Transnasal pharyngoscopy to assist nasobiliary tube placement: a simple technique to avoid injury to the patient, endoscopist, and endoscope.

摘要

We read with interest the article by Dr Baron [1] on his "safe" transnasoral endo-scopic technique to facilitate nasobiliary catheter placement while avoiding injury to the endoscopist. Oral-nasal transfer of a nasal transfer tube (NTT) is the final step of endoscopic nasobiliary drainage (ENBD), which involves introduction of a NTT from the nose to the posterior oro-pharynx. This blind insertion process, similar to nasogastric tube placement, can cause pain and nasomucosal injury. Moreover, according to most manufacturers' instructions, a pair of forceps is used to grasp the NTT out of the posterior oro-pharynx; however, this rigid instrument may also cause mucosal injury to the oral cavity and oropharynx ( Fig. 1 a). Sometimes endoscopists risk their fingers being bitten during this procedure ( Fig. 1 b). Transnasal insertion is a proper route for a transnasal endoscope (TNE) but the endo-scope is susceptible to damage when inserted into or retrieved out through the mouth. An undersedated patient or a patient awakening from anesthesia tends to mumble, expel the mouthpiece, and shut his or her mouth tightly.