A simple hands-off method for converting a biliary drain from mouth to nose.

is a widely used technique for bile duct decompression. It also provides access to the bile duct and allows cholangiography to be repeated. After placement, the drainage tube is left exiting from the mouth and re−routing via one of the nos− trils is necessary. Conventionally, a naso− pharyngeal tube, which is used as a carri− er, is advanced into the patient’s nose and into the posterior pharynx. The endosco− pist then retrieves the tip of the tube in the pharynx with his fingers in the pa− tient’s mouth. This step causes discom− fort to the patient and puts the endosco− pist at risk of being bitten. A new method was reported recently using a pair of grasping forceps to capture the carrier through an end−viewing scope [1]. This method requires, of course, the use of an end−viewing endoscope. We describe here our novel method of extracting the carrier tube using a section of guide wire. A 3 cm ” 2 cm loop is made with a piece of guide wire (Jagwire; Boston Scientific Corporation, Miami, FL, USA) and inserted into the patient’s oral cavity until it touches the posterior wall of the pharynx (l" Fig. 1). The endoscopist then loosens the wire loop, allowing it to occupy the width of the pharynx. A 16F soft naso− pharyngeal tube is advanced through the nose down to the pharynx. The tube can be easily trapped within the loop. When the wire is withdrawn, it pulls the carrier with it out of the mouth (l" Fig. 2). A clas− sical conversion is then performed to bring the drain out through the nose, using the carrier as the guide (l" Video 1). This method is quite simple and needs no additional accessories, as a used guide wire is readily available when ENBD is performed. The endoscopist does not re− quire special training, and in our unit there is a more than 90% success rate at the first attempt. It takes only about 1 min to accomplish the conversion ± much shorter than the traditional way, which takes about 3±5 min. This method causes negligible discomfort to the pa− tient and can be used when the patient is under conscious sedation even with the teeth−guard in situ. This novel technique is a simple, safe, convenient and time− saving method to convert an orobiliary to a nasobiliary tube.