Nasogastric feeding tube placement in patients with esophageal cancer: application of ultrathin transnasal endoscopy.
BACKGROUND
Patients with esophageal cancer often present with dysphagia and malnutrition. Obstructive symptoms may improve after radiotherapy and chemotherapy. Nutrition support via a nasogastric tube (NG) or gastrostomy is very important during treatment. The newly developed ultrathin endoscope (Olympus, GIF-N230, outer diameter: 6 mm) has a smaller diameter than the standard endoscope and can be introduced into the esophagus via the nasal cavity. This article reports on the use of an ultrathin endoscope for NG placement for patients with esophageal cancer who presented with dysphagia and failed traditional NG tube placement.


METHODS
A consecutive series of 40 patients with esophageal cancer were referred to our hospital from November 2001 to October 2002 for endoscopic placement of NG tubes due to failure of traditional methods of NG placement. An ultrathin endoscope was used to advance the guidewire into the stomach via the nasal cavity. After withdrawal of the scope, the NG tube was inserted over the guidewire under fluoroscopy.


METHODS
A total of 71 procedures were performed in 40 patients (37 males, 3 females), age 57 +/- 15 years (range, 37-91 y). Seventy procedures (99%) were successful in completing NG tube placement by using an ultrathin transnasal endoscope. Only one procedure failed because the esophageal lumen was completely occluded and the guidewire was not able to be passed through the obstructed site. The average duration that the NG tube was left in place was 49 +/- 35 days (range, 2-144 days). No procedure-related complications, such as bleeding or perforation, occurred.


CONCLUSIONS
Using ultrathin transnasal endoscopy to place an NG tube for esophageal cancer patients is effective and safe. It simplifies the procedures and increases the success rate.
Lin
Cheng-Hui
CH
Division of Digestive Therapeutic Endoscopy, Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Linkou, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan.
Liu
Nai-Jen
NJ
Lee
Ching-Song
CS
Tang
Jui-Hsiang
JH
Wei
Kuo-Liang
KL
Yang
Chun
C
Sung
Kai-Feng
KF
Cheng
Chi-Liang
CL
Chiu
Cheng-Tang
CT
Chen
Pang-Chi
PC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D003680:Deglutition Disorders / Q000628:therapy; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000628:therapy*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D008875:Middle Aged