Endoscopic Ryle’s Tube Insertion

Upper gastrointestinal endoscopy is often used to introduce nasogastric tubes in patients with difficulties in the classic procedure or in patients with esophageal strictures. This procedure starts with a UGI endoscopy. The guide wire is introduced through the operating channel of the endoscope. The endoscope is removed while the guide wire is introduced with synchronized movements. The distal end of the guide wire remains in the gastric cavity when the dndoscope is completely withdrawn. The nasogastric tube is then inserted over the guide wire. This procedure is usually effective, allowing the nasogastric tube to remain in place. The main problem is passing the tube from the mouth to the nose. The use of the thin (5.3 mm in diameter) Olympus GIF N30 endoscope (Olympus Corp., Mamburg, Germany) makes this procedure easier. The endoscope is introduced through the nose after local anesthesia of the selected nasal cavity with lidocaine. The distal end of the endoscope easily reaches the gastric antrum. Both the guide wire and the selected nasogastric tube must be lubricated with silicone to facilitate introduction. The guide wire should be kept straight while the nasogastric tube is placed. This procedure can be performed immediately after esphageal dilation. In cases in which a stricture cannot be passed, fluoroscopic guidance is necessary to monitor the position of the tip of the guide wire.