title: Transnasal endoscopy for the placement of nasoenteral feeding tubes: does the working length of the endoscope matter?
abstract: BACKGROUND
  Transnasal endoscopy with a small-caliber endoscope has been shown to be helpful for the placement of nasoenteral feeding tubes in patients who are critically ill. Success rates were limited by the short working length of the small-caliber endoscopes.
  
  
  OBJECTIVE
  To compare the success rate of a 133-cm-long, small-caliber, prototype videoendoscope with a standard 92-cm-long, small-caliber, fiberoptic endoscope for the transnasal placement of feeding tubes.
  
  
  METHODS
  Randomized controlled study.
  
  
  METHODS
  University Hospital of Zurich, Switzerland.
  
  
  METHODS
  Patients who were critically ill were randomly assigned to transnasal feeding tube placement with the standard 92-cm-long, small-caliber, fiberoptic endoscope, or with a new 133-cm-long, small-caliber, prototype videoendoscope. Patient characteristics, procedure time, technical difficulties, patient tolerance, and radiologic tube position were assessed.
  
  
  METHODS
  Success rates of endoscopic placement of enteral feeding tubes.
  
  
  RESULTS
  A total of 157 patients were analyzed in 2 groups. The 2 groups were similar with regard to patient characteristics, body length, technical difficulty, and patient tolerance. The 133-cm-long instrument was superior with respect to successful placement of the nasoenteral feeding tube (93.6% vs 74.4%, P = .0008). Patient tolerance, procedure times, and overall technical difficulty were the same in both treatment groups, whereas passage through the duodenum was more difficult with the 133-cm-long instrument (P < .0001).
  
  
  CONCLUSIONS
  In rare cases, the randomization list could not be followed correctly.
  
  
  CONCLUSIONS
  This study demonstrated that placement of a nasoenteral feeding tube with a 133-cm-long, small-caliber videoendoscope is feasible, safe, and distinctly more successful than with a 92-cm-long, small-caliber standard instrument.
authors.affiliation: Current affiliations: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital of Zurich, Switzerland.
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Wildi
authors.forename: Christoph
authors.initials: C
authors.lastname: Gubler
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Vavricka
authors.forename: Michael
authors.initials: M
authors.lastname: Fried
authors.forename: Peter
authors.initials: P
authors.lastname: Bauerfeind
mesh_terms: D016638:Critical Illness; D019723:Endoscopes; D004724:Endoscopy; D004750:Enteral Nutrition; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D014741:Video Recording