Analysis of the causes of failed placement of nasoenteric tube under DSA guidance and treatment strategies for successful re-catheterization.

Abstract

For patients with advanced cancer or patients who have undergone digestive tract reconstruction, enteral nutrition is the most important nutritional support therapy, which can reduce the risk of enteral infection and improve self-immunity; while digital subtraction angiography (DSA) guided nasoenteric tube placement is suitable for nutritional support and palliative treatment of most patients with advanced cancer, many doctors because the preoperative preparation is not sufficient or the intraoperative operation is not standardized, resulting in catheter failure can not achieve the purpose of nutritional supply, and we need to summarize the lessons of failure and optimize the catheterization strategy. From February 2015 to July 2020, A total of 3,810 cases were treated with DSA guided nasoenteric feeding tube placement. According to the requirements that enteral nutrition could not be performed by the initial catheterization, 94 cases of catheterization failure were selected as the study subjects. The causes of catheterization failure were analyzed and summarized by analyzing the intraoperative image data and operation process; 42 cases of catheterization failure experienced successful catheterization after re-catheterization. By studying the relevant preoperative preparation and intraoperative operation, the treatment strategies and operation methods for successful re-catheterization were summarized. In 94 patients with primary catheterization failure, anastomotic stenosis or obstruction accounted for 20.2%, excessive dilatation of gastric lumen accounted for 17.0%, pyloric stenosis or obstruction of antrum accounted for 13.8%, efferent loop stenosis or obstruction accounted for 11.7%, and the above factors were the main causes of DSA guided feeding tube failure; of the 42 patients with successful recatheterization, 9 patients underwent adequate negative pressure drainage before surgery, 7 patients modified the projection angle by adjusting the C-arm, 5 patients applied cone-beam CT technique, 5 patients used balloon dilatation of the stenotic segment, and the above factors were the main strategy methods for successful recatheterization. The success rate of DSA guided nasoenteric feeding tube placement will be greatly improved by adequate gastrointestinal decompression and drainage and other related preoperative preparation as well as good intraoperative application of cone-beam CT technique or combined application of balloon, gastroscope, stent and other technical means.