title: Systematic review on bedside electromagnetic-guided, endoscopic, and fluoroscopic placement of nasoenteral feeding tubes.
abstract: BACKGROUND
  Nasoenteral tube feeding is frequently required in hospitalized patients to either prevent or treat malnutrition, but data on the optimal strategy of tube placement are lacking.
  
  
  OBJECTIVE
  To compare the efficacy and safety of bedside electromagnetic (EM)-guided, endoscopic, and fluoroscopic placement of nasoenteral feeding tubes in adults.
  
  
  METHODS
  Systematic review of the literature.
  
  
  METHODS
  Adult hospitalized patients requiring nasoenteral feeding.
  
  
  METHODS
  EM-guided, endoscopic, and/or fluoroscopic nasoenteral feeding tube placement.
  
  
  METHODS
  Success rate of tube placement and procedure- or tube-related adverse events.
  
  
  RESULTS
  Of 354 screened articles, 28 studies were included. Data on 4056 patients undergoing EM-guided (n = 2921), endoscopic (n = 730), and/or fluoroscopic (n = 405) nasoenteral feeding tube placement were extracted. Tube placement was successful in 3202 of 3789 (85%) EM-guided procedures compared with 706 of 793 (89%) endoscopic and 413 of 446 (93%) fluoroscopic procedures. Reinsertion rates were similar for EM-guidance (270 of 1279 [21%] patients) and endoscopy (64 of 394 [16%] patients) or fluoroscopy (10 of 38 [26%] patients). The mean (standard deviation) procedure time was shortest with EM-guided placement (13.4 [12.9] minutes), followed by endoscopy and fluoroscopy (14.9 [8.7] and 16.2 [23.6] minutes, respectively). Procedure-related adverse events were infrequent (0.4%, 4%, and 3%, respectively) and included mainly epistaxis. The tube-related adverse event rate was lowest in the EM-guided group (36 of 242 [15%] patients), followed by fluoroscopy (40 of 191 [21%] patients) and endoscopy (115 of 384 [30%] patients) and included mainly dislodgment and blockage of the tube.
  
  
  CONCLUSIONS
  Heterogeneity and limited methodological quality of the included studies.
  
  
  CONCLUSIONS
  Bedside EM-guided placement of nasoenteral feeding tubes appears to be as safe and effective as fluoroscopic or endoscopic placement. EM-guided tube placement by nurses may be preferred over more costly procedures performed by endoscopists or radiologists, but randomized studies are lacking.
authors: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Arja
authors: A
authors: Gerritsen
authors: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors: Marcel J
authors: MJ
authors: van der Poel
authors: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors: Thijs
authors: T
authors: de Rooij
authors: Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: I Quintus
authors: IQ
authors: Molenaar
authors: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
authors: Jacques J
authors: JJ
authors: Bergman
authors: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors: Olivier R
authors: OR
authors: Busch
authors: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
authors: Elisabeth M
authors: EM
authors: Mathus-Vliegen
authors: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: m.g.besselink@amc.nl.
authors: Marc G
authors: MG
authors: Besselink
mesh_terms: D016099:Endoscopy, Gastrointestinal; D005471:Fluoroscopy; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000379:methods*; D060526:Magnetic Fields; D061646:Operative Time; D019095:Point-of-Care Systems; D019233:Retreatment