We read with interest the letter of Shah and Barkin in which they describe a new hands-off method for the conversion from an orobiliary to a nasobiliary tube by using a forward-viewing endoscope. We share the authors' objections to the conventional method of manually grasping a polyethylene catheter introduced via the nose. To prevent penetration of the endoscopists' skin with infectious diseases and trauma from biting, we adopted a technique that appears to be simpler and cheaper than the method described by Shah and Barkin. Instead of a forward-viewing endoscope, we use a laryngoscope to directly visualize the oropharynx and then snatch the polyethylene tube introduced via the nose with a McGill forceps (Fig. 1). Special attention is paid to not grasp the uvula. The McGill forceps is also useful during the next step of the procedure, in which the tube is pulled through the nose. The inferior part of the nasobiliary tube is grasped under direct visualization to avoid dislocation until the loop is straightened at the posterior pharyn-geal wall.
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