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Abstract

We thank Matsushita et al for their interest in our article and greatly appreciate their comments on this case. Although a tangled or knotted tube is a known complication of nasogastric tube placement, the predisposing factors are not well-understood. The possible causes include small-caliber tubes and an excessive length of the tube left in the stomach.1Dasani B. Sahdev P. Knotting of a nasogastric tube: a case report.Am J Emerg Med. 1991; 9: 565Abstract Full Text PDF PubMed Scopus (14) Google Scholar, 2Cappell M.S. Scarpa P.J. Nadler S. et al.Complications of nasoenteral tubes: intragastric tube knotting and intragastric tube breakage.J Clin Gastroenterol. 1992; 14: 144-147Crossref PubMed Scopus (26) Google Scholar, 3Mandal N.G. Foxell R. Knotting of a nasogastric tube.Anaesthesia. 2000; 55: 99Crossref PubMed Scopus (15) Google Scholar A small-caliber tube is softer and can form a loop more easily than a large-caliber one. When an excessive length of the tube is left in the stomach, the tube may coil back on itself, and a knot will develop if the tip of the tube passes through the loop. In this patient, a 16F tube was used, but the inserted length of the tube was not recorded. We agree with Dr Matsushita that insertion of an excessive length of the nasogastric tube may be one of the most likely causes of the tangled tube in our patient. We thank Matsushita et al for their interest in our article and greatly appreciate their comments on this case. Although a tangled or knotted tube is a known complication of nasogastric tube placement, the predisposing factors are not well-understood. The possible causes include small-caliber tubes and an excessive length of the tube left in the stomach.1Dasani B. Sahdev P. Knotting of a nasogastric tube: a case report.Am J Emerg Med. 1991; 9: 565Abstract Full Text PDF PubMed Scopus (14) Google Scholar, 2Cappell M.S. Scarpa P.J. Nadler S. et al.Complications of nasoenteral tubes: intragastric tube knotting and intragastric tube breakage.J Clin Gastroenterol. 1992; 14: 144-147Crossref PubMed Scopus (26) Google Scholar, 3Mandal N.G. Foxell R. Knotting of a nasogastric tube.Anaesthesia. 2000; 55: 99Crossref PubMed Scopus (15) Google Scholar A small-caliber tube is softer and can form a loop more easily than a large-caliber one. When an excessive length of the tube is left in the stomach, the tube may coil back on itself, and a knot will develop if the tip of the tube passes through the loop. In this patient, a 16F tube was used, but the inserted length of the tube was not recorded. We agree with Dr Matsushita that insertion of an excessive length of the nasogastric tube may be one of the most likely causes of the tangled tube in our patient. Excessive length of a tube in the stomach: a risk factor for a tangled or knotted tubeGastrointestinal EndoscopyVol. 74Issue 1PreviewWe read with interest the article by Tai et al1 on a patient with a tangled nasogastric tube. One week after tube placement, complete occlusion of the tube was suspected because of an inability to flush. After failure to remove the tube, EGD confirmed a tangled tube obstructing the esophagus. We suspect that the most important risk factor for a tangled or knotted tube is present in this patient. Full-Text PDF