Sigmoid stiffener for decompression tube placement in colonic pseudo-obstruction

Background and Study Aims: Decompression tube placement improves outcome in colonic pseudo-obstruction (CP) which is refractory to conservative measur es, especially if the decompression tube is placed proximal to the hepatic flexure. We evaluate the ability of a sigmoid stiffener to facilitate more proximal colonoscopy and decompression tube placement. Patients and Methods: A sigmoid stiffener is used in the standard fashion d uring colonoscopic decompression for pseudo-obstruction. After cecal wire p lacement, the colonoscope is,withdrawn, leaving the stiffener and wire in p lace. By passing through the stiffener, an over-wire decompression tube can avoid sigmoid looping. We compared proximal extent of colonoscopy, tube po sition, endoscopy time, and patient outcomes using a sigmoid stiffener, wit h a control group of patients treated previously. Patients with colonic isc hemia were excluded. Results: Using this technique, nine consecutive colonoscopies and decompres sion tube placements reached the right colon. Significantly, only three of seven control colonoscopies and two control decompression tubes did so. How ever, improvements in procedural time and patient outcome did not reach sta tistical significance. No complications occurred. Conclusion: The use of a sigmoid stiffener during colonic decompression all ows more proximal colonoscopy and decompression tube placement, with possib le clinical benefit. We do not use this technique in the setting of left co lon ischemia.