Elsevier

Gastrointestinal Endoscopy

Volume 62, Issue 5, November 2005, Pages 661-666
Gastrointestinal Endoscopy

Original Article
Transnasal endoscopy vs. fluoroscopy for the placement of nasoenteric feeding tubes in critically ill patients

https://doi.org/10.1016/j.gie.2005.04.027Get rights and content

Background

Placement of a nasoenteric feeding tube (NET) beyond the pylorus in critically ill patients is desirable. Bedside methods are unreliable, and fluoroscopic methods require transport and/or radiation exposure. Traditional endoscopic methods require sedation and oronasal transfer techniques. Transnasal techniques of NET placement by using recently developed ultrathin endoscopes have been described. The object of this prospective study was to compare the efficacy of NET placement by using ultrathin transnasal endoscopy vs. fluoroscopic placement.

Methods

This is a prospective randomized study of endoscopic vs. fluoroscopic NET placement. The settings of the study were intensive care units at academic medical center. The study included 100 consecutive patients who required NET placement. They received endoscopic NET placement at the bedside with a 5.1-mm, ultrathin endoscope by using a transnasal over-the-wire technique vs. fluoroscopic NET placement by using standard techniques. The procedure success was defined as postpyloric (beyond the duodenal bulb) NET placement, jejunal placement success, and procedure time.

Results

Tube placement success was not significantly different between endoscopic and fluoroscopic methods (90% with both methods; p = 1.00). The endoscopic procedure duration (12.8 ± 6.4 minutes) was significantly shorter than fluoroscopic procedure duration (19.3 ± 12.0 minutes) (p < 0.001). Procedure duration decreased significantly (from 17.3 ± 6.2 minutes to 8.0 minutes ± 4.2 minutes, p = 0.04), and jejunal placement increased significantly (from 60% to 100%, p = 0.04) from the first to the last 10 endoscopic procedures.

Conclusions

NET placement success with an ultrathin transnasal endoscope is equivalent to fluoroscopic placement with faster procedure times. More distal placement and procedure times improve with increasing experience with the endoscopic technique. Endoscopic NET placement can be performed at the bedside without the need for oronasal transfer, additional sedation, or fluoroscopy.

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

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Grant support: American Society for Gastrointestinal Endoscopy endoscopic research award.

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