Transpyloric Feeding Tube Research Articles

Transpyloric Feed in Reflux-Associated Apnea in Preterm Newborns: A Prospective Study.

The etiological correlation between gastroesophageal reflux (GER) and apnea is controversial. We conducted a prospective interventional study designed to address the controversy. Preterm neonates with apnea at a tertiary care center, who had clinical features of GER without any other comorbidities likely to cause apnea, were included in the study. The enrolled neonates underwent continuous transpyloric tube feeding for 72 hours. The primary outcome measure was the difference in the number of apneic episodes pre- and post-initiation of nasoduodenal (ND) feeding. Secondary outcome measures included the incidence of necrotizing enterocolitis, other gastrointestinal disturbances, and mortality. Sixteen preterm neonates were included in the study. A substantial proportion (n =11, 68.8%) of the included neonates had a reduction in the number of apneic episodes. There was a significant decrease in the mean number of apneic episodes from 1.75 (±0.837) to 0.969 (±0.957) (P=.007). The median number of apneas was 1.5 (IQR 0.875) before and 0.5 (IQR 0.875) after ND feeds. There were no serious adverse events observed that were attributable to transpyloric feeding. This prospective study suggests that in a selected group of preterm neonates with reflux- associated apnea, transpyloric feeding can be an effective therapeutic modality.

The “Silk Road”: A novel method for inserting transpyloric feeding tubes in low resource settings

IntroductionTranspyloric tube (TPT) feeding is used in a multitude of conditions including gastroesophageal reflux disease. We here describe a new simple method to insert TPTs. Methods6 French feeding tube is premeasured nose to xiphisternum, and then another 7cm of length is added and 3-5 silk (4-0) ties are applied to the end of the tube spaced 0.5–1cm apart. The knots are placed in different radial directions, and multiple throws are placed on each knot so as to add bulkiness. The tube is then inserted transnasally to the premeasured length and secured. The child is given a single dose of metoclopramide and placed on his right side for 4h. A plain abdominal x-ray is then performed to confirm adequate TP placement. Following correct placement the patient is tube fed with small volumes every 15–20min. Descriptive data was prospectively collected. Results34 patients were recruited, median age 3.5months. All presented with vomiting, and 26 had failure to thrive. 24had successful TP tube placement from the first attempt, 6 from the second attempt, 2 on third attempt, and in 2 placement was unsuccessful. In 28 patients vomiting almost stopped completely. 9 patients had fundoplication, and 1 had gastrostomy placement. 3 patients died during the study because of unknown reasons. ConclusionThe silk tie technique is a safe and simple way to treat persistent vomiting and may prove useful in low resourced environments. Level of evidenceIV

Transpyloric Feeding Tube Placement Using Electromagnetic Placement Device in Children.

Transpyloric feeding tubes (TPT) are often recommended in critically ill children. Blind tube placement, however, can be difficult, be time-consuming, and incur multiple radiation exposures. An electromagnetic device (EMD) is available for confirmation of successful placement of TPTs. We conducted a retrospective cohort study to evaluate the efficacy of an EMD for TPT placement in children and determine its impact on placement success, radiation exposure, confirmation time, and cost for tube placement compared with traditional blind TPT placement. Retrospective data were collected in patients receiving a TPT before (pre-EMD group) and after implementation of an EMD (EMD group). Need for radiographic exposure decreased significantly in the EMD group (n = 40) compared with the pre-EMD group (n = 38) (0.6 vs 1.6 x-rays, P < .001). TPTs were placed and confirmed without abdominal x-ray in 21 of 40 patients in the EMD group. There were no serious adverse events such as misplacement into the lung or pneumothorax or perforation injury of the stomach. Successful tube confirmation took a significantly shorter time in the EMD group than in the pre-EMD group (1.45 vs 4.59 hours, P < .0001). There was an estimated cost savings of $245.10 per placement associated with decreased x-ray and fluoroscopy. The use of an EMD in children significantly decreased radiation exposure and confirmation time while maintaining TPT placement success. The use of an EMD can potentially offer large cost savings. Elimination of abdominal x-ray with EMD during TPT placement was achieved without any serious complications in approximately half of the children.

Ultrasound‐guided positioning of transpyloric feeding tubes in critically ill infants

Ultrasound‐guided positioