Endoscopic insertion of an ileus tube with attached silk threads as endoscope grasping points

Abstract

Successful ileus tube (I-tube) insertion requires passing the I-tube into the pylorus,^{1, 2} which may be achieved using an endoscope, and then advancing the I-tube through the duodenum. The latter can be difficult because the force pushing the I-tube may not be effectively transmitted to the tip.^{3, 4} Because the duodenum runs through the retroperitoneum like a tunnel and does not stretch, the I-tube can pass smoothly through the duodenum if directly pushed from inside the stomach, ensuring that the tip does not get trapped into the duodenal folds.

Here, we propose a new I-tube insertion method that involves attaching grasping points by tying silk threads on the I-tube and pushing the I-tube from inside the stomach with an endoscope (Fig. 1). Specifically, we used a 16F closed-end I-tube with a soft atraumatic tip that was designed to avoid getting trapped into the folds. Silk threads were tied on the I-tube at 5 cm intervals to cover 60 cm from the tip. After the I-tube entered the duodenum, it was pushed by using an endoscope (Fig. 2; Video S1).

A 60-year-old man underwent surgery for an abdominal aortic aneurysm. The patient presented with abdominal distention and was suspected to have a combination of paralytic ileus and adhesive intestinal obstruction. Endoscopic I-tube insertion was performed on the sixth operative day. Insertion to a depth of 60 cm into the pylorus was smoothly completed within 6 min, with the balloon successfully entering the jejunum. The patient was discharged on the 27th postoperative day.

The body of the designed I-tube showed sufficient stiffness to not require the use of a guidewire, and the I-tube did not retract during endoscope removal. Insertion was performed in 14 cases and was successful in all cases. The proposed use of an I-tube with endoscope grasping points is a promising method for rapid and simple ileus tube insertion.^{2, 5}

Author Y.B. holds a United States Patent on the naso-jejunal medical tubes (Patent No. US10,524,988 B2). The other authors declare no conflict of interest for this article.