Nasointestinal tube for decompression or enteroclysis: experience with 150 patients

Nasointestinal tubes versus nasogastric tubes in the management of small-bowel obstruction: A meta-analysis

BACKGROUND

There is no consensus regarding the therapeutic effect of nasointestinal tubes (NITs) versus nasogastric tubes (NGTs) in the management of small-bowel obstruction (SBO). This study aimed to compare the clinical outcomes between the use of NITs and NGTs in the management of SBO.

METHODS

Published studies on comparing NITs with NGTs in the treatment of SBO were searched from electronic databases. Two investigators independently extracted the data; any discrepancies were adjudicated by a third investigator. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using Review Manager 5.0.

RESULTS

An extensive literature search identified 268 relevant publications, 4 of which met the inclusion criteria. There were no significant differences in the nonrequirement of operative intervention between NITs and NGTs groups (OR: 1.79; 95% CI: 0.55, 5.84). Compared with the NGTs, the NITs, which successfully passed through the pylorus, did not decrease the rate of operation in patients with SBO (OR: 2.19; 95% CI: 0.59, 8.15). There was no advantage of NITs over NGTs in patients with partial SBO (P-SBO) (OR: 1.04; 95% CI: 0.23, 4.60). Postoperative complications were compared between the groups (OR: 2.13; 95% CI: 1.09, 4.15).

CONCLUSION

The result of this meta-analysis showed no advantage of NITs over NGTs in the management of patients with SBO.

A prospective randomized trial of transnasal ileus tube vs nasogastric tube for adhesive small bowel obstruction

AIM: To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.

METHODS: A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study. The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube (NGT) was used in 90 patients. The therapeutic efficacy was compared between the two groups.

RESULTS: Compared with the NGT group, the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph (4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests (P < 0.01). The overall effectiveness rate was up to 89.6% in the ileus tube group and 46.7% in the NGT group (P < 0.01). And 10.4% of the patients in the ileus tube group and 53.3% of the NGT group underwent surgery. For recurrent adhesive bowel obstruction, ileus tube was also significantly more effective than NGT (95.8% vs 31.6%). In the ileus tube group, the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure (P < 0.05). The abdominal radiographic improvement was correlated with whether or not the patient underwent surgery.

CONCLUSION: Ileus tube can be used for adhesive small bowel obstruction. Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.

CT enteroclysis in incomplete small bowel obstruction

The timing of surgical intervention as well as the optimal method of radiologic investigation for patients with incomplete, open loop small bowel obstruction has changed over the past two decades. This review focuses on the role of computed tomographic enteroclysis in the evaluation of patients with suspected small bowel obstruction. The technique of examination is described and an overview of its clinical applications and imaging controversy are presented.

Small-bowel obstruction: state-of-the-art imaging and its role in clinical management

Small-bowel obstruction (SBO) is a common clinical condition with signs and symptoms similar to other acute abdominal disorders. The radiologic investigation of patients with SBO as well as the indications and timing of surgical intervention have changed over the past 2 decades. This review focuses on modern imaging techniques and their role in both the diagnosis and treatment of patients with SBO.

Multislice CT enteroclysis: technique and clinical applications

Computed tomography (CT) enteroclysis was introduced to overcome the individual deficiencies of barium enteroclysis and abdominal CT. The use of multislice CT technology has made the procedure a feasible extension of the intubation infusion method of small bowel examination. This review is an update of the technique and clinical application of CT enteroclysis with illustrations.

Radiology of small bowel obstruction: contemporary approach and controversies

The radiologic workup of patients with known or suspected small bowel obstruction and the timing of surgical intervention in this complex situation have undergone considerable changes over the past two decades. The diagnosis and treatment of small bowel obstruction, a common clinical condition often associated with signs and symptoms similar to those seen in other acute abdominal disorders, continue to evolve. This article examines the changes related to the use of imaging in the diagnosis and management of patients with this potentially dangerous problem and revisits pertinent controversies.

Mr enteroclysis using iron oxide particles (ferristene) as an endoluminal contrast agent: An open phase III trial

To evaluate efficacy and safety of a superparamagnetic iron oxide contrast agent (ferristene) as an endoluminal contrast medium for magnetic resonance (MR) enteroclysis in a phase III trial. Twenty-three patients with history of known or suspected small bowel Crohn's disease underwent MR imaging of the abdomen at 0.5 T unit. The imaging protocol included two phases: the first one without administration of any contrast agent and the second one, where the small bowel was filled by enteroclysis with 800 ml of the luminal iron oxide contrast medium and Gd-DTPA (0.1 mmol/Kg) was administered intravenously. Axial Spin-Echo (SE) T1-weighted (T1w), proton-density and T2w images, sagittal and coronal SE T1w and Short TI Inversion Recovery (STIR) sequences were subsequently obtained. Three investigators blindly evaluated images to determine small bowel distribution of ferristene, presence of artifacts, delineation of bowel lesion/wall and the diagnostic value of ferristene combined with gadolinium. Pre- and postcontrast signal intensity measurements of bowel lesion/wall, bowel lumen and background noise were also calculated. Three patients withdrew before the procedure, therefore 20 patients were effectively included in the study. No significant difference between the three investigators' evaluations of the improvement of the diagnostic information was found (percentage of improvement of 90% with 95% confidence limits of 68% and 99%). A statistically significant difference between the first and third investigators was found for grading of quality of delineation of bowel lesion/wall. Signal intensity measures showed a significant increase of the bowel lesion/wall and background noise/lesion for the SE T1w images. No serious adverse event was reported in our series. MR enteroclysis using ferristene as an endoluminal contrast agent appears to be a safe and efficient procedure for the study of the small bowel.

