Long-tube decompression first was applied in the 1920s during laparotomy through jejunotomy in patients with small bowel obstruction. Decompressing the bowel relieved the obstruction in 80% of these patients.The second advance came with the use of the duodenal drainage tube that decompressed the distended small bowel without operation. The third advance was the use of the Miller Abbott tube that could proceed through the entire small bowel and decompress all segments leading to the point of obstruction. This nonoperative method was 80% successful in relieving the obstruction. By decompressing the fluid-filled loop just proximal to the obstruction, a 95% obstruction caused by the weight of the fluid returned to a 50% obstruction, allowing the return of normal flow.Endoscopic placement of the tube into the jejunum, the fourth advance, allowed the tube to become functional immediately and avoided the frustrating delay of passage from the stomach into the small bowel. The modification of the Miller Abbott tube was the fifth advance and provided a better flow rate, a sump, a guide wire, a suture at the tip, and control of the balloon; there was no need for mercury or fluoroscopy. The guide wire allows fluoroscopic placement beyond the pylorus, and further studies are planned to compare endoscopic and fluoroscopic methods. In properly selected patients, immediate endoscopic placement of the improved tube has achieved successful decompression in 15 of 17 patients (88%).