Versatility and ease of using disposable flexible bronchoscopes as an alternative to transnasal video gastroscope for difficult nasogastric tube insertion in critical patients in a resource-limited setting

Abstract

Background and AimsThe flexible bronchoscope has evolved from use in the management of difficult airways to several diagnostic and therapeutic procedures. It has equipped the anesthesiologist’s armamentarium by enabling the management of difficult airways, foreign body retrieval, and endotracheal tube suctioning under vision in intensive care units. Recently, however, the flexible bronchoscope has also proven invaluable in aiding the placement of nasogastric tubes (NGTs) in patients when all other modalities fail, especially in the absence of dedicated transnasal video gastroscopes. The disposable Ambu aScope (Ambu A/S Baltorpbakken, Ballerup, Denmark) has the potential to serve as an alternative to conventional fiberscopes for this purpose.MethodsWe report the use of Ambu aScope for NGT insertion in 3 cases of increasing complexity to highlight the importance of Ambu aScopes for the management of NGT insertion.ResultsThis series demonstrates successful application of Ambu aScope for NGT insertion in 2 cases of advanced carcinoma in the gastroesophageal junction and in 1 case of suspected esophageal perforation.ConclusionsAmbu aScopes can be used reliably as an alternative to transnasal gastroscope in resource-limited centers for NGT insertion. The flexible bronchoscope has evolved from use in the management of difficult airways to several diagnostic and therapeutic procedures. It has equipped the anesthesiologist’s armamentarium by enabling the management of difficult airways, foreign body retrieval, and endotracheal tube suctioning under vision in intensive care units. Recently, however, the flexible bronchoscope has also proven invaluable in aiding the placement of nasogastric tubes (NGTs) in patients when all other modalities fail, especially in the absence of dedicated transnasal video gastroscopes. The disposable Ambu aScope (Ambu A/S Baltorpbakken, Ballerup, Denmark) has the potential to serve as an alternative to conventional fiberscopes for this purpose. We report the use of Ambu aScope for NGT insertion in 3 cases of increasing complexity to highlight the importance of Ambu aScopes for the management of NGT insertion. This series demonstrates successful application of Ambu aScope for NGT insertion in 2 cases of advanced carcinoma in the gastroesophageal junction and in 1 case of suspected esophageal perforation. Ambu aScopes can be used reliably as an alternative to transnasal gastroscope in resource-limited centers for NGT insertion.