Nutrition Tube Research Articles

Corticosteroid-resistant bulbar neurosarcoidosis responsive to intravenous immunoglobulin

We report an intriguing case of corticosteroid-resistant bulbar neurosarcoidosis responding to intravenous immunoglobulin. A 37-year-old man presented with dysphagia to solids and liquids, dysphonia, fatigue and 50 lb weight loss...

Inclusive Discourse? Local Media Coverage of the Terri Schiavo Case

This article contributes to a more systematic understanding of the role of mainstream media in deliberative processes by analyzing how inclusive local newspapers are of diverse perspectives on the Terri Schiavo case. Using both Pearson's chi-square test and multinomial logistic regression, we assess how ownership, state political ideology, geographic location, and news format affect what ideas are included in the debate over whether Terri Schiavo's hydration and nutrition tubes should be removed as well as the tone with which these ideas are discussed. We find that mainstream newspapers are relatively inclusive of diverse ideas and perspectives—regardless of whether the newspaper is independently or corporately owned, the political leanings of the target audience, and the geographic location of the outlet. However, we also find that local newspapers do significantly differ from one another in terms of the frequency and tone with which they include diverse viewpoints. Our research suggests that local outlets downplay ideas that are likely to be regarded as controversial by their target audiences. We conclude with a discussion of the implications of this research for understanding the role of media in deliberative democratic processes in the United States.

Comparison of the effects of two flushing fluid in the prevention of gastrointestinal nutrition tube blocking

Objective To compare the effect of two kinds of flushing fluid in the prevention of gastrointestinal nutrition tube blocking .Methods Sixty-four patients who were placed the gastrointestinal nutrition tube for enteral nutrition were randomly divided into observation group , which contained 35 cases, and control group, which contained 29 cases.After daily infusion of nutrient solution , 5% sodium bicarbonate solution plus 2 Multi-enzyme flushed gastrointestinal nutrition tube for the observation group; while for the control group, the 20ml normal saline was used .Results Compared the incidence of clogging rate of the two gastrointestinal nutrition tube , observation group was 5.7% and control group was 34.5%, the difference was statistically significant （P 〈0.01）.Conclusions The sodium bicarbonate solution plus Multi-enzyme can wash, dissolve the contents ’ adhering to the catheter wall , and reduce the obstruction of gastrointestinal nutrition tube effectively , so that enteral nutrition can proceed smoothly . Key words: Gastrointestinal nutrition tube; Flushing fluid; Tube blocking; 5％ sodium bicarbonate solution

A Ten-Year Evaluation of Jejunostomy Tube Indications, Complications, and Clinical Outcomes for Nutritional Support at a Tertiary University Hospital

Introduction: Malnutrition affects up to 40% of hospitalized patients, increases morbidity and mortality, and can be severe enough to warrant enteral delivery of nutrients. A jejunostomy (J) tube route is recommended in settings of a high aspiration risk, gastric dysmotility, refractory nausea and vomiting, gastric outlet obstruction, and pancreatitis. Our goal was to document the clinical indications, complications, and long-term outcomes of patients requiring nutrition via a J tube at a tertiary medical center. Methods: This was a retrospective medical chart review conducted from January 2004 to December 2014 to define the demographics, clinical settings, and diagnoses of J tube recipients, as well as duration of use, complications, and outcomes. Results: One hundred-sixty patients, mean age 50.5 (18-84), 50% female, 71% Hispanics, 26% Caucasians, 2% Asians, and 1% African Americans, received a J tube during that time period. Their baseline mean serum albumin was 2.56 g/dL (0.9-4.5 g/dL). Indications were: 1.) 72% with anatomically compromised esophagus, stomach, or duodenum due to esophageal (9%) or gastric (13%) cancer; esophageal (4%), gastric, or duodenal (14%) perforation, gastric outlet or duodenal obstruction (25%), and abdominal trauma (7%); 2.) gastroparesis and refractory nausea/vomiting (14%), with 41% being diabetic; 3.) Pancreatic pathology (14%): pancreatitis (12%), pancreatic adenocarcinoma (2%). The J tube was surgically placed in 92.5%, and endoscopically by a gastroenterologist in 7.5% of cases. The J tube size ranged from 12-24 French and infusion rates varied from 20-100 mL/hr either continuous or nocturnal. Duration of use ranged from 2 weeks to ≥1 year. J tube complications included tube leak (6%), localized skin reactions (3%), clogging (2%), and enterocutaneous fistula (1%). Twenty-four (15%) patients died related to their underlying esophageal, gastric, and pancreatic adenocarcinoma or bowel perforation. Of the 85% of patients who survived, 15% achieved their goal weight, 31% tolerated PO and J tube was eventually discontinued, 23% continued on long-term jejunostomy tube feeding, and 31% did not have documented long-term outcomes. Conclusion: In an academic tertiary care facility: 1.) Approximately 0.5% of patients admitted to the medical service required placement of a J tube for nutrition. 2.) Indications varied from an anatomically compromised esophageal or gastroduodenal junction (72%), to gastroparesis and refractory nausea/vomiting (14%), to pancreatic pathology (14%); 3.) A significant benefit was evident by adequate weight gain, and return to PO nutrition was achieved in the majority. Our study supports J tube feeding as the preferred route to safely achieve long-term nutritional support and clinical outcomes.

