Endoscopic Nasoenteral Feeding Tube Placement: A Combined Push and Pull Method

Abstract

This study introduces a simple and effective method of endoscopic postpyloric feeding tube placement. We used a 12 French, 114-cm long, polyurethane feeding tube with a distal tungsten weighted tip. A 3-0 nylon suture was tied to the tube end. An endoscopic channel cleaning brush was loaded into the feeding tube as a pusher. The internal lumen of the feeding tube was flushed with water. The outer wall of the feeding tube was then lubricated with lidocaine jelly and inserted through the nostril into the stomach. A biopsy forceps was inserted via the endoscopic biopsy channel, and used to grasp the suture firmly. The endoscope pulled the feeding tube through the pyloric sphincter. The biopsy forceps advanced the feeding tube as far as possible. When the endoscope was withdrawn to the antrum, the brush pushed tightly against the distal end of the feeding tube. Then, the biopsy forceps was removed. Using this technique, we successfully placed 91 of 94 (97%) feeding tubes in these patients. This procedure required an average of 7 minutes and caused no major complications. In conclusion, postpyloric feeding tube placement by this method is safe and easy to perform. We believe that application of this technique will be an efficient modality in the future.