Catheter-guided endoscopic intubation: a new technique for intubating a difficult esophagus

Tsang, Tat-Kin; Buto, Stephen K.

doi:10.1016/s0016-5107(92)70331-9

Cited by 26 publications

(7 citation statements)

References 4 publications

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“…However, the literature on patients with IF due to anatomical causes remains confined to case reports which show case techniques for overcoming difficult intubation, especially in cases of ZD. These include the use of an overtube [12], guidewire [13] or catheter to facilitate passage through the upper oesophageal sphincter [14]. …”

Section: Discussionmentioning

confidence: 99%

Intubation Failure During Gastroscopy: Incidence, Predictors and Follow-Up Findings

Siau

Fisher

et al. 2017

JGLD

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Background: Intubation failure (IF) occurs when an endoscopist is unable to progress via the oropharynx into the upper oesophagus. Aim: To assess incidence and aetiology of IF and predictors of structural pharyngeal abnormalities in patients with IF.Methods: All gastroscopies (n=26,130) performed in our centre, between August 2010 and August 2016 were retrospectively reviewed. Barium radiology and repeat gastroscopy findings were evaluated for structural causes of IF. Patients were categorised into ‘failure to tolerate’ and ‘failure to progress’ based on endoscopy reports.Results: The incidence of IF was 0.95%. Rates of IF varied with endoscopist specialty (p=0.021), but not with patient age, sex or sedation dose. Among cases of IF, structural pharyngeal abnormalities were detected on barium radiology in 28.9%, consisting of cricopharyngeal hypertrophy and/or Zenker’s diverticulum in 73.2%. ‘Failure to progress’ predicted pharyngeal pathology in 55.6%. Predictors of structural causes on barium radiology following IF included: age ≥65 (OR 4.0, 95% CI: 1.8-8.9, p<0.001); indication of dysphagia (OR 5.5, 95% CI: 2.5-11.8, p<0.001), and failure of endoscopic progression (OR 5.2, 95% CI: 2.3-12.0, p<0.001).Conclusion: Patients with IF should be investigated owing to the high risk of underlying pathology, particularly if associated with age ≥65, dysphagia, and failure of endoscopic progression. We propose that IF rates of <1% could be used as a quality indicator in gastroscopy. .Abbreviations: ASGE: Association for Gastrointestinal Endoscopy; CI: Confidence interval; CP: Cricopharyngeus; CPH: Cricopharyngeal hypertrophy; FESD: Flexible endoscopic septum division; GRS: Global rating scale; IF: Intubation failure; JAG: Joint Advisory Group for gastrointestinal endoscopy; NME: Non-medical endoscopist; OR: Odds ratio; SI: Successful intubation; ZD: Zenker’s diverticulum.

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Section: Discussionmentioning

confidence: 99%

Intubation Failure During Gastroscopy: Incidence, Predictors and Follow-Up Findings

Siau

Fisher

et al. 2017

JGLD

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“…In most cases, this risk can be minimized by passing the endotracheal tube over a catheter or guide-wire. [1][2][3][4] In cases where the entry to the diverticulum is significantly wider than the entrance to the oesophagus, intubation is a challenge despite the use of this guide-wire technique. In addition, in patients with low BMI use of standard overtube may be impossible.…”

Section: Introductionmentioning

confidence: 99%

“…If ZD is present, problems with intubation may be overcome by using the guidewire/catheter endoscopic intubation technique. 1,2 However, if the diverticulum orifice is much larger than the oesophageal orifice, the duodenoscope may not be introduced easily, even with the use of this technique. Tsang and Buto, in 1992 described a hybrid technique in which a guide-wire was introduced first, followed by the use of an overtube, which allowed safe, "blind" intubation.…”

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confidence: 99%

Modification of intubation techniques during ERCP in patients with Zenker’s diverticulum

Jamry¹

2018

AMJ

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Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with Zenker's diverticulum can be technically difficult and is associated with the risk of oesophageal perforation with subsequent mediastinitis. Therefore, resistance is felt during oesophageal intubation with a duodenoscope, the operator should use a gastroscope to visualize any obstruction. If the existence of an oesophageal pouch is recognised, intubation can be safely performed using a guide-wire over tube technique. However, in specific situations (e.g., narrow oesophageal orifices in patients with low body mass index (BMI)) despite use of guide-wire technique, intubation can still be difficult. Therefore we present a modified guide-wire technique involving rotation of the duodenoscope under fluoroscopy, which opens the entrance to the oesophagus and enables safe intubation.

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“…Approaches for negotiating ZD have previously been described. These include the use of an overtube, 6 a guidewire, 7 or a catheter 8 to facilitate passage through the UES. Although intubation with a nasendoscope may be more tolerable compared with conventional gastroscopy, 1 it is unclear whether this method is effective in ZD.…”

mentioning

confidence: 99%

Difficult intubation of a Zenker's diverticulum with an acute angle

et al. 2017

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Catheter-guided endoscopic intubation: a new technique for intubating a difficult esophagus

Cited by 26 publications

References 4 publications

Intubation Failure During Gastroscopy: Incidence, Predictors and Follow-Up Findings

Intubation Failure During Gastroscopy: Incidence, Predictors and Follow-Up Findings

Modification of intubation techniques during ERCP in patients with Zenker’s diverticulum

Difficult intubation of a Zenker's diverticulum with an acute angle

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