P444: An intervention aimed at improving junior doctors’ prescribing in a large geriatric department

Introduction: Many hospitalized patients require enteral feeding and medication administration via nasogastric tube or percutaneous endoscopic gastrostomy; many of them are elderly patients. The right practice for medication administration via enteral tube includes appropriate formulation, adequate tube flushing, and proper nutrition scheduling. Impaired administration may lead to medication ineffectiveness, toxicity or clogged feeding tube [1]. The aim of our study was to evaluate the current practices and knowledge regarding medication administration via enteral feeding tubes. Methods: Pre-intervention assessment evaluated the knowledge and practices of nurses and pharmacists regarding medication administration via enteral feeding tubes using a self-structured questionnaire or oral questioning. After this evaluation, an intervention through a presentation and new guidelines for the improvement of knowledge and practices was performed. Post intervention assessment was later completed. Assessment results were electronically recorded and analyzed (Microsoft Excel 2010). Results: Pre-intervention assessment was completed in 106 nurses and 10 pharmacists. Knowledge and practice among nurses were lacking; 41% did not receive any training, 75% crush all tablets together, 47% do not flush the tubes before administration. In addition, nutrition scheduling is usually not taken into consideration. Pharmacists’ knowledge was also lacking, especially concerning nutrition scheduling and tube flushing. Post intervention assessment demonstrated improved knowledge. Conclusion: Knowledge and practices of nurses and pharmacists regarding medication administration via enteral feeding tubes is lacking without active intervention. Proper education and clear guidelines can improve knowledge and practice.

Outcomes after Hematopoietic Stem Cell Transplantation for Children with I-Cell Disease

Mucolipidosis type II (MLII), or I-cell disease, is a rare but severe disorder affecting localization of enzymes to the lysosome, generally resulting in death before the 10th birthday. Although hematopoietic stem cell transplantation (HSCT) has been used to successfully treat some lysosomal storage diseases, only 2 cases have been reported on the use of HSCT to treat MLII. For the first time, we describe the combined international experience in the use of HSCT for MLII in 22 patients. Although 95% of the patients engrafted, overall survival was low, with only 6 patients (27%) alive at last follow-up. The most common cause of death post-transplant was cardiovascular complications, most likely due to disease progression. Survivors were globally delayed in development and often required complex medical support, such as gastrostomy tubes for nutrition and tracheostomy with mechanical ventilation. Although HSCT has demonstrated efficacy in treating some lysosomal storage disorders, the neurologic outcome and survival for patents with MLII were poor. Therefore, new medical and cellular therapies should be sought for these patients.

A comparative study on endoscopic placement methods of nasal jejunum nutrition tube

Objective To compare the clinical application effect of placing nasal jejunum nutrition tube by gastroscope and transnasal gastroscope. Methods In Jun 2011, the patients who need nasal jeju- num nutrition tube due to obstruction of gastric antrum, pylorus and duodenum were assigned randomly into gastroscope pushing group （GP） and transnasal gastroscope guide wire group （TNGGW）. Operation time, achievement ratio, and tube displacement ratio were compared. Results Nasal jejunum nutrition tubes were successfully placed in all patients by two methods. In GP group, the success rate was 85%, and mean time cost was （750. 3 ± 445.9） s, and tube displacement ratio was 30%. In TNGGW group, the success rate wasl00%, and mean time cost was （ 157.4 ± 79. 3）s with no tube displacement ratio. There was a statisti- cally significant difference in mean time cost between GP group and TNGGW group （ P 〈 0. 01 ）. Conclusion It is a more reliable and convenient method to place nasal jejunum nutrition tube by transnasal gastroscope than by gastroseope. Key words: Jejunum; Enteral nutrition; Transnasal gastroscope; Guide wire

