duotube

(from Greek δουπτύρον, "twice"), also known as a duo-dual or duo-triple tube, is a type of endoscopic device designed for the simultaneous insertion of two or more tubes through a single incision. It is commonly used in medical procedures, particularly in gastrointestinal (GI) surgeries and interventions.

History

The concept of endoscopic tube placement was first introduced in the late 1980s by Dr. J. Robert White, a cardiothoracic surgeon at the University of California, San Francisco (UCSF). He recognized the need for a less invasive method to aid in the removal of foreign bodies from the lungs and to improve the comfort and accessibility of the upper intestinal tract.

Development

Over the years, several iterations of the duotube design have been developed. The first generation of duotubes were limited in their functionality and could only accommodate a single tube. Improvements in materials and technology allowed for the creation of double-lumen tubes, which could house two or more tubes within the same incision.

Structure and Function

A duotube is typically made of biocompatible materials, such as silicon or polyurethane, and features multiple lumens that allow for the insertion of different types of endoscopic instruments. The inner lumens are equipped with valves to prevent air or fluid from escaping while the outer lumens are used to introduce or remove larger instruments.

Indications

The most common indications for duotube placement include:

1. Endoscopic mucosal resection (EMR) – for the removal of polyps or early-stage cancer in the duodenum.
2. Pancreaticojejunostomy – to create a connection between the head of the pancreas and the jejunum.
3. Biliary drainage – to aid in the removal of bile from the gallbladder or_common bile duct.
4. Enteral nutrition support – when patients are unable to eat or have difficulty swallowing.

Procedure

Duotube placement is typically performed under general anesthesia. The patient is positioned supine with the head elevated, and an incision is made in the mouth or nose to gain access to the nasoenteric area. A duotube is then inserted through the incision, allowing for the simultaneous introduction of multiple instruments.

Insertion Steps

1. A small incision is made in the mouth or nose to aid in the insertion of the duotube.
2. The duotube is navigated through the duodenum and into the jejunum using an endoscope and catheters.
3. Once the duotube is in place, it is filled with contrast media to confirm proper placement.
4. Endoscopic instruments can then be inserted through the duotube to aid in the performance of the indicated procedure.

Recovery

Following the procedure, patients are monitored in the hospital until they are stable enough to be discharged. Generally, recovery from a duotube placement is straightforward, and most patients are able to return home within a few days.

Complications

As with any medical procedure, there are potential complications associated with duotube placement. These include:

1. Bleeding – at the incision site or within the duodenum.
2. Air embolism – rare but potentially life-threatening.
3. Perforation – of the esophagus, stomach, or duodenum.
4. Infection – at the incision site or within the duodenum.

Duotube placement is a versatile and effective endoscopic technique that has gained widespread acceptance in the medical community. Its use allows for the simultaneous presentation of both endoscopic and ultrasonic guidance, which minimizes the risk of injury to surrounding structures and ensures accurate placement of the feeding tube.

However, potential并发症 such as air embolism, bleeding, or perforation require careful monitoring and immediate action. Healthcare professionals must be skilled in the use of duotube devices and capable of managing potential complications should they arise. With proper training and experience, the benefits of the duotube for patients in need of gastrointestinal interventions far outweigh the risks involved.