Decompression tube insertion using double balloon endoscopy in a case following initial difficulty in passing the duodenojejunal junction

In a patient in whom it was initially difficult to pass the duodenojejunal junction, a long decompression tube was easily inserted using double balloon endoscopy. The patient was a 16-year-old male with bowel obstruction who had undergone proctocolectomy for ulcerative colitis. A double balloon endoscope was inserted into the jejunum about 50 cm from the ligament of Treitz. A stiff hydrophilic-coated guidewire, 350 cm in length, was inserted into the deep jejunum through the accessory channel of the endoscope. A long 16Fr silicon tube was easily inserted over the guidewire into the deep jejunum through the nose. The obstruction was successfully decompressed without laparotomy. This technique is a useful method that can be used in patients in whom other techniques of decompression tube insertion fail; it allows the possibility of directly diagnosing the cause of the bowel obstruction without prior decompression. (