Cerebellar Ataxia, Vertical Supranuclear Gaze Palsy, Sensorineural Deafness, Epilepsy, Dementia, and Hallucinations in an Adolescent Male

We encountered an adolescent male with cerebellar ataxia since age 11, difficulty in vertical gaze from age 2, leg weakness since age 10, and partial epilepsy since age 8. At age 14, he developed visual and auditory hallucinations, as well as mild sensorineural deafness. He was evaluated as having a mitochondrial disorder. No common mitochondrial DNA mutations were detected in the blood. Muscle biopsy revealed nonspecific changes and normal respiratory chain enzyme complexes. He developed progressive cognitive decline leading to diagnosis of dementia at age 15, and intractablepartial epilepsy persisted despite treatment with multiple anticonvulsants. He also had progressive dysphagia requiring gastrostomy tube for nutrition. He required many other diagnostic investigations for neurodegenerative disorders, but was eventually confirmed as having Niemann-Pick disease type C with excessive free cholesterol using filipin staining and zero activity for cholesterol esterification in fibroblast as well as two pathogenic mutations in the NPC1 gene.

Self‐Insertion of a Nasogastric Tube for Home Enteral Nutrition

Enteral tube feeding can be a source of discomfort and reluctance from patients. We evaluated for the first time the tolerability of self-insertion of a nasogastric (NG) tube for home enteral nutrition (EN). All patients requiring enteral tube feeding for chronic diseases were enrolled in a therapeutic patient education (TPE) program at Nancy University Hospital. In our department, between November 2008 and August 2012, 66 patients received EN with an NG tube. Twenty-nine of 66 had self-insertion of the NG tube (median age, 44 years), 17 had an anatomical contraindication, and 20 were excluded because of cognitive disability or language barrier or refusal. Twenty-eight of 29 patients completed the TPE program. One patient died of pancreatic cancer in palliative care during the study. Median follow-up was 20 months (interquartile range [IQR], 4-31). Median gain weight was 3.1 kg (IQR, 1.8-6.0) (P = .0002). Median duration of self-insertion of the NG tube was 3 months (IQR, 2-5), and it was well tolerated by all 29 patients. Two patients described minor adverse events: abdominal pain and nausea for 1 patient and epistaxis leading to temporary discontinuation of EN for another patient. A group of 10 consecutive patients previously had a long-term NG tube for EN. If they had the choice between a self-inserted NG tube and a long-term NG tube, all 10 patients reported they would prefer to start again with the self-inserted NG tube. This pilot study suggests that self-insertion of an NG tube may be efficacious and well tolerated in patients receiving EN for chronic conditions.

Pregnancy in homozygous familial hypercholesterolemia – a successful case

Pregnancy in homozygous familial hypercholesterolemia – a successful case

An Interesting Case of Oropharyngeal Dysphagia after a Botox injection for Sialorrhea

Purpose: Sialorrhea is caused by excessive salivation that is commonly seen in patients with neurodegenerative diseases. Botox injection to the parotid gland and submandibular gland offer an effective and localized method to decreased saliva secretion. Although botox injection is relatively safe and effective, serious complication such as hypoglossal nerve paralysis, diffuse oropharyngeal muscle paralysis, or death can occur. We present an interesting case of oropharyngeal dysphagia from diffuse muscular paralysis of oropharyngeal muscles and hypoglossal nerve paralysis after a Botox injection for idiopathic sialorrhea. This patient had hypersalivation for over 1 year and was seen by ENT for Botox injections. She received her first Botox injection (25 units of Botox to each parotid gland) 2 months prior with symptomatic improvement. Shortly after the first botox injection, her hypersalivation returned back to baseline. She was seen by a neurologist for evaluation. Patient had a normal EMG and MRI brain. She then returned to ENT for her second botox injection (total of 70 units of botox was injected to bilateral parotid glands and left submandibular gland). Two days after her second Botox injection, the patient developed dysarthria and dysphagia to both solid and liquids. Due to severe dehydration, patient was admitted for intravenous hydration. ENT evaluation showed symmetric and mobile vocal cords with good abduction and closure, intact gag reflex, and laryngeal sensation. CT neck and chest showed a collapsed esophagus. Esophagram was limited with tertiary contractions seen throughout the esophagus. Upper endoscopy was unremarkable and did not reveal any mass or stricture. Video fluoroscopy swallow showed a significant reduced lingual anterior to posterior propulsion, and poor pharyngeal transit resulting in moderate pharyngeal retention. Given the clinical presentation and repeat EMG study, neurology concluded that it is unlikely ALS or myasthenia gravis. In exclusion, patient was thought to have lingular dyscoordination and dysarthria consistent with bilateral cranial nerve XII palsy or diffuse muscular paralysis of oropharyngeal muscles. Due to severe dehydration, patient had a PEG tube placement for nutrition until her symptoms improved. Patient continued to require PEG tube for nutrition 1 year after the initial event because of persistent oropharyngeal dysphagia. An ultrasound-guided Botox injection will offer a safer approach by delivering Botox to the proper location and minimizing complications. Also, decreasing the dose or frequency of botox injections should be considered to avoid serious complications.

