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DOI: 10.1055/s-0030-1256568
© Georg Thieme Verlag KG Stuttgart · New York
Reply to Hu
Publication History
Publication Date:
07 October 2011 (online)
I appreciate the comments raised by Dr Hu regarding the method I described for transferring a nasobiliary tube from the mouth to the nose, and especially the concerns raised about nasal trauma and endoscope damage. Our patient was actually edentulous, though a bite block was in place nonetheless. The self-limited nasal bleeding our patient experienced may also have been due to the prior unsuccessful attempt at passage of the transfer tube. Using the technique I described the assistant at the head of the bed needs to ensure that the bite block is not expelled if moderate sedation or monitored anesthesia care is administered.
The approach mentioned by Dr Hu certainly seems easier and less traumatic to the patient, though one wonders whether, on occasion, the tube and string might not pass so easily or precisely to enable good visualization upon introduction of the transnasal endoscope.
One ”hybrid” technique that combines the two methods would be attachment of the string to the proximal end of the nasobiliary tube, as suggested by Dr Hu, and then passage of the endsocope out of the mouth as I described followed by grasping with a forceps rather than a snare. This may reduce trauma during withdrawal of the forceps and endoscope.
In any case, I am most grateful that my minor contribution to the literature resulted in some discussion, and hopefully better patient care and physician safety.
T. H. BaronMD
Division of Gastroenterology and Hepatology
Mayo Clinic
College of Medicine
200 First Street SW
Rochester
MN
55905
USA
Fax: +1-507-266-3939
Email: baron.todd@mayo.edu