[Essay on physiopathology of timed duodenal intubation. III. Significance of dark bile during the choledochal phase of duodenal intubation].
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A widely held assumption is that postpyloric intubations occur more often with weighted than with unweighted nasally inserted feeding tubes. This randomized, prospective study compared the frequency of duodenal intubations using weighted and unweighted nasoenteric feeding tubes. One hundred sixteen patients had either weighted (61 patients) or unweighted (55 patients) 10F silicone elastomer feeding tubes inserted nasally 85 cm. Tubes were placed with wire stylets. Tube positions were verified radiographically within 4 hr after insertions. Radiographs were repeated daily for 3 days or until duodenal intubation occurred. Successful duodenal intubations were achieved in 35 patients (57%) with weighted feeding tubes and in 37 patients (67%) with unweighted feeding tubes. This difference was not significant. Weighted nasoenteric feeding tubes offer no advantage over unweighted tubes in achieving duodenal intubations.
The aim of this work was to analyse the value of duodenal intubation in the differential diagnosis of obstructive jaundice in infants. Thirty-six patients were studied, ages varying between one and five months (average 2.4), 21 males and 15 females, all presenting cholestasis characterized by jaundice, choluria and fecal acholia. Of the 36 patients, 15 with negative intubations had during surgery a confirmation of a diagnosis of biliary atresia. The other 21 infants with positive duodenal intubation received at that moment the diagnosis of "neonatal hepatitis syndrome". Because it is efficient, harmless and inexpensive, duodenal intubation is an useful method in deciding whether cholestasis in infants requires medical or surgical treatment.
Typhoid fever developed in three patients during a period of 13 weeks. Although each of these patients was admitted to a different London hospital, the patients became ill approximately 10 days after undergoing duodenal intubation in one gastroenterology unit. All other patients who had undergone duodenal intubation in the unit during that period of time were investigated. Salmonella typhi was isolated from bile and feces of two out of the 20 other patients (carriers). In each of the three patients who developed typhoid fever, intubation followed within two days of intubation of one of the carriers. After use in each patient, the polyvinyl tubes had been thoroughly washed with disinfectant and detergent. There were no further cases of typhoid fever when a new tube was used for each patient.
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AIMS: To examine the influence of duodenal intubation on gastric emptying measured by the paracetamol absorption test using a new algorithm developed to estimate emptying parameters, and to determine the sensitivity of this test. METHODS: A caloric liquid meal with paracetamol as marker of emptying was administered orally to eight healthy volunteers during phase I and phase II of the migrating motor complex (MMC) and without intubation on 3 separate days, and to 10 patients with partial gastrectomy. RESULTS: Healthy subjects: With duodenal tube, time until 25% of the meal had emptied (t25%) was 24+/-7 (phase I, P<0.02) and 21+/-6 min (phase II, P<0.02) compared with 14+/-4 min for meal intake without intubation. Time until 50% of the meal had emptied (t50%) was 45+/-8 (phase I, P<0.001) and 35+/-8 min (phase II, P<0.02) compared with 26+/-9 min for meal intake without intubation. Intraduodenal instillation of 10-20 mL of the liquid meal was reliably detected. PATIENTS: In 9 out of 10 patients with partial gastrectomy t25% was below the lower limit of the range for healthy controls, and t25% detected accelerated emptying with a higher degree of sensitivity than the commonly applied pharmacokinetic parameters Cmax and Tmax. CONCLUSIONS: A duodenal tube delays gastric emptying of a caloric liquid meal. The paracetamol absorption test emerges as a sensitive method suitable for detecting both delayed and accelerated gastric emptying of caloric liquid meals.
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Between January 1997 and December 1998, 30 consecutive children with suspected biliary atresia (BA) were selected to assess whether duodenal intubation (DI) and testing of aspirate for bile would help to rule out BA. Duodenal fluid was aspirated every 2 h for 24 h and tested for bile. A HIDA scan was also done in all cases. Every patient underwent a peroperative cholangiogram (POC) and liver biopsy; a Kasai portoenterostomy was done in indicated cases. In 22 cases all three investigations (DI, HIDA scan, POC) suggested BA. In 3 the HIDA scan ruled out BA, but DI and POC suggested BA. In 2 other cases, both the HIDA scan and DI suggested BA, but POC ruled it out and suggested biliary hypoplasia; in 3 others the HIDA scan suggested BA, but DI and POC both, ruled it out. There was no case where DI ruled out BA (i.e., showed bile in aspirate) and POC suggested BA. A liver biopsy confirmed BA in all proven cases. DI and testing the aspirate for bile is a very reliable means to rule out BA if the aspirate tests positive. It is an inexpensive, noninvasive, and quick bedside test that may be especially useful in developing countries where biliary scintigraphy is not available.
Cholesterol crystallization in a necessary step in the formation of cholesterol gallstones. Our purpose was to study the relationship between the presence of biliary cholesterol crystals and radiolucent gallstones. Bile was obtained by duodenal intubation from 60 subjects free of hepatic disease: 40 patients had radiolucent gallstones and in the remaining 20 subjects no gallstones could be found either by oral cholecystography or by ultrasound examination. In each patient a bile sample was used to search for cholesterol crystals; in another sample, biliary cholesterol, phospholipids and bile acids were measured to calculate the lithogenic index. Among the 44 subjects with lithogenic bile, 34 had radiolucent gallstones. Twenty-two out of the 60 patients had both cholesterol crystals and radiolucent gallstones; 21 subjects out of the 22 had lithogenic bile. In patients with frequent biliary colic or subacute pancreatitis without visible gallstones, finding cholesterol crystals in bile might suggest medical or surgical specific treatment.
X-ray examination of the small bowel was performed in 52 patients by means of the conventional barium meal as well as the duodenal intubation method - Sellink modification - as a comparative study. The visualization of the jejunum and ileum except the terminal ileum was significantly better by the Sellink method compared to the routine examination. The intubation modification seems to be a valuable diagnostic supplement.
The authors present a clinical case of post-traumatic stenosis of the small intestine. The improvement in the quality of radiological diagnosis by the use of double contrast study of the small bowel after duodenal intubation is emphasised. On the basis of this case, together with a review of the literature, they review the various problems of diagnosis, physiopathology and histology which may be posed by these stenoses, which it would seem possible to integrate into a wider physiopathological group: ischaemic stenoses of the digestive tract.
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The diagnosis of chronic pancreatitis usually is based on imaging studies, pancreatic function tests, and the presence of characteristic clinical features. In Japan, diagnostic criteria for chronic pancreatitis were established in 1983 and revised in 1995. Under the new criteria, the secretin test (a duodenal intubation test) and the combination of noninvasive tests, N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) and fecal chymotrypsin (FCT), have been recommended for evaluating exocrine pancreatic function in patients with chronic pancreatitis. In the present study, the diagnostic value of these two noninvasive tests was compared to the secretin test. Although noninvasive tests are less sensitive and specific for determining exocrine pancreatic impairment than the secretin test, greater reliability for diagnosing chronic pancreatitis can be obtained by performing the BT-PABA and fecal chymotrypsin tests simultaneously. Combining BT-PABA and FCT is easy and useful and should be performed at least twice to obtain reliable results.
This method was used in examinations of 313 patients with the digestion organ diseases treated at a health resort. Dysfunction of the biliary tract, often combined with other organic dysfunctions, was detected in 52% of the examinees; in 34.6% of these gallbladder dyskinesia was diagnosed and in 17.4% abnormal secretion and sphincter dyssynergia. The author recommends a wider employment of multipoint duodenal intubation for the examination of patients with gastrointestinal diseases.