S0579 The Utility of Obtaining Abdominal Radiograph to Confirm Nasoenteric Feeding Tube Placement by Endoscopy

Abstract

INTRODUCTION: Enteral feeding is the preferred method of nutrition support in patients unable to maintain volitional intake given its low cost, preservation of gut integrity, and lower infection rate as compared to parenteral nutrition. At our institution, nasoenteric tubes are either placed by nutrition support nurses who are trained to use electromagnetically visualized enteral system or placed by endoscopy either by gastroenterology or general surgery. We aimed to validate feeding tube placement by endoscopy using abdominal x- rays and to determine the risk factors associated with a mal-positioned feeding tube. METHODS: In this retrospective observational study, all patients who underwent nasoenteric feeding tube placement by endoscopy during the year 2019 at Cleveland Clinic were identified using electronic medical records. Data was collected on indication for feeding tube, location (inpatient vs. outpatient), feeding tube tip position on endoscopy report and x-ray report (obtained within 24 hours post-placement), demographics, BMI, medications, comorbidities including gastroparesis, ileus, post-op GI surgery, and post-op non-GI surgery. RESULTS: A total of 308 patients were included in the final analysis. The mean age was 58.9 years, 53.9% were females and 77.3% were white. Majority of the feeding tubes were placed in outpatient or ambulatory setting compared to inpatient (208 vs 100). The main indication for feeding tube placement was dysphagia (24.4%) followed by malnutrition (14.9%), nausea and vomiting (8.4%), and gastroparesis (8.1%). Feeding tube tip location by endoscopy was in the proximal or distal duodenum 61% of the time and in the proximal jejunum 26.3%. Tip location on abdominal film was 22% in the jejunum, 22.1% in the stomach, 15.6% in the third and fourtpart of the duodenum, and 14.6% in first or second part of the duodenum. Endoscopy and x-ray were 75% of the time in agreement. Some of the factors associated with EGD and x-ray discrepancy include younger age, male gender, greater BMI, longer endoscopy duration and having a fellow present during the case although none are statistically significant (P > 0.05). CONCLUSION: The tip of nasoenteric feeding tube may migrate during or post procedure. Therefore, abdominal films should remain the gold standard to confirm tip position in nasoenteric feeding tube placed by endoscopy.