Mouthpiece made of syringe renders gastroscopy in patients with partial trismus

Background: For performing safe endoscopy it is necessary to use a mouthpiece. In patients who are unable to open their mouths to a satisfactory degree for the introduction of a mouthpiece endoscopic procedures fail. Partial trismus may hamper oral access to the upper gastrointestinal tract.

Materials and Methods: The barrel of a disposable plastic syringe was cut about 2 cm from where the plunger enters it. This short piece was put within the teeth. One flag looked towards the philtrun and the other to the chin. On the inner side there was no flange and on the outer side the flags of the tube prevented the displacement of that self-made mouthpiece. An endoscope could be passed through this tube into the oesophagus and further till the duodenum.

Results: Five upper gastrointestinal endoscopies were performed on patients with partial trismus or mouth opening difficulties. Three procedures were percutaneous endoscopic gastrostomy tube placements on head and neck cancer patients by the means of a 20 ml syringe. Two endoscopies were carried out because of upper gastrointestinal bleeding through a 5 ml syringe. All oesophago-gastro-duodenoscopies were successful via the self-made mouthpiece. No complications occurred. A gastroscope less than 12 mm in diameter can be passed even through a 5 ml syringe. A PEG tube could be placed via the 20 ml syringe.

Conclusions: Syringes of 5, 10 or 20 ml are of smaller diameter than the commercially available mouthpieces. About a 2 centimetre long part of these syringes can be used as a mouthpiece. Extra care must be taken for preventing of displacing and swallowing them.