Long-tube insertion with the ropeway method facilitated by a guidewire placed by transnasal ultrathin endoscopy for bowel obstruction: a prospective, randomized, controlled trial

Background: It is often difficult to insert a long intestinal tube in the small bowel of patients with bowel obstruction, and it often results in long procedure time and severe patient distress. Objective: To assess the usefulness of the ropeway method by using a guidewire placed with the assistance of transnasal ultrathin endoscopy in long-tube insertion for patients with bowel obstruction. Design: Prospective, randomized, controlled, single-center study. Patients and Interventions: Thirty-four consecutive patients with bowel obstruction requiring decompression participated in the study and were randomized to the insertion of a long tube with the ropeway method (ILTR) group (ie, insertion along an endoscopically placed guidewire that was passed through only the distal 4 cm of the tube) or insertion by a conventional method group (C group). Main Outcome Measurements: The time required for the procedure (main), success rate, x-ray exposure time, and intensity of patient distress measured with a visual analog scale of 1 to 5 (better to worse). Results: The mean (± standard deviation) duration of the procedure in the successful cases in the ILTR group and the C group was 16.1 ± 5.6 minutes and 26.4 ± 13.8 minutes, respectively (P = .010). The success rate was 100% in the ILTR group and 88% in the C group (P = .48). The mean (± standard deviation) x-ray exposure time and intensity of patient distress were, respectively, 16.4 ± 8.7 minutes and 33.2 ± 12.3 minutes (P < .001) and 2.6 ± 0.7 and 3.7 ± 1.2 (P = .016). Limitations: Single-center study and small sample size to evaluate overall safety. Conclusions: Long-tube insertion for bowel obstruction with the ropeway method facilitated by transnasal ultrathin endoscopy was superior to conventional fluoroscopic placement with regard to overall procedure success, time required, and patient comfort.