastric and intestinal tube placement. One hundred ventilator-supported subjects, with an order for nasoduodenal feeding tube placement were randomly selected. The feeding tube was placed into the stomach, verified by auscultation, and 2 pH measurements were obtained. After the pH measurements were taken, tube location was then verified by fluoroscopy. When the tube was advanced into the small intestine, location was verified by fluoroscopy, and 2 additional pH measurements were obtained. From the selected subjects, both a gastric and intestinal aspirate were obtained from 82 subjects. For the 82 subjects, the mean gastric and intestinal pH values were 4.8 +/- 2.3 and 7.1 +/- 1.0, respectively. For patients receiving acid-suppressing agents, these values were 5.0 +/- 2.3 and 7.2 +/- 1.0, respectively. For subjects not receiving acid-suppressing agents, these pH values were 4.0 +/- 2.5 and 6.7 +/- 1.1, respectively. For all patients, using a pH value of 6.5 as a predictor of feeding tube location, the sensitivity and specificity were 0.66 and 0.90. In addition, when an increase in pH > or = 1.0 was used as a predictor of location change for all patients, the sensitivity was 0.58. The pH value was a reliable predictor of nasoduodenal tube placement. However, radiographic confirmation of location could not be excluded because of the low sensitivity using pH measurements alone. An increase of > or = 1.0 in gastric vs intestinal pH specimens could be useful to determine use of radiography confirmation of tube placement.

Effectiveness of pH Measurements In Predicting Feeding Tube Placement

This paper reports further findings from an ongoing clinical study designed to evaluate the extent to which pH values of aspirates from feeding tubes can be used to differentiate between gastric and intestinal tube placement and gastric and respiratory tube placement. The sample consisted of 405 aspirates from small-bore nasogastric tubes and 389 aspirates from nasointestinal tubes, which were obtained from 605 subjects ranging in age from 18 to 94 years. Data were collected at the time of initial placement and again, when possible, after feedings were initiated. A total of 794 pH-meter readings were made concurrently with X-rays to determine feeding tube position. Gastric placement was successfully distinguished from intestinal placement of the feeding tubes on the basis of pH-meter readings (p < .0001). Approximately 85% of the 405 pH-meter readings from gastric fluid were between 0 and 6.0, while over 87% of the 389 pH-meter measurements performed on intestinal aspirates were greater than 6.0. Four aspirates from feeding tubes inadvertently placed in the respiratory tract (two in the pleural space and two in the tracheobronchial tree) were tested with a pH-meter, all had pH values greater than 6.5.