A randomized trial of endoscopic and fluoroscopic placement of postpyloric feeding tubes in critically ill patients.
BACKGROUND
Early postpyloric feeding is considered the accepted method of nutrition support in critically ill patients. Endoscopic and fluoroscopic techniques are associated with the highest percentage of successful placement. The purpose of this study was to compare endoscopic vs fluoroscopic placement of postpyloric feeding tubes in critically ill patients.


METHODS
This is a randomized prospective clinical trial. Forty-three patients were randomized to receive feeding tubes by endoscopic or fluoroscopic technique. All procedures were performed at the bedside in the critical care unit. A soft small-bore nonweighted feeding tube was used in all cases. Successful placement was confirmed by either an abdominal x-ray for endoscopic technique or a fluoroscopic radiograph for fluoroscopic technique.


RESULTS
Postpyloric feeding tubes were successfully placed in 41 of 43 patients (95%). The success rate using endoscopic technique was 96% (25 of 26), whereas the rate using fluoroscopy was 94% (16 of 17). The average time of successful placement was 15.2 +/- 2.9 (mean +/- SEM) minutes for endoscopic placement and 16.2 +/- 3.2 minutes for fluoroscopic placement, which was not statistically significant (p > .05).


CONCLUSIONS
Endoscopic and fluoroscopic placement of postpyloric feeding tubes can safely and accurately be performed at the bedside in critically ill patients. Our results showed no significant difference in the success rate or time of placement between endoscopic vs fluoroscopic placement of postpyloric feeding tubes.
Foote
James A
JA
Spectrum Health Department of Surgical Critical Care, Michigan State University, 515 Michigan Street NE, Suite 102, Grand Rapids, MI 49503, USA.
Kemmeter
Paul R
PR
Prichard
Pablo A
PA
Baker
Randal S
RS
Paauw
James D
JD
Gawel
Jeffery C
JC
Davis
Alan T
AT
D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011860:Radiography, Abdominal; D013997:Time Factors; D016896:Treatment Outcome