Current concepts in imaging of small bowel obstruction

The diagnosis and treatment of small bowel obstruction continue to evolve. The imaging approach in the work-up of patients with known or suspected small bowel obstruction and the timing of surgical intervention in this disease have undergone considerable changes over the past two decades. This article examines the current concepts related to the use of imaging technology in the diagnosis and management of patients with small bowel obstruction. The meaning of frequently used but poorly defined terms in describing intestinal obstruction is clarified and illustrated.

Technical refinements in enteroclysis

As the primary method of investigating the small bowel, enteroclysis remains a technique in evolution. Technical refinements have made the examination faster to perform, better tolerated by patients, and easier to interpret. More recently, its essential principle of volume challenge has been combined with the tremendous advantage of CT cross-sectional imaging with multiplanar reformatting to give rise to the exciting new techniques of CT enteroclysis and MR enteroclysis (see separate reviews in this issue). Through improvements in methodology and advancements in technology, the future of enteroclysis looks bright indeed.

Multidetector-row helical CT enteroclysis

Currently, CT-E is not recommended as the first-line examination in patients when mucosal detail is required. Double-contrast barium air enteroclysis has advantages in demonstrating small mucosal abnormalities. The authors find CT-E of value in the work-up of patients with symptoms of intermittent small bowel obstruction, particularly those with a history of prior abdominal surgery; in the further work-up of selected patients with high-grade obstruction in whom general surgeons prefer initial conservative management (immediate postoperative small bowel obstruction, patients with history of prior abdominal surgery for malignant tumor, history of radiation treatment, and possible internal extraintestinal fistulae); in looking for complications of small bowel Crohn's disease; and in the patient with unexplained anemia or gastrointestinal bleeding. In a series of patients who had both abdominal CT and barium enteroclysis done, each examination provided unique and complimentary diagnostic information. Because CT-E combines the advantages of both methods of examination, is it the optimum imaging work-up in the investigation of small bowel disease? Further research and clinical experience will define the precise role of CT-E in the investigation of small bowel disease. Experience with this method of examination is limited to a few institutions, performed by investigators with interest in small bowel diseases. The addition of cross-sectional display and multiplanar reformatting made possible by multidetector-row helical CT to enteral volume change and the use of multifunctional nasointestinal catheters make CT-E an important tool in the investigation of small bowel disease. Experience has shown the increased reliability of any method of examining the small bowel that challenges intestinal wall distensibility by fluid enteral volume infusion.

Small-bowel obstruction: optimizing radiologic investigation and nonsurgical management

Small-bowel obstruction is an old and common problem. Like most illnesses, its diagnosis and treatment continue to evolve. The radiologic approach to the investigation of small-bowel obstruction and the timing of surgical intervention have undergone considerable changes during the past decade. In this review, the authors analyze the recently described radiologic techniques used in the examination of patients with suspected mechanical small-bowel obstruction, revisit the controversy of the short versus long decompression tube, and provide insights on how to optimize the radiologic investigation and nonsurgical management of small-bowel obstruction.

[Value of intraluminal intestinal decompression by endoscopic placement of a Dennis tube in therapy of ileus. Retrospective clinical study of 174 patients]

For determination of the efficacy of intraluminal bowel decompression by an endoscopically placed Dennis tube, 174 patients with paralytic ileus or different kinds of partial small bowel obstruction were reviewed retrospectively. There were 66 cases (37.9%) of early postoperative ileus (A), 27 (15.5%) of late postoperative ileus (B), 38 (21.8%) of paralytic ileus (C), 31 (17.8%) with obstruction due to advanced intraabdominal tumors (D), and 12 (6.8%) of obstructive ileus caused by inflammatory stenosis of the small bowel in Crohn's disease (E). Successful endoscopic placement of the intestinal tube was achieved in 97.2% of patients. Placement of the tube was impossible in 5 cases. A total of 95 patients (54.6%) were successfully managed by long intestinal tube decompression. Success rates for the individual groups were 71.2% (A), 18.5% (B), 86.8% (C), 16.1% (D), and 41.7% (E). Some 75 patients (43.1%) had to be operated on because of insufficient conservative therapy. Four patients with advanced intraabdominal tumors died during the treatment with the intestinal tube; 13 patients died postoperatively. There was no tube-related mortality, but tube-related complications occurred in 6.9%. We conclude that intraluminal intestinal tube decompression after endoscopic placement provides a therapeutic tool with a concomitant low complication and high success rate in paralytic and early postoperative ileus.