Medidas antropométricas na introdução da sonda nasogástrica para nutrição enteral empregando a esofagogastroduodenoscopia

The correct placement of a nasogastric tube for enteral nutrition is subject of several investigations, demonstrating the controversy of the procedure. To establish an external measure that can correspond to the internal measurement which determines the insertion length of nasogastric feeding tube up to the stomach. External measures were obtained between points: nose tip vs earlobe vs xiphoid appendix vs umbilicus and height correlated with the standard measures obtained from patients undergoing diagnostic esophagogastroduodenoscopy. It was found a significative statistical correlation between esophagogastric junction, identified during the esophagogastroduodenoscopy, with the distance measured between the anatomic points of the earlobe and xiphoid appendix (r= 0.75) and from this line with the orthostatic height (r=0.72). The distance between the earlobe to the xiphoid appendix (0.75) and the distance between the earlobe to the xiphoid appendix to the midpoint of the umbilicus, subtracting the distance from tip of nose to earlobe, were safe anatomical parameters to reach the esophagogastric junction. The height in the standing position (r= 0.72) also can be used as an indicator of the length necessary to insert the tube into the stomach. The height in the standing position (r= 0.72) also can be used as an indicator of the length necessary to insert the tube into the stomach.

Cell Wall Composition, Biosynthesis and Remodeling during Pollen Tube Growth.

The pollen tube is a fast tip-growing cell carrying the two sperm cells to the ovule allowing the double fertilization process and seed setting. To succeed in this process, the spatial and temporal controls of pollen tube growth within the female organ are critical. It requires a massive cell wall deposition to promote fast pollen tube elongation and a tight control of the cell wall remodeling to modify the mechanical properties. In addition, during its journey, the pollen tube interacts with the pistil, which plays key roles in pollen tube nutrition, guidance and in the rejection of the self-incompatible pollen. This review focuses on our current knowledge in the biochemistry and localization of the main cell wall polymers including pectin, hemicellulose, cellulose and callose from several pollen tube species. Moreover, based on transcriptomic data and functional genomic studies, the possible enzymes involved in the cell wall remodeling during pollen tube growth and their impact on the cell wall mechanics are also described. Finally, mutant analyses have permitted to gain insight in the function of several genes involved in the pollen tube cell wall biosynthesis and their roles in pollen tube growth are further discussed.

Value of nasojejunal nutrition in the treatment of children with acute pancreatitis

To evaluate the feasibility and effectiveness of placement of nasojejunal feeding tube and nasojejunal nutrition feeding in children with acute pancreatitis. Twenty-two patients (of whom 13 had severe acute pancreatitis and 9 acute mild pancreatitis) who needed nutritional intervention were selected. They were from Department of Gastroenterology and Surgery during the years 2009 - 2012, and they were at high nutritional risk after STONGkid nutrition risk screening. The average age of them was 5 - 15 years (9.1 years ± 2.8 years). Assisted by endoscopy, the nasojejunal feeding tube was placed in 22 of 24 patients (in 2 cases of recurrent pancreatitis the tubes were placed again after extubation). Besides the use of regular fasting, antacids, inhibitors of trypsin secretion, and anti-infective treatment, 23 cases of all children got nasojejunal nutrition treatment as well. The outcome measures included the success rate, complications of endoscope-assisted nasojejunal tube placement. The children's tolerance and nutrition indicators (weight, blood lymphocytes count, erythrocytes count, serum albumin, serum creatinine, blood urea nitrogen) were observed before and after enteral nutrition therapy. Malnutrition evaluation was done 24 times before treatment among 22 patients, incidence of malnutrition was 33% in 22 cases. Placement of nasojejunal tube placement was attempted for a total of 24 times and was successful on first placement in 22 cases, in two cases the placement was successful on the second placement, so the success rate of the first attempt for placement was 92%. No significant complications were observed in any of the cases. Twenty-three of 24 cases were given standardized enteral nutrition (one case was not given enteral nutrition therapy but underwent ERCP due to obstructive jaundice). Twenty-two of 23 cases could tolerate enteral nutrition well, only 1 case was unable to tolerate enteral nutrition due to the pancreas schizophrenia, paralytic ileus. The treatment of jejunal feeding success rate was 96%. The feeding duration was 2 - 74 d (27.0 d ± 18.3 d). The adverse reactions include plugging of the tube in two cases, constipation in two cases, five cases had abdominal pain, diarrhea in 2 cases, vomiting in 2 cases and 1 case of jejunum retention. No case had nasopharynx ulcers, gastrointestinal perforation, gastrointestinal bleeding, re-feeding syndrome and infection etc. Blood erythrocytes count, serum creatinine, blood urea nitrogen were not significantly changed. Twenty of 23 cases were cured, 2 cases were improved and 1 case was unchanged. Endoscope-assisted nasojejunal tube placement for children with acute pancreatitis is safe and feasible. Nasojejunal nutrition therapy is effective for acute pancreatitis patients who are at severe nutritional risk, especially for the improvement of the nutritional status of children.

