In most normal persons, the duodenum can be intubated within one-half hour by the use of a properly weighted duodenal tip. The patient should be in the right Sims position, half a glass of water should be swallowed or injected through the tube, and the last 10 inches to the end mark of the tube should be swallowed slowly over a period of one-half hour. By fluoroscopic observation, the tip of the tube can be seen to advance along the antrum of the stomach and to pass directly through the pylorus into the duodenum. However, when pylorospasm, adhesions or other organic conditions about the pylorus are present, the tip enters the duodenum with difficulty. Here the tip impinges on a constricted or insufficiently relaxed pylorus, and as the tube is swallowed to the end mark, either the tip moves backward toward the cardia or else the tube coils on itself
Hollander E. A MODIFICATION FOR DUODENAL TIPS. JAMA. 1924;82(16):1264. doi:10.1001/jama.1924.26520420004013c
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