Nasobiliary tube placement: how to accomplish oral-to-nasal transfer.

We would like to present our experience of nasobiliary tube (NBT) transfer. A description of this technique, called the guidewire maneuver, follows (●" Video 1). The patient changes from the prone to the left lateral decubitus position while continuing to bite on the mouthpiece. The guidewire (Jagwire, 0.035in; Boston Scientific, Natick, Massachusetts, USA) previously used for endoscopic retrograde cholangiopancreatography (ERCP) can be reused instead of a transfer tube. First, a snare with one or two loops is made from the guidewire at about 40cm from the soft tip (●" Fig.1). The endoscopist uses the left hand to grasp the snare and insert it through the mouthpiece to the posterior wall of oropharynx as far as possible. At the same time, two fingers of the right hand are used to introduce the soft end of the guidewire into the oropharynx through the nasal cavity. When the soft tip of the guidewire has been inserted into the snare about 20 to 25cm from the nostril, the snare should be retrieved, and the soft end of the guidewire can be pulled out of the oral cavity simultaneously. Then, the tip of the NBT is passed over the soft end of the guidewire and advanced for about 20cm. Finally, the endoscopist pinches the NBT firmly so as to prevent the guidewire from slipping from the NBT and pulls them out of the nasal cavity together. We have used this technique for more than 3 years with great success. It avoids accidental trauma to the endoscopist’s fingers and damage to the NBT. At the same time, nasal bleeding seldom occurs, and the patient feels little discomfort because of the tiny diameter of the guidewire. Comparedwith other reported techniques [1–3], we think that our unique method offers a simpler and safer way to perform the last step of NBT placement.