Palliative care and end-of-life planning in Parkinson’s disease

In Parkinson's disease (PD) typical "palliative care" type symptoms, such as pain, nausea, weight loss and breathlessness can occur throughout the condition, but become more prevalent in later disease stages. Pain may be specifically related to PD, e.g. dystonic pain with wearing off, but is more commonly due to other conditions. The cause can usually be elicited by a careful history and examination, and this guides intervention, both non-pharmaceutical, and pharmaceutical. For example, dystonic pain will respond best to appropriate changes to dopaminergic medication. In later disease stages people have increasing problems with swallowing, and also cognitive impairment. Impaired swallowing may lead to aspiration pneumonia, which is a common cause of hospital admission, and also death. Decisions about interventions towards the end of life, such as insertion of percutaneous endoscopic gastrostomy (PEG) tube for nutrition, can be very challenging, particularly if, as in most cases, the person with PD has not previously expressed their views upon this while they still maintained capacity to make decisions. Advance care planning (ACP) in PD should be encouraged in relation to interventions such as PEG tubes. It may also cover issues such as preferred place of death. Over recent years lower proportions of people have been dying at home, and this is especially true for PD, but home may well be where they would have preferred to die. However, there is little evidence to guide health professionals about how, when, and by whom, ACP should be approached.

Intraoperative placement of transnasal small intestinal feeding tube during the surgery in 5 cases with high position intestinal obstruction and postoperative feeding

To explore the value of employing the small intestinal feeding tube in treating high position intestinal obstruction of newborn infant. Five newborn infants (3 males and 2 females; 1 premature infant and 4 fully-mature infants; 2 had membranous atresia of duodenum, 1 had annular pancreas, and 2 had proximal small intestine atresia; 1 infant had malrotation). The duodenal membrane-like atresia and the blind-end of small intestine were removed and intestinal anastomosis was performed, which was combined with intestinal malrotation removal. Before the intestinal anastomosis surgery, the anesthetist inserted via nose a 6Fr small intestinal ED tube, made by CREATE MEDIC CO LTD of Japan[ the State Food and Drug Administration-instrument (Im.) 2007-NO.2661620]. Twenty-four hours after surgery, abdominal X-ray plain film was taken and patients were fed with syrup; 48 hours later, formula milk was pumped or lactose-free milk amino acids were given by intravenous injection pump through the feeding tube. The amount of milk and fluids was gradually increased to normal amount according to the condition. In initial 3 days the intravenous nutrition was given and one week after operation, the infants were fed through mouth in addition to pumping milk through the tube and stopped infusion. Ten to 22 days after operation, the tube was removed and the infant patients were discharged. All the five infants showed that the feeding through the nutrition tube was accomplished and the time of venous nutrition was reduced and fistula operation was avoided. None of the infants on question was off the tube and no jaundice exacerbation was found and the liver function was also found normal. At the very beginning, the tube was occasionally blocked by milk vale in one infant and after 0.9% sodium chloride solution flushing patency restored. After that, the feeding tube was washed once with warm water after feeding. In one infant vomiting occurred due to enough oral milk. The photograph of upper gastrointestine did not show anastomomotic stricture or fistula, or intestinal obstruction. After pulling out the tube, the symptoms disappeared and then the patient was discharged. One child was found to have diarrhea with no lactose nutrition liquid and given compound lactic bacteria preparations for oral administration, the symptom disappeared. In the 5 cases, the shortest hospital stay was 10 days and the longest was 22 days, the average stay was 16 days. Three to 5 days after operation the weight restored to birth weight, the weight had increased, when discharged, to an average of 5.5 g (kg·d). The small intestinal feeding tube was very effective for the postoperative nutrition maintenance of high position intestinal obstruction in newborn infants.

