title: Transnasal endoscopic placement of nasoenteric feeding tubes: outcomes and limitations in non-critically ill patients.
abstract: 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.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. sanjiv@ummc.edu.my
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Mahadeva
authors.forename: Abdul
authors.initials: A
authors.lastname: Malik
authors.forename: Ida
authors.initials: I
authors.lastname: Hilmi
authors.forename: Choon-Seng
authors.initials: CS
authors.lastname: Qua
authors.forename: Choon-Heng
authors.initials: CH
authors.lastname: Wong
authors.forename: Khean-Lee
authors.initials: KL
authors.lastname: Goh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016145:Endoscopy, Digestive System / Q000379:methods*; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome