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Transnasal Endoscopic Placement of Nasoenteric Feeding Tubes: Outcomes and Limitations in Non–Critically Ill Patients

From the Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Address correspondence to: Sanjiv Mahadeva, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; e-mail: sanjiv{at}ummc.edu.my.

Transnasal endoscopic placement of nasoenteric tubes (NETs) has been demonstrated to be useful in the critical care setting, with limited data on its role in non–critically ill patients. The authors collected data on consecutive patients from a non–critical care setting undergoing transnasal endoscopic NET placement. All NETs were endoscopically placed using a standard over-the-guidewire technique, and positions were confirmed with fluoroscopy. Patients were monitored until the removal of NETs or death. Twenty-two patients (median age = 62.5 years, 36.4% female) were referred for postpyloric feeding, with main indications of persistent gastrocutaneous fistula (n = 6), gastroparesis or gastric outlet obstruction (n = 5), duodenal stenosis (n = 6), acute pancreatitis (n = 4), and gastroesophageal reflux after surgery (n = 1). Postpyloric placement of NET was achieved in 19 of 22 (86.3%) patients, with 36.8% tube positions in the jejunum, 47.4% in the distal duodenum, and 15.8% in the second part of the duodenum. NET placement was least successful in cases with duodenal stenosis. NETs remained in situ for a median of 24 days (range, 2-94), with tube dislodgement (n = 3) and clogging (n = 5) as the main complications. NET feeding resulted in complete healing of gastrocutaneous fistulae in 5 of 6 patients and provision of total enteral nutrition in 3 of 4 cases of acute pancreatitis and 9 of 11 cases of gastroparesis or proximal duodenal obstruction. Transnasal endoscopy has a role in the placement of NET in non–critically ill patients requiring postpyloric feeding. However, there are some limitations, particularly in cases with altered duodenal anatomy.

Key Words: transnasal endoscopy • nasoenteric tubes • nasojejunal tubes • enteral nutrition • postpyloric feeding • non–critically ill • outcomes

Nutrition in Clinical Practice, Vol. 23, No. 2, 176-181 (2008)
DOI: 10.1177/0884533608314535


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