ClinicalRadiology (1992) 45, 35-36
Technical Report: A 'New' Tube Providing Rapid Insertion for the Small Bowel Enema R. L. LAW and A. J. L O N G S T A F F
Department of Radiology, Frenchay Hospital, Bristol Small bowel enteroclysis (SBE) is considered to be diagnostically superior to the conventional barium follow through examination (Sanders and H o 1976; Maglinte et aL, 1982; Herlinger, 1982) and would be more generally acceptable if jejunal intubation could be undertaken rapidly with minimum fluoroscopy and patient discomfort. Using a modified Merck 'Coresafe' tube 75 out of 80 patients referred for SBE were intubated, with considerably reduced fluoroscopic and intubation times. No tube related difficulty was encountered and patient tolerance was good. Law, R.L. & Longstaff, A.J. (1992). Clinical Radiology 45, 35 36. Technical Report: A 'New' Tube Providing Rapid Insertion for the Small Bowel Enema
Approximately 120 small bowel enteroclyses (SBE) have been undertaken annually in this hospital over the last 10 years using a variety of tubes. Based on this experience modifications were made to the tungsten weighted Merck 'Coresafe' SBE tube and its accompanying stylet, with the aim of reducing fluoroscopy and overall intubation time, as well as reducing patient discomfort. The 140 cm 10 F gauge, radiopaque, polyurethane 'Coresafe' tube with a prelubricated lumen was elongated by 12 cm, as variations of gastric anatomy can make jejunal intubation problematic if the tube is too short. The weighted tip was removed as it was found to be an unnecessary aid to fluoroscopy (Fig. 1) and increased the discomfort of the intubation. In addition with certain patients the stiffness of the weighted tube tip made transit around acute flexures more problematic. With the stylet fully inserted and the 'Flo-thru' stylet connector engaged into the tube the distal end of the styler is safely accepted by a tapered radiopaque plug, without risk of exit through the side ports. Insertion and withdrawal through the prelubricated lumen can be effected easily and safely. The stylet is of finer gauge than that provided with many SBE tubes. This allows greater flexibility, improving its effectiveness as well as patient comfort. An additional advantage is that when required, even with the stylet in situ, barium can be injected through the tube, via the connector, to outline anatomy.
RESULTS Using the modified Merck SBE tube (reorder no. 803601; E. Merck Ltd., Four Marks, Alton, Hampshire, GU34 5HG) and the technique described above, jejunal intubation was successful in 75 out of a consecutive series of 80 patients. The mean intubation fluoroscopy time for placing the tube tip 5 4 0 cm past the duodenal-jejunal flexure was 0.74 min with a mean total intubation time of 5.7 min. Two registrars without previous experience in performing small bowel enemas intubated a total of l 0 patients with a mean time for fluoroscopy of 0.63 min (recorded range
Technical Report: A 'New' Tube Providing Rapid Insertion for the Small Bowel Enema R. L. LAW and A. J. L O N G S T A F F
Department of Radiology, Frenchay Hospital, Bristol Small bowel enteroclysis (SBE) is considered to be diagnostically superior to the conventional barium follow through examination (Sanders and H o 1976; Maglinte et aL, 1982; Herlinger, 1982) and would be more generally acceptable if jejunal intubation could be undertaken rapidly with minimum fluoroscopy and patient discomfort. Using a modified Merck 'Coresafe' tube 75 out of 80 patients referred for SBE were intubated, with considerably reduced fluoroscopic and intubation times. No tube related difficulty was encountered and patient tolerance was good. Law, R.L. & Longstaff, A.J. (1992). Clinical Radiology 45, 35 36. Technical Report: A 'New' Tube Providing Rapid Insertion for the Small Bowel Enema
Approximately 120 small bowel enteroclyses (SBE) have been undertaken annually in this hospital over the last 10 years using a variety of tubes. Based on this experience modifications were made to the tungsten weighted Merck 'Coresafe' SBE tube and its accompanying stylet, with the aim of reducing fluoroscopy and overall intubation time, as well as reducing patient discomfort. The 140 cm 10 F gauge, radiopaque, polyurethane 'Coresafe' tube with a prelubricated lumen was elongated by 12 cm, as variations of gastric anatomy can make jejunal intubation problematic if the tube is too short. The weighted tip was removed as it was found to be an unnecessary aid to fluoroscopy (Fig. 1) and increased the discomfort of the intubation. In addition with certain patients the stiffness of the weighted tube tip made transit around acute flexures more problematic. With the stylet fully inserted and the 'Flo-thru' stylet connector engaged into the tube the distal end of the styler is safely accepted by a tapered radiopaque plug, without risk of exit through the side ports. Insertion and withdrawal through the prelubricated lumen can be effected easily and safely. The stylet is of finer gauge than that provided with many SBE tubes. This allows greater flexibility, improving its effectiveness as well as patient comfort. An additional advantage is that when required, even with the stylet in situ, barium can be injected through the tube, via the connector, to outline anatomy.
RESULTS Using the modified Merck SBE tube (reorder no. 803601; E. Merck Ltd., Four Marks, Alton, Hampshire, GU34 5HG) and the technique described above, jejunal intubation was successful in 75 out of a consecutive series of 80 patients. The mean intubation fluoroscopy time for placing the tube tip 5 4 0 cm past the duodenal-jejunal flexure was 0.74 min with a mean total intubation time of 5.7 min. Two registrars without previous experience in performing small bowel enemas intubated a total of l 0 patients with a mean time for fluoroscopy of 0.63 min (recorded range
