title: Electromagnetic-Guided Versus Endoscopic Placement of Nasojejunal Feeding Tubes After Pancreatoduodenectomy: A Prospective Pilot Study.
abstract: OBJECTIVE
  An altered anatomy such as after pancreatoduodenectomy is currently seen as relative contraindication for bedside electromagnetic (EM)-guided nasojejunal feeding tube placement. The aim of this study was to determine the feasibility and safety of bedside EM-guided placement of nasojejunal feeding tubes as compared with endoscopy in patients after pancreatoduodenectomy.
  
  
  METHODS
  We performed a prospective monocenter pilot study in patients requiring enteral feeding after pancreatoduodenectomy (July 2012-March 2014). Primary end point was the success rate of primary tube placement confirmed on plain abdominal x-ray followed by successful enteral feeding.
  
  
  RESULTS
  Overall, 53 (42%) of 126 patients who underwent pancreatoduodenectomy required a nasojejunal feeding tube, of which 36 were placed under EM guidance and, in 17, it was placed by endoscopy. Initial tube placement was successful in 21 (58%) of 36 patients with EM guidance and 9 (53%) of 17 patients with endoscopy (P = 0.71). No complications occurred during the placement procedures. Dislodgement and/or blockage of the tube occurred in 14 (39%) of 36 patients in the EM-guided group and 8 (47%) of 17 patients in the endoscopic group (P = 0.57).
  
  
  CONCLUSIONS
  Bedside EM-guided placement of nasojejunal feeding tubes by nurses was equally successful as endoscopic placement in patients after pancreatoduodenectomy.
authors.affiliation: From the Departments of *Surgery and †Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Arja
authors.initials: A
authors.lastname: Gerritsen
authors.forename: Ann
authors.initials: A
authors.lastname: Duflou
authors.forename: Max
authors.initials: M
authors.lastname: Ramali
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: Els J M
authors.initials: EJ
authors.lastname: Nieveen van Dijkum
authors.forename: Elisabeth M H
authors.initials: EM
authors.lastname: Mathus-Vliegen
authors.forename: Marc G H
authors.initials: MG
authors.lastname: Besselink
mesh_terms: D000368:Aged; D020776:Endoscopes, Gastrointestinal; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D060328:Magnetic Phenomena; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D015203:Reproducibility of Results