Rapid resolution of small-bowel obstruction with the long tube, endoscopically advanced into the jejunum.

Background: Long-tube decompression has achieved a 75% to 80% success rate in 5 studies, and the short tube had a 40% success rate in 3 studies.

Methods: From 1984 to 1991, an endoscope-advanced long intestinal tube was placed into the jejunum in 17 patients, and from 1992 to 2004 an improved long tube was used in 23 patients. Costs were calculated for each type of procedure.

Long tube decompression is successful in 90% of patients with adhesive small bowel obstruction.

Background: For patients with small bowel obstruction (SBO), who do not have strangulation obstruction or other contraindications, long tube decompression has been successful in 75% in two studies. In a 1995 prospective randomized study, comparing nasogastric suction (short tube) with long tube decompression, the short tube was successful in 51% and the long tube was successful in 75%. Using upper gastrointestinal endoscopy, a long tube can be advanced into the jejunum in 20 minutes, so the delay in function has been eliminated.

Five risk factors identify patients with gastroesophageal intussusception.

Hypothesis: Risk factors in patients with gastroesophageal intussusception who have noncardiac chest pain need to be identified and analyzed.

Design: Prospective consecutive series of 43 patients with gastroesophageal intussusception.

Setting: Outpatient gastrointestinal endoscopy suite for 42 patients; 1 patient sustained gastroesophageal intussusception during labor and delivery and underwent an emergency laparotomy.

Thoracoscopic vagotomy as a safe adjunct to remedial gastric surgery.

Patients who have had prior subdiaphragmatic dissection with an incomplete vagotomy or Nissen fundoplication present added challenges when they require vagotomy and gastric resection. In this setting, thoracoscopic vagotomy offers significant advantages. A second attempt at vagotomy in a previously dissected field can be prolonged and frustrating.