Use of an Overtube for Enteroscopy: Depth of Insertion

Dear Sir,

We read with interest, in a recent issue, the paper by Taylor et al. entitled “Use of an Overtube for Enteroscopy - Does It Increase Depth of Insertion? A Prospective Study of Enteroscopy with and without an Overtube” [1].

We do not agree with authors that their Figure 2 a shows an overtube fully advanced into the duodenum (in D2). The tip of the overtube is situated only in the gastric antrum in that picture. Furthermore, the open arrow does not indicate the duodenojejunal flexure either in Figure 2 a or in Figure 2 b.

Previously we used to employ the overtube routinely at our department; nowadays its use is quite exceptional. The tip of the overtube can be introduced into the proximal duodenum but it is often difficult to maintain correct positioning of the overtube during further insertion of the enteroscope. If one uses an overtube it is necessary to perform enteroscopy under fluoroscopic control in order to prevent bizarre loop formation in the stomach.

Reference

• 1 Taylor A CF, Chen R YM, Desmond P V. Use of an overtube for enteroscopy - does it increase depth of insertion? A prospective study of enteroscopy with and without an overtube.  Endoscopy. 2001;  33 227-230