The rapid placement of jejunal feeding tubes: the Setdinger technique applied to the gut

Abstract

The jejunal placement of enteral feeding tubes can be quite difficult. There are three methods for positioning naso-enteral tubes or tubes placed through a gastrostomy. These require blind passage of a weighted tube into the stomach allowing peristalsis to propel the tube into the small intestine, radiographic placement with fluoroscopic manipulation, or endoscopic placement of the tube with direct vision techniques. 9 All methods have limitations. With duodenal placement, backwash of fluid or retrograde movement of the weighted feeding tube into the stomach can occur. Weighted tubes may require a few days to pass out of the stomach and placement beyond the ligament of Treitz is often not accomplished. Endoscopic placement often fails due to friction between the feeding tube and the endoscope as the latter is withdrawn. Placement of the feeding ports beyond the ligament of Treitz is the only method that will ensure that the tube will not fall back toward the stomach and that feeding will not reflux into the stomach. We have applied a guide wire technique to insert a 12 French feeding tube to achieve a rapid and reliable placement of jejunal tubes both naso-enterally and through pre-existing gastrostomies.