A method for rapid placing of small intestinal perfusion tubes

Abstract

Small intestinal perfusion for studying intestinal absorption in man has been utilized for the past 12 years and has been adequately described. The technique requires a multilumen tube to be placed in the jejunum or ileum. A standard triple lumen perfusion tube is constructed of multiple polyvinyl tubes to which a rubber bag containing mercury is attached. The subject swallows the weighted rubber bag and gastrointestinal motor activity 'pulls' the bag and attached tube to the desired level of the small intestine. Using the present standard tube, the shortest time required for passage of a jejunal tube is 1 to 3 hr and an ileal tube 3 to 12 hr; progress is frequently especially slow in patients with intestinal diseases. In some instances, the tube does not pass the pylorus for a period of 4 hr or more. A number of factors such as tube flexibility, anatomical variations, pylorospasm, and variable gastrointestinal motility make the time required for placing the tube highly variable. Intermittent fluoroscopy is used to locate the position of the tube and assist in navigation of the pylorus and duodenal sweep. The length of time required and degree of difficulty encountered in passing a tube causes a proportional increase in radiation exposure and thus decreases the number of studies a cooperative volunteer may perform. Internal stiffening wires have been used to facilitate passage of Cantor tubes and Crosby capsule biopsy tubes. The authors modified the standard triple lumen perfusion tube to include a removable stiffening wire. The modified tube can be used for safe, reliable, and rapid insertion of small intestinal perfusion tubes.