Endoscopic placement of jejunal feeding catheters in critically ill patients by a "push" technique.

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Enteral nutrition is less expensive and often preferred to parenteral nutrition in the critically ill or injured patient. Gastric feedings are poorly tolerated in some patients, however, and postpyloric access is frequently difficult to obtain. In this report, we describe our experience with a new technique for bedside endoscopic placement of small intestinal feeding tubes. Using both prospective and retrospective analysis, we studied our results with endoscopically placed postpyloric feeding tubes in intensive care unit (ICU) patients. In this method, a 7F nasobiliary tube is passed via an endoscope into the proximal small bowel by a "push" technique. We recorded the demographic data of the patients, the feeding regimens subsequently used for these patients, and the overall feasibility and complications of the procedures themselves. The technique was performed on 71 occasions in 61 ICU patients. The entire procedure averaged 29 minutes in a prospectively evaluated subset of patients. Small intestinal cannulation was successful in every case, including cases in which fluoroscopic attempts had failed. No complications developed from placement of the feeding tubes. This report demonstrates that our bedside method of endoscopic placement of proximal small-bowel feeding tubes may be safely and expediently performed in ICU patients. Although not yet formally compared with other techniques, this procedure may have some advantages over traditional methods of small-bowel feeding tube placement.