Kisa T, Sakai Y, Tadenuma T, Maniwa S. History, application, procedures, and effects of intermittent oral catheterization (IOC). Jpn J Compr Rehabil Sci 2015; 6: 91-104.Intermittent catheterization (IC), developed in Japan, involves inserting a catheter or feeding tube from the patient's mouth or nose for the purpose of dysphagia rehabilitation or feeding. Among the various IC methods, intermittent oral catheterization (IOC) involves inserting a catheter from the mouth to the lower part of the esophagus or stomach. Because the gag reflex is decreased in encephalopathy patients with dysphagia, oral insertion of a catheter is generally easy, and can be applied to patients who are capable of complaining of incorrect insertion or showing an objective symptom (regardless of dementia, etc.). IOC is effective for dysphagia patients, including those with cancer of the oral cavity or head and neck, neuromuscular disease, and for stroke patients in the acute convalescent, and chronic stages. Stroke patients receiving IOC showed higher oral intakes of regular meals than patients fed by a gastrostomy tube or continuous nasogastric catheterization (CNG). IOC care requires less monitoring and restraining time than CNG and results in better stomach discharge function than a gastrostomy. Gastrostomy should be applied to patients for whom IOC is not applicable or those in the convalescent stage who previously received IOC but who require alternative nutrition over a long period because only small amounts can be ingested via IOC.

持続的経鼻経管栄養法(CNG)または胃瘻管理で回復期リハビリテーション病床に転床した脳卒中患者57例を対象に，間欠的口腔カテーテル栄養法(IOC)に変更し管理したIOC加療群，CNGのまま管理したCNG群，胃瘻のまま管理した胃瘻群の3群に分け，前方視的に調査した．退院時に3食経口摂取可能となった割合は，IOC群で71.4%，CNG群で21.4%，胃瘻群で9.1% と，IOC群で有意に(p‹.05)高かった．また，23例でバリウム・ボール+造粘剤の胃腔への経管注入法による胃排出能検査を行ったところ，35分を過ぎてもバリウム・ボールが胃内に残存(ないしは殆ど残存)した症例が，IOC群と比べて胃瘻群のほうに有意に(p‹.05)多く，IOCに比べ胃瘻では胃排出能が不良なことが示唆された．脳卒中の摂食・嚥下障害の急性期～回復期ではIOC開始の条件を満たす場合は胃瘻ではなく先ずIOC，回復期～慢性期であっても安直に胃瘻に踏み切るのでなく，十分な検査と説明に基づきIOCとの使い分けを行う必要があると思われた．