Intestinal Obstruction and the Utility of Ileus Tubes

Nasal Endoscopy-Assisted Ileus Tube Insertion
Gastroenterological Endoscopy Vol. 52(6), Jun. 2010

Intestinal obstruction is defined as "a pathological condition caused by an impairment in the transport of intestinal contents toward the anal side", and it is also referred to as ileus in Japan (in Western countries, the terms bowel obstruction or intestinal obstruction are generally used, and the word ileus is rarely used except for paralytic ileus). Intestinal obstruction is a condition that, if not treated appropriately, can progress to dehydration, sepsis, and multiple organ failure. If ischemia is present, it can also cause intestinal necrosis or rupture. In cases of intestinal obstruction without ischemia, conservative treatment is the first-line therapy, and intestinal drainage using an ileus tube or similar device is effective. In the early 1900s, with the spread of surgical procedures, intestinal obstruction due to postoperative adhesions increased dramatically, and its mortality rate reportedly reached 50%; however, with the advent of the ileus tube (called a long intestinal tube in Western countries), this decreased dramatically, and it is now less than 3%. Ileus tube insertion is an effective treatment, but it is often experienced that the procedure time is long and causes significant patient discomfort. Various methods have been devised historically to increase the success rate of insertion into the small intestine, but this is also proof that difficult cases exist. In recent years, ultra-thin endoscopes with an outer diameter of around 5 mm have become commercially available, making nasal insertion possible with minimal discomfort. Reports of using these for enteral feeding tube placement have followed one after another, and subsequently, their utility in ileus tube insertion has been reported.