Original ArticleTransnasal endoscopy vs. fluoroscopy for the placement of nasoenteric feeding tubes in critically ill patients
Section snippets
Patients and methods
A total of 100 consecutive patients in the medical or surgical intensive care units (ICU) at the University of Utah Hospital, who required nasoenteric feeding tube placement were randomized to routine fluoroscopic placement vs. bedside placement with an ultrathin nasal endoscope. Randomization was by computer-generated random numbers in consecutively numbered, sealed opaque envelopes to assure concealed allocation. Inclusion criteria were the following: the need for short-term enteral support,
Results
Demographic data and the procedure locations are given in Table 1. A total of 100 NETs were placed from June 2000 to April 2002. Fifty tubes were placed endoscopically, and 50 were placed fluoroscopically. All tubes were successfully placed into the stomach or more distally. Postpyloric tube placement was successful 90% of the time by either endoscopic or fluoroscopic methods (p = 1.00). The postpyloric tube positions into the duodenum and the jejunum (past the ligament of Treitz) were not
Discussion
Early enteral feeding when using nasoenteric tubes has become the standard practice in critically ill patients. Intragastric feedings are less reliable and may place patients at increased risk for aspiration. Postpyloric feeding tube placement usually is done blindly or by using fluoroscopic guidance, though each method has its shortcomings. Multiple endoscopic techniques have been described, but there are no data comparing these techniques to more widely practiced bedside or fluoroscopic
References (24)
- et al.
Enteral compared with parenteral nutrition: a meta-analysis
Am J Clin Nutr
(2001) Nutritional support in the critically ill patient: a critical review of the evidence
Crit Care Clin
(1998)Nasogastric and nasoenteric feeding tubes
Gastrointest Endosc Clin N Am
(1998)- et al.
Transnasal endoscopy for enteral feeding tube placement in critically ill patients
Am J Gastroenterol
(1999) - et al.
Endoscopic approaches to enteral nutritional support
Gastrointest Endosc
(2002) - et al.
Endoscopic nasogastric-jejunal feeding tube placement in critically ill patients
Gastrointest Endosc
(1997) - et al.
Transnasal versus transoral endoscopy for the placement of nasoenteral feeding tubes in critically ill patients
Gastrointest Endosc
(2000) - et al.
A reliable method for the endoscopic placement of a nasoenteric feeding tube
Gastrointest Endosc
(1994) Bedside method for placing small bowel feeding tubes in critically ill patients. A prospective study
Chest
(1991)- et al.
American Gastroenterology Association technical review on tube feeding for enteral nutrition
Gastroenterology
(1995)
Endoscopic placement of nasojejunal tubes: a randomized, controlled, prospective trial comparing suitability and technical success for two different tubes
Gastrointest Endosc
Nutritional support
N Engl J Med
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Enteric tube placement for gastroparesis: Gastrostomy, gastrojejunostomy and jejunostomy
2020, Gastroparesis: Pathophysiology, Clinical Presentation, Diagnosis and TreatmentUpdate on endoscopic enteral access
2018, Techniques in Gastrointestinal EndoscopyEnteral Access and Associated Complications
2018, Gastroenterology Clinics of North AmericaEndoscopy versus fluoroscopy for the placement of postpyloric nasoenteric tubes in critically ill patients: A meta-analysis of randomized controlled trials
2016, Journal of Critical CareCitation Excerpt :Sixteen studies were case-only studies, review articles, comments, or case reports and were excluded after screening so that only the studies comparing endoscopic versus fluoroscopic placement of PNTs were included. Of the five remaining articles, 3 were RCTs [18,22,23] and two were retrospective studies [15,24]. Therefore, 3 eligible RCTs were included in the analysis (Fig. 1).
Enteral access in adults
2015, Clinical NutritionSafe, timely, convenient, and cost-effective: A single-center experience with bedside placement of enteral feeding tubes by midlevel providers using fluoroscopic guidance
2012, American Journal of SurgeryCitation Excerpt :Welpe et al18 also examined bedside fluoroscopic-guided placement of feeding tubes by ICU staff and reported a success rate of 84% with a median time of 17 minutes for bedside placement by ICU physicians. Fang et al,19 in a prospective study of endoscopic versus fluoroscopic feeding tube placement in 100 consecutive ICU patients, showed successful placement in 90% of patients with both methods. The reported mean procedure time in this series was 12.8 minutes for endoscopic placement by gastroenterologists versus 19.3 minutes for fluoroscopic placement by radiologists.19
Grant support: American Society for Gastrointestinal Endoscopy endoscopic research award.