The application of intermittent mouth-stomach tube feeding method on swallowing disorder patients nutrition support

Objective To discuss the intermittent mouth - stomach tube feeding method used in swallowing disorder patients＇nutrition support.Methods All of the 64 cases were swallowing disorder after stroke which were randomly divided into the experimental group and the control group.Both groups had been implemented synchronous swallowing rehabilitation training,but intermittent mouth -way stomach tube feeding method used in experimental group.Traditional lien gastric tube nutrition support had been used in control group.Forty five days later,the acceptance of two groups were compared,at the same time,the different nutrition indexes was measured and the swallowing function was evaluated.Results In experimental group,the tube feeding method of compliance was obviously better than that of the control group ( P ＜ 0.05 ).At the same time,nutrition index and swallowing function were improved better than those of the control group ( P ＜0.05 ).Conclusions Intermittent mouth - gastric tube feeding method improves the compliance of swallowing disorder patients.The method can effectively improve the nutritive condition of the patients with swallowing disorder and swallowing function. Key words: Swallowing disorder; Intermittent mouth-gastric tube feeding; Nutrition

Diagnostic and Therapeutic Endoscopy in Children and Adolescents with Cancer

Chemotherapy regimes in children with cancer often cause gastrointestinal side effects. Only limited data exist on the use of endoscopy in this group of patients. Methods: Retrospective review over a time period of 8.5 years identified 57 endoscopies (49 upper endoscopies, four colonoscopies, three sigmoidoscopies, one rectoscopy) in 38 patients (mean age 12.8 years). Seventeen children (45%) had hematological malignancies and 21 (55%) had solid tumors. In 12 children, platelet count was <50 × 109/L and 10 children were neutropenic (ANC < 1 × 109/L; absolute neutrophil count). Results: Forty diagnostic endoscopies, seven follow-up endoscopies, and 10 therapeutic endoscopies were performed. Biopsies were taken in 30 (75%) of 40 diagnostic endoscopies and microbiology samples in 17 (42.5%). Pathological findings identified in 33 (82.5%) diagnostic endoscopies: esophagitis 15 (37.5%)—two of them infections: 1 candida, 1 HSV (herpes simplex virus); Mallory–Weiss tears 5 (12.5%); gastritis 18 (45%; four Helicobacter pylori positive); ulcer 1 (2.5%); duodenitis 11 (27.5%); neoplasia 3 (7.5%); and colitis 5 (12.5%). Therapeutic endoscopies: Four PEG (percutaneous endoscopic gastrostomy) tube placements, one tube removal, two sclerotherapies for esophageal varices, three nasojejunal tubes for enteral nutrition (EN), and three additional tubes in primary diagnostic endoscopies. Complications: One episode of fever (>38.5°C) after colonoscopy, one localized infection after PEG tube placement, and two episodes of temporary desaturation. No association of neutropenia with more infections was observed. No bleeding in thrombocytopenic patients was observed. Conclusion: The data show that endoscopy in high-risk pediatric patients with malignant diseases is a safe procedure. Endoscopy reveals relevant information and have therapeutic impact with high probability. Tube placement techniques can help to maintain EN.

Application of enteral nutrition tube placement and feeding equipment

Although considerable clinical problems were solved by parenteral nutrition since 1960s, because of the risk of infectious and metabolic complications and advance in feeding tube placement, feeding methods, and artificial ingredient nutrients, enteral nutrition from 400 years ago has been brought to attention again. This review article is aimed to illustrate the issues related to enteral tube feeding in esophageal surgery.

PEG tube placement in morbidly obese patients

We present two patients both of whom had severe morbid obesity and needed placement of a percutaneous endoscopic gastrostomy (PEG) for albumin and visceral protein replenishment. The first patient was a 53-year-old woman (body mass index [BMI], 85.8; weight, 191 kg) who presented with respiratory distress and dysphagia; the second was a 26-year-old woman (BMI, 88.6; weight, 259 kg) who presented with sepsis complicated by respiratory distress and dysphagia. Both women required placement of a PEG tube for long-term enteral nutrition.