ENDuodenal intubation in Germany is often requested by patients from Eastern Europe and Central Asia, because it is the test their doctors at home ordered. A thin tube is passed through the mouth into the duodenum, the first part of the small intestine, and bile is collected in portions, sometimes after the gallbladder has been stimulated to contract.
In everyday practice, German hospitals as a rule do not use classic multi-portion duodenal intubation as a routine test. The questions it answered remain, but other methods now answer them: German guidelines on gallstones, pancreatitis and gut infections rely on ultrasound, MRI, endoscopy and stool tests for these questions. This reflects a difference in methods, not a judgement on the care you received before.
What Duodenal Intubation Was For and How Those Questions Are Answered Today
Duodenal intubation was used to assess bile, search for parasites and check the pancreas; today each of these questions has its own test. Bile stasis, stones and sludge in the gallbladder and bile ducts are looked for with ultrasound, endoscopic ultrasound (EUS: ultrasound from inside the stomach and bowel) and MR cholangiography (MRI of the bile ducts without inserting any instruments). In EUS, a thin endoscope with an ultrasound probe is passed through the mouth, which brings the probe close to the bile ducts. The German S3 guideline on gallstones, a guideline based on a systematic review of the research and a structured expert consensus, names ultrasound as the method of choice for gallbladder stones, and EUS or MR cholangiography when it is unclear whether there are stones in the bile ducts. How a digestive system examination in Germany begins and what gallbladder treatment involves is explained on separate pages.
Giardia and other intestinal parasites are now looked for in stool, by testing for their antigen or for their genetic material using PCR. For Giardia, these tests are more sensitive than examining duodenal fluid, and for the patient they mean no tube and no endoscopy.
Pancreatic function, meaning whether the pancreas makes enough digestive enzymes, is assessed by measuring faecal elastase, an enzyme produced by the pancreas itself. If bacterial overgrowth in the small intestine is suspected, a breath test can help: the patient drinks a sugar solution, hydrogen is measured in the exhaled air, and the result may point to excess bacteria. What follows if enzymes are lacking is covered on the page on pancreas treatment.
When Duodenal Fluid Is Still Collected
Duodenal fluid is still collected, but in a targeted way, when the gastroenterologist sees an indication: during a gastroscopy, an EUS or an ERCP, a procedure in which contrast dye is injected into the bile and pancreatic ducts through an endoscope and X-rays are taken. Bile can be checked for microcrystals, tiny particles from which stones form and which ultrasound can miss, and aspirated fluid can be sent for culture to see which bacteria grow in it.
Another option is a biopsy of the duodenal lining: during a gastroscopy, a few tiny pieces of tissue are taken and examined under a microscope, for example when coeliac disease, an intolerance to the gluten in wheat, rye and barley, is suspected. This is not intubation, but it is often what the patient actually needs.
How to Prepare for the Examination
Preparation starts with paperwork: bring your earlier results, including intubation reports, ultrasound reports and lab tests. They are translated into German, so the doctor can see how your findings have changed. Even if the intubation is not repeated, its results show what was looked for before and what was found.
Come to a gastroscopy or EUS on an empty stomach; the hospital will tell you when you can last eat and drink. Endoscopy can be done under sedation, a light medication-induced sleep, so you must not drive afterwards. Send a list of your medicines in advance, especially blood thinners: the doctor will decide whether they need adjusting before the procedure.
Frequently asked questions
Is duodenal intubation done in Germany?
As a rule, no: in everyday practice, German hospitals do not perform classic multi-portion duodenal intubation. You will not be left without an answer, though. The gastroenterologist finds out which question the test was meant to answer and chooses a method for it: ultrasound, endoscopy, a stool test or a breath test. If duodenal fluid is really needed, it is collected during endoscopy.
What replaces duodenal intubation when Giardia is suspected?
A stool test: the laboratory looks for Giardia antigen or the parasite’s genetic material using PCR. All that is needed is a stool sample collected as the laboratory instructs. If the result does not explain the symptoms, the gastroenterologist decides on further tests, for example checking pancreatic function or ruling out coeliac disease.
Are the results of earlier intubations useful?
Yes, bring them along with your ultrasound reports and lab results. The documents are translated, and the German gastroenterologist will see what was looked for before, what was found and how the findings have changed. This helps decide which test to start with. As a rule, the intubation itself will not be repeated: other methods will answer the same question.
Are the tests that replace duodenal intubation easier for the patient?
Usually, yes. Ultrasound, MR cholangiography and stool tests need no tube, and gastroscopy and EUS can be done under sedation. In classic intubation, the tube stayed in the bowel while bile was collected portion by portion. Which test you need is decided by the gastroenterologist: sometimes ultrasound and lab tests are enough, and sometimes endoscopy is needed.
How AlenMed Organises a Digestive System Examination
AlenMed translates your documents and sends them to a gastroenterologist, who decides which method will answer the question for which the intubation was originally ordered.
Examples of specialists: Dr. med. Markus Dollhopf, head physician of the Department of Gastroenterology and Hepatology at München Klinik Harlaching, who teaches on the Munich ERCP and EUS training courses; and Prof. Roland M. Schmid, a gastroenterologist and director of the Department of Internal Medicine II at Klinikum rechts der Isar.
An interpreter accompanies you at the consultation and the examination, and you receive the report in translation. AlenMed’s office is in Munich, and its partner hospitals are across Germany; how arranging treatment in Germany works is explained on a separate page.
This material is for reference only and is not an offer. The examination method is chosen by a doctor at an in-person consultation.