Tu1727 Nasoenteral Feeding Tube Placement Using Ultra-Thin Endoscopy in Daily Clinical Practice Is Associated With Low Success Rates

Abstract

Nasoenteral Feeding Tube Placement Using Ultra-Thin Endoscopy in Daily Clinical Practice Is Associated With Low Success Rates Meike M. Hirdes*, Lily Nagtzaam, Elisabeth M. Mathus-Vliegen, Frank P. Vleggaar, Jan J. Koornstra, Peter D. Siersema, Jan F. Monkelbaan Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, Netherlands; Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, Netherlands; Gastroenterology & Hepatology, University Medical Center Groningen, Groningen, Netherlands Background and Aim: In case of short term intolerance to gastric feeding, nasoenteral feeding tubes are commonly used to provide nutritional support. Tube placement over a guide wire using transnasal endoscopy is a minimally invasive technique for post-pyloric feeding tube placement at the bedside, with a reported success rate of 90% in experienced hands. In daily clinical practice, transnasal endoscopic tube placement is often performed by less experienced trainee endoscopists, which may affect success rates. The aim of this study was to determine success rate of transnasal endoscopic feeding tube placement in teaching hospitals and to identify independent patient and procedure-related predictors of successful tube placement. Methods: From January October 2011, all consecutive patients referred for first nasoenteral feeding tube placement with ultra-thin endoscopy were included. Exclusion criteria were altered anatomy of the upper gastrointestinal tract, alternative strategy of endoscopic tube placement, and no abdominal X-ray made within 3 hours after endoscopy. Abdominal X-rays were evaluated by radiologists not involved in the study. Multivariable logistic regression analysis was performed to identify independent predictors of successful tube placement. Successful nasoenteral tube placement was defined as a post-pyloric location of the tip of the feeding tube on abdominal radiograph. Results: In total, 175 patients (95 males, mean age 59 17 years) were included from 3 Dutch teaching hospitals. Patients were mostly admitted to the ward (48%) or intensive care unit (ICU, 36%). Common indications for nasoenteral tube feeding included gastroparesis due to critical illness (31%) or surgery (21%). Most endoscopic tube placements were performed by trainee endoscopists (81%) and under conscious sedation (74%). Radiographic control revealed that 26% of the tubes were placed in the stomach, 9% in the proximal duodenum, 16% in the distal duodenum and 49% in the jejunum. Multivariable logistic regression showed that use of sedation was the only independent predictor of successful feeding tube placement (OR 2.4 (95% CI 1.1-5.1)). Tube placement by a trainee instead of staff endoscopist, ICU admission or the presence of large gastric residuals ( 300 cc) were not associated with an increased risk of incorrect tube placement. Conclusions: In daily clinical practice, success rate of endoscopic nasoenteral feeding tube placement is much lower than reported in previous ‘study settings,’ however, this cannot be explained by the difference in experience between staff and trainee endoscopists. We recommend routine use of an abdominal X-ray after transnasal endoscopic tube placement to verify correct placement. The use of sedation can be considered as this may prevent incorrect tube placement.