Fluoroscopic Placement Research Articles

Efficacy and Complications of Enteral Feeding Tube Insertion After Liver Transplantation

BackgroundAdequate nutritional support for patients undergoing major surgery significantly affects postoperative recovery. Data on enteral feeding after liver transplantation (LT) are scarce. The aim of this work was to determine the efficacy and complications of feeding tubes inserted with the use of fluoroscopic assistance, endoscopic assistance, or transperitoneal jejunostomy in patients who underwent LT. MethodsFrom January 2008 to August 2013, 2,058 LTs were performed at Asan Medical Center, Seoul, Korea. Enteral feeding tubes were inserted in 155 patients (7.5%) after LT: with the use of fluoroscopic placement in 81 (52%), endoscopic placement in 49 (32%), and transperitoneal jejunostomy in 25 (16%). We retrospectively analyzed the efficacy and complications of enteral feeding tubes. ResultsThe median age was 55 years (interquartile range [IQR] 49–60). Enteral feeding indications were a high risk of gastric aspiration (n = 90), gastric stasis (n = 27), pneumonia (n = 23), gastrointestinal bleeding (n = 12), and bowel rest (n = 3). Median enteral feeding durations were 14.5 days (IQR 8.0–30.7) for fluoroscopic placement, 20.0 days (IQR 8.0–40.0) for endoscopic placement, and 37.5 days (IQR 18.2–86.2) for transperitoneal jejunostomy. Times to establishment of oral feeding were 13.0 days (IQR 6.2–25.7) for fluoroscopic placement, 24.0 days (IQR 10.5–43.5) for endoscopic placement, and 37.0 days (IQR 17.0–64.2) for transperitoneal jejunostomy. After tube insertion, tube dislocation and blockage occurred in 34 patients (22%) and 16 patients (25%), respectively. ConclusionsEnteral feeding tube insertion in patients who can not maintain a nasogastric tube or start oral intake for a long time is important for nutritional support after LT. Proper feeding method selection according to patient condition can help patients by improving nutritional support after major operations such as LT.

Isolated limb infusion chemotherapy with or without hemofiltration for recurrent limb melanoma.

To better define the efficacy and the safety of intra-arterial infusion performed with or without hemofiltration for recurrent limb melanoma. Patients with the following characteristics were included in the study: recurrent limb melanoma not indicated for surgical resection, measurable disease in the extremity, > 18 years, performances status (Eastern Cooperative Oncology Group ) was 0-1 and life expectancy of at least 6 mo. Twenty nine consecutive patients were enrolled in the study. Patients underwent fluoroscopic placement of angiographic arterial and venous catheters to infuse the drug in the artery [isolated limb infusion (ILI)], and to stop the out flow (venous). Melphalan was rapidly infused into the isolated limb via the arterial catheter after the inflation of venous balloon catheter. Then the circulation of the limb was completely blocked with a pneumatic cuff at the root of the limb. Haemofiltration (HF) was available only in the main center, and was performed with an extracorporeal perfusion system, in order to reduce high systemic toxic peaks of drug. Thirty seven ILI were done in 29 cases (31 ILI-HF and 6 ILI) between 2001 and 2014 at Ancona and Pesaro Hospitals, Italy. Clinical outcomes were monitored 30 d after treatment. Eleven patients (38%) received infusion of melphalan alone, 7 (24%) melphalan associated to mitomicin C and 7 (24%) melphalan associated to cisplatin, the remaining 4 were treated with cisplatin, melphalan and epirubicin or cisplatin and mitomicin C. The overall response rate was 66%, in particular, 3 patients (10%) were complete responders and 16 (56%) were partial responders; whereas 7 patients (24%) had stable disease, and 3 (10%) showed progressive disease. Limb toxicity was assessed adopting Wieberdink scale, with evidence of 90% of low grade (I and II) toxicity. ILI-HF and ILI are effective and safe treatments for recurrent non-resectable limb melanoma. They present evidence of favorable clinical benefit and is effective in delaying progression.

Palatal erosion and oronasal fistulation following covered nasopharyngeal stent placement in two dogs

Treatment options for dogs with nasopharyngeal stenosis include fluoroscopic placement of metallic stents. Reported complications include entrapment of hair and food, obstruction and persistent nasal discharge. Two toy breed dogs were examined for persistent nasal discharge and halitosis at 4 and 20 months after placement of permanent metallic stents for acquired nasopharyngeal stenosis. Full thickness defects were found in the palate of both dogs, with extensive communication between the mouth and the nasal passages. Portions of the metal stent were observed within the lesion in both patients. Additional treatment was declined by the owner of one dog; the stent was removed through the fistula in the other dog. Palatal erosion with secondary oronasal fistulation is a potential complication of nasopharyngeal stent placement in dogs.

Usefulness of a Guiding Sheath for Fluoroscopic Stent Placement in Patients with Malignant Gastroduodenal Obstruction

Self-expandable metallic stent placement is widely used to manage malignant gastroduodenal obstructions. However, there are difficulties in negotiating a guidewire (GW) and a stent delivery system (SDS). To investigate feasibility, usefulness, and safety of a guiding sheath for fluoroscopic stent placement in patients with malignant gastroduodenal obstructions. In July 2001 to August 2011, 726 patients with malignant gastroduodenal obstructions underwent stent placement. Guiding sheath was used in patients in whom a GW could not be passed through the obstruction and a SDS failed to reach the obstruction. Sheath usefulness was evaluated based on the ability of the sheath to successfully assist. The technical success rate and the most frequent reasons for the use of a sheath were evaluated. The guiding sheath was needed in 148 of 726 patients (20%). The overall technical success rate was 98% with the guiding sheath. In two of 148 patients, stent placement failed because, the GW could not be passed through the obstruction, in the other, the SDS could not be passed. A minority of patients reported mild discomfort. Patients with pancreatic cancer and duodenal obstruction were significantly more likely to require the use of guiding sheaths (P = 0.002, P < 0.001, respectively). Using a guiding sheath for fluoroscopic stent placement appears to be feasible, useful and safe in patients with malignant gastroduodenal obstructions.

4:02 PM Abstract No. 227 - Optimization of iterative reconstruction technique for CT pulmonary arteriography: systemic assessment in a porcine model

Purpose To evaluate the quantitative and qualitative image quality of pulmonary CT arteriography images reconstructed with filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR), and model-based iterative reconstruction (MBIR) scanned at differential radiation doses. Materials and Methods A healthy 56.1 kg Yorkshire pig underwent fluoroscopic placement of a femoral central venous catheter. The catheter was subsequently injected with macerated, previously clotted autologous blood. After pulmonary emboli were visualized in the left lower lobe segmental pulmonary arteries, successive pulmonary arterial CT angiography on a Discovery 750HD MDCT scanner (GE Healthcare) was performed at 700, 400, 200, 100, and 50 mA at 120, 100, and 80 kVp, for a total of 15 scans. Each scan was reconstructed FBP, ASIR (50% blend) and MBIR. Noise (SD) and contrast-to-noise ratios were calculated from ROIs over the left lower lobe segmental pulmonary artery and paraspinous muscle. Selected axial images were scored subjectively for PE visibility and overall image quality. Results Averaged across all doses, MBIR reduced noise and improved contrast to noise ratio (CNR) compared to FBP by 73% and 232%, and reduced noise and improved CNR compared to ASIR by 69% and 110%, respectively. The effect was more pronounced in higher noise settings. Averaged across all doses, MBIR improved subjective image quality and diagnostic sensitivity for pulmonary embolism (PE) compared to FBP by 50% and compared to ASIR by 25%. Subjective improvements in image quality were most pronounced in higher noise settings. At 120 kVp/400 mA, readers scored FBP, ASIR, and MBIR images equally. At 100 mA/120 kVp, readers scored FBP and ASIR images as nondiagnostic for detection of PE, while MBIR images were considered of moderate quality but remained diagnostic for detection of PE. Conclusion MBIR reduced image noise and improved CNR for the pulmonary arteries compared to ASIR and FBP across all dose levels. Furthermore, MBIR resulted in higher subjective image quality and improved diagnostic sensitivity for pulmonary embolism, particularly in higher noise settings.

Biodegradable stent for the treatment of a colonic stricture in Crohn’s disease

Biodegradable polydioxanone stents were developed for the treatment of refractory benign esophageal strictures but have been suggested as a new therapeutic option for intestinal strictures. The primary advantage of biodegradable stents over self-expandable metallic stents is that removal is not required. There are, however, few data available on their use in the small or large bowel. We herein describe the case of a 33-year-old patient with long-standing Crohn's disease (CD) who developed a fibrotic stricture of the sigmoid too long to be amenable to balloon dilation. The use of a biodegradable polydioxanone stent was chosen to avoid surgery. Combined endoscopic and fluoroscopic placement of the stent was technically simple, safe and clinically successful, and no recurrence of obstructive symptoms occurred during a 16-mo follow-up. Further studies are needed to evaluate the long-term efficacy and safety of biodegradable stents in the treatment of intestinal strictures, particularly in the context of CD.

Evaluation of a new method for placing nasojejunal feeding tubes.

To compare fluoroscopic, endoscopic and guide wire assistance with ultraslim gastroscopy for placement of nasojejunal feeding tubes. The information regarding nasojejunal tube placement procedures was retrieved using the gastrointestinal tract database at Tongji Hospital affiliated to Tongji Medical College. Records from 81 patients who underwent nasojejunal tubes placement by different techniques between 2004 and 2011 were reviewed for procedure success and tube-related outcomes. Nasojejunal feeding tubes were successfully placed in 78 (96.3%) of 81 patients. The success rate by fluoroscopy was 92% (23 of 25), by endoscopic technique 96.3% (26 of 27), and by guide wire assistance (whether via transnasal or transoral insertion) 100% (23/23, 6/6). The average time for successful placement was 14.9 ± 2.9 min for fluoroscopic placement, 14.8 ± 4.9 min for endoscopic placement, 11.1 ± 2.2 min for guide wire assistance with transnasal gastroscopic placement, and 14.7 ± 1.2 min for transoral gastroscopic placement. Statistically, the duration for the third method was significantly different (P < 0.05) compared with the other three methods. Transnasal placement over a guidewire was significantly faster (P < 0.05) than any of the other approaches. Guide wire assistance with transnasal insertion of nasojejunal feeding tubes represents a safe, quick and effective method for providing enteral nutrition.

Decompression of the small bowel by endoscopic long-tube placement

To investigate and compare the decompression effect on small bowel obstruction of a long tube inserted using either endoscopic or fluoroscopic placement. Seventy-eight patients with small bowel obstruction requiring decompression were enrolled in the study and divided into two groups. Intubation of a long tube was guided by fluoroscopy in one group and by endoscopy in the other. The duration of the procedure and the success rate for each group were evaluated. A statistically significant difference in the mean duration of the procedure was found between the fluoroscopic group (32.6 ± 14.6 min) and the endoscopic group (16.5 ± 7.8 min) among the cases classified as successful (P < 0.05). The success rate was significantly different between the groups: 88.6% in the fluoroscopic group and 100% in the endoscopic group (P < 0.05). For patients with adhesive small bowel obstruction, long-tube decompression is recommended and long-tube insertion by endoscopy was superior to fluoroscopic placement.

Usefulness of a Guiding Sheath for Fluoroscopic Colorectal Stent Placement

ObjectiveTo investigate the technical feasibility, clinical usefulness, and safety of a guiding sheath in fluoroscopic stent placement for patients with malignant colorectal obstructions.Materials and MethodsBetween June 2007 and January 2011, fluoroscopic placement of a dual colorectal stent was attempted in a total of 97 patients with malignant colorectal obstructions. A polytetrafluoroethylene guiding sheath was used in patients in whom a stent delivery system failed to reach the obstruction. Usefulness of the sheath was evaluated depending on whether the sheath could successfully assist the stent delivery system reach its area of interest.ResultsThe guiding sheath was needed in 22 patients (15 men, 7 women; age range, 33-77 years; mean age, 59 years). The overall success rate for passing the sheath to the area of interest was 100%. There were no procedure-related deaths or major complications. The majority of the patients reported mild discomfort. In 2 of 22 patients with successful passing of the sheath to the area of interest, stent placement failed because of failure in the negotiation of a guide wire through the obstruction.ConclusionUsing a guiding sheath seems to be easy, safe and useful in fluoroscopic stent placement for patients with malignant colorectal obstructions.

Is Endoscopic Initial Low Profile Mickey GT Placement in Children Cost Effective and What to Expect

Purpose: Gastrostomy tubes (GT) are useful to provide optimal nutrition support and growth in children, who are unable to ingest sufficient calories orally. Low profile GT placement is preferable to conventional one. The absence of long external tube allows for greater mobility of the patients. GT can be placed either surgically, endoscopically, or with radiographic guidance. Since the availability of new Kimberly Clark Introducer Kit, we report the technical success and tolerance of initial low profile GT tube placement endoscopically with surgical assistance vs open surgery or fluoroscopic technique and finally a comparison of cost using different methods. Methods: A retrospective study of children who require GT insertion in our institution was undertaken. Cost data for different methods of placement was compared using an institutional activity-based cost methodology. Low profile gastrostomy tube was placed in 22 patients (6 endoscopic, 2 surgical and 14 fluoroscopically). Results: Indications for GT tube placement were: FTT (n: 6), dysphagia (n: 10), seizure disorder (n: 6). There were 6 females and 16 males with mean age of 4 8/12 years. Two patients had perforation of the bowel and one patient had significant pain upon fluoroscopic insertion. All three required surgical repair. 1 patient had repeat GT placement the day after newly endoscopically-placed tube became dislodged when the balloon was deflated accidentally. Another placement was immediately abandoned when the stomach was noted to be abnormally positioned on the right side. One patient, had a repeat fluoroscopic replacement when the tube became dislodged after surgically placed. Endoscopic and fluoroscopic placement were done in an ambulatory setting without intubation. Surgical placement was done in the OR with intubation. The global average cost for the entire process was about $2400 for endoscopic placement in GI suite, $2000 for fluoroscopic placement in IR and $ 4000 for surgical placement in OR. Conclusion: 1. Low profile Mickey GT can be placed not only under fluoroscopic but also using endoscopic approach, which can be done safely as an initial feeding tube in children. 2. Complications related to GT placement with endoscopic guidance are not significantly different than other methods of placement. Direct visualization in the stomach aids in placement position, avoiding potential risks such as partial blockage/outlet obstruction and risk of bleeding. 3. Given the significant cost differential between endoscopic vs surgical GT placement, without increase in incidence of complications that can be associated with fluoroscopy placement, the endoscopic placement is preferable for a non-surgical candidate patients.

Evaluation of Gastropexy and Stoma Tract Maturation Using a Novel Introducer Kit for Percutaneous Gastrostomy in a Porcine Model

Fluoroscopic placement of percutaneous gastrostomy (PG) requires the use of T-bar fasteners to affix the stomach to the anterior abdominal wall; the effect of T-fasteners on stoma tract maturation is unknown. The authors studied PG stoma tract maturation, comparing PG + gastropexy with standard percutaneous endoscopic gastrostomy (PEG). Sixteen pigs underwent PG placement using a novel introducer kit. Three absorbable suture T-fasteners were placed around the stoma site, and PG was placed using the Russell method. A standard PEG was then placed using the Ponsky pull method, allowing each animal to serve as its own control. Gross and histopathological integrity of stoma tract formation was assessed at 1-3 weeks. At sacrifice, all PGs were intact with no evidence of infection, disruption, or significant leakage. Stoma tracts of all test and control sites were robust and histologically mature at all time points. Stoma tract diameters were also similar between test and control PGs (mean ± SEM: control 13.1 ± 0.7 mm, test 12.1 ± 0.4 mm; P = .2, n = 15). Histopathological evaluation demonstrated a generally comparable tissue response between test and control PGs, with slight decreases in fibrosis noted in test compared to control sites (P = .02, n = 15). Stoma tract maturation of PG with gastropexy provides similar results to standard PEG. Stoma tracts were mature at 1 week regardless of placement method. Placement and performance of PG using the new introducer kit with novel T-fasteners and absorbable suture yields effective gastric anchoring and has similar ease of use as standard PEG placement.

Erythromycin to Promote Bedside Placement of a Self‐Propelled Nasojejunal Feeding Tube in Non—Critically Ill Patients Having Pancreatitis: A Randomized, Double‐Blind, Placebo‐Controlled Study

Postpyloric enteral feeding often requires endoscopic or fluoroscopic placement of a feeding tube. Self-propelled feeding tubes are designed to facilitate spontaneous migration into the jejunum. This study aimed to assess the rate of success and time to migrate a self-propelled feeding tube to jejunal position using erythromycin, a prokinetic agent. Non-critically ill patients with pancreatitis who required jejunal enteral feeding were included. A self-propelled nasoenteric feeding tube was placed into the stomach using either placebo or erythromycin. At 24 and 48 hours after initial placement, an abdominal x-ray was taken to determine the position of the tube. Forty subjects were included and randomized. After 48 hours, there was no difference in the rates of success between placebo 56% (9/16) and erythromycin 50% (10/20) (P = .71). Self-propelled feeding tubes migrated into the jejunum in 53% of the subjects within 48 hours. However, this study failed to determine any benefit of erythromycin in terms of success or time to migrate to jejunal position using a self-propelled feeding tube. Selection of subjects without impaired motility and tachyphylaxis may have contributed to clinical failure of erythromycin as a prokinetic agent in this study.

A Team-Based Protocol and Electromagnetic Technology Eliminate Feeding Tube Placement Complications

To examine whether feeding tube placement into high-risk patients using a team-based protocol and electromagnetic tube tracking reduces complications associated with blind tube placement and to evaluate safety of blind tube placement in alert, low-risk patients. Approximately 1·2 million feeding tubes with stylets are placed annually in the US. Serious complications during placement exceed the rates of retained sponges and wrong site surgery. Several suggested solutions to the problem have been proposed but none completely eliminate the serious complications and many are neither cost-effective nor practical. In a retrospective, single center study, we compared complications after bedside feeding tube placement using a blind technique in 2005 to a hospital protocol mandating tube placement in high-risk patients by a Tube Team in 2007 using electromagnetic tracking. Outcome variables included airway placement, pneumothorax, death, and radiology resource utilization. The Tube Team protocol eliminated airway tube placement (0 of 1154 vs. 20 of 1822, P < 0.001), pneumothorax (0/715 vs. 11/1822, P = 0.009), and all mortality whereas improving placement (83.9% success vs. 60.5%, P<0.001) in high-risk patients compared to the 2005 study. The number of x-rays obtained per tube (1.07 +/− 0.01 vs. 1.49 +/− 0.026, P < 0.001) and need for fluoroscopy (2.1% vs. 10.9%, P < 0.001) significantly dropped with the Tube Team. A final comparison was made to low-risk patients considered acceptable for blind tube placement in 2007 due to their alertness and ability to cooperate and provide feedback during tube placement. Although no mortality occurred during blind placement in low risk, alert patients, blind placement resulted in significantly increased airway placement (3/143, p = 0.001) and pneumothorax (2 of 143, P = 0.01) compared to the Tube Team protocol. Most patients who would have required fluoroscopic placement of feeding tube due to failed blind technique had successful placement by the Team avoiding fluoroscopy. Feeding tube placement by a dedicated team using electromagnetic tracking eliminates the morbidity and mortality of this common hospital procedure. Blind placement is not acceptable in awake, alert patients.

Repair of long gap esophageal atresia without anastomosis

Background/Purpose Repair of long gap esophageal atresia represents a challenge. Several different techniques may be used. We describe 5 cases of long gap esophageal atresia managed successfully with suture approximation without anastomosis. Methods Retrospective review identified 5 newborns (4 males; 1 female) with long gap esophageal atresia treated with suture approximation and subsequent endoscopic and fluoroscopic placement of string for guided dilatations. Three babies had esophageal atresia without fistula, and 2 had the common type with proximal atresia and distal tracheoesophageal fistula. The babies with pure esophageal atresia had delayed repair, and those with the common type had repair 2 days after birth. All had a gastrostomy for feedings. Results All 5 babies recovered uneventfully. Three babies had spontaneous fistulization that allowed easy placement of guide wire and string. Two other babies required endoscopic and fluoroscopic combined fistula creation bypassing a long needle from the upper pouch to the lower one. Initially, all had string-guided dilatations that were subsequently converted to balloon dilatations. All babies had a functioning esophagus and did not need any further surgical intervention. An average of 8 postoperative dilatations were needed. Conclusions The baby's own functional esophagus is superior to any esophageal replacement. Familiarity with different techniques to preserve it is therefore important. Suture approximation without anastomosis is a safe technique that can be applied to long gap esophageal atresia. The downside of this technique is a prolonged hospital stay, multiple dilatations, prolonged fasting, and therapy to learn to eat orally.

Electromagnetic Sensing Devices as a Cost-Effective and Safer Option for Bedside Placement of Postpyloric Feeding Tubes

I read with interest the recent work reported by Cone et al1 on fluoroscopic placement of nasoduodenal feeding tubes. They are to be congratulated on their successful placement rates and improvement in patient safety through reduction in fluoroscopy-related radiation exposure by staff training and the use of thresholds for fluoroscopy time. They also discussed the use of novel techniques for postpyloric tube placement but unfortunately failed to refer to the use of electromagnetic sensing devices. We recently audited the Cortrak® (Corpak MedSystems, Chicago) bedside placement system for nasogastric and postpyloric feeding tubes after the first 14 months of implementation in our institution.2 An electromagnetic transmitting guide wire is inserted into the tube preinsertion. A receiving disc tracks “real-time” passage of the tube, which is visualized by a monitor. Thirty-nine tube placements were attempted, with 69% of postpyloric referrals resulting in successful placement. This placement rate is in excess of “blind” bedside techniques reported in the literature.3,4 X-ray confirmation was required in only 22% of all postpyloric placements. Placement costs were ∼180 US dollars (USD) per tube. Potential cost savings for reduced need of x-ray and parenteral nutrition were calculated at ∼3310 USD and 9930 USD, respectively. Analysis against endoscopic placement, often considered a standard for postpyloric tube placement, indicated a cost avoidance of more than 33,130 USD.

Are Supine Chest and Abdominal Radiographs the Best Way to Confirm PICC Placement in Neonates?

Peripherally inserted central catheters (PICCs) are commonly used in NICUs. Although they have many benefits, they also have many potential complications. Confirming catheter tip position is essential to decreasing complications, but the best method to achieve confirmation is unclear. Literature review for studies that address line position confirmation to assist health care providers in evaluating the available research and to identify gaps in the literature. A literature search of four major databases followed by an ancestry approach was performed. Articles reviewed specifically discuss PICC lines and PICC line placement confirmation. Data on confirming PICC placement were lacking. Fluoroscopic placement is ideal, but cannot be done at the bedside and is costly. Supine chest radiograph is the most widely used method and is convenient, but when line tip position is unclear, contrast or ultrasound confirmation can be used. When PICC lines are placed in the saphenous vein, infants may benefit from supine and lateral abdominal radiographs to ensure placement in the inferior vena cava. More studies are needed to generalize findings. PICC line tips should be located in the superior vena cava or inferior vena cava close to the junction with the right atrium (0.5-1 cm outside of the cardiac chambers in premature infants and 1-2 cm outside of the cardiac chambers in larger infants). Arm position is very important when performing radiographs for placement because movement of the arm can cause migration of the catheter. There is also significant inter-observer variability when identifying line tip position.

Peritoneal Dialysis Catheter Insertion by Interventional Nephrologists

Peritoneal dialysis (PD) catheter placement is performed by surgeons, interventional radiologists, and interventional nephrologists. Catheter insertion is accomplished through various methods including open surgical technique and laparoscopic, peritoneoscopic, and fluoroscopic guidance. Complication rates and catheter survival can vary based on the insertion technique used. Recently, nephrologists have made significant advances in the area of peritoneal dialysis catheter design and placement. Current data suggest that nephrologists are increasingly placing PD catheters using peritoneoscopic and fluoroscopic technique. This review focuses on peritoneoscopic and fluoroscopic insertion and highlights the advantages of catheter insertion by nephrologists.

Long-tube insertion with the ropeway method facilitated by a guidewire placed by transnasal ultrathin endoscopy for bowel obstruction: a prospective, randomized, controlled trial

It is often difficult to insert a long intestinal tube in the small bowel of patients with bowel obstruction, and it often results in long procedure time and severe patient distress. To assess the usefulness of the ropeway method by using a guidewire placed with the assistance of transnasal ultrathin endoscopy in long-tube insertion for patients with bowel obstruction. Prospective, randomized, controlled, single-center study. Thirty-four consecutive patients with bowel obstruction requiring decompression participated in the study and were randomized to the insertion of a long tube with the ropeway method (ILTR) group (ie, insertion along an endoscopically placed guidewire that was passed through only the distal 4 cm of the tube) or insertion by a conventional method group (C group). The time required for the procedure (main), success rate, x-ray exposure time, and intensity of patient distress measured with a visual analog scale of 1 to 5 (better to worse). The mean (+/- standard deviation) duration of the procedure in the successful cases in the ILTR group and the C group was 16.1 +/- 5.6 minutes and 26.4 +/- 13.8 minutes, respectively (P = .010). The success rate was 100% in the ILTR group and 88% in the C group (P = .48). The mean (+/- standard deviation) x-ray exposure time and intensity of patient distress were, respectively, 16.4 +/- 8.7 minutes and 33.2 +/- 12.3 minutes (P < .001) and 2.6 +/- 0.7 and 3.7 +/- 1.2 (P = .016). Single-center study and small sample size to evaluate overall safety. Long-tube insertion for bowel obstruction with the ropeway method facilitated by transnasal ultrathin endoscopy was superior to conventional fluoroscopic placement with regard to overall procedure success, time required, and patient comfort.

A randomised clinical trial of transnasal endoscopy versus fluoroscopy for the placement of nasojejunal feeding tubes in patients with severe acute pancreatitis

Objectives:To compare transnasal endoscopy with fluoroscopy for the placement of nasojejunal feeding tubes (NJTs) in patients with severe acute pancreatitis.Methods:100 patients were randomised to receive NJTs by transnasal endoscopy or...

Chest radiograph after central line placement under fluoroscopy: utility or futility?

BackgroundPostoperative portable chest films are routinely performed after fluoroscopic placement of central venous catheters to evaluate positioning and to rule out significant complications (eg, pneumothorax). Emerging evidence in the literature has called this practice into question suggesting that routine postoperative chest x-ray is unnecessary. Therefore, we investigated our recent experience to examine the utility of these films, to examine the development of symptoms relative to therapeutic intervention, and to report a cost-benefit analysis. MethodsAfter obtaining institutional review board approval, all charts of patients undergoing central venous catheter placement from January 2004 to December 2005 at our institution were reviewed. Outcome measures included whether or not there was a complication and whether or not that complication required an intervention. Peripherally inserted central catheters were not included. ResultsIn the study population, 237 catheters were placed in the operating room. There were two complications, both pneumothoraces (0.085%). One patient required tube thoracostomy, whereas the other was asymptomatic and the pneumothorax resolved spontaneously. Fourteen patients had no postoperative chest film without adverse consequences. Total cost for portable chest films was $56,196. ConclusionsFor catheters placed under fluoroscopic guidance, postoperative chest films in asymptomatic patients add unnecessary cost. For this reason, we feel discontinuation of postoperative chest films in asymptomatic patients undergoing catheter placement with fluoroscopy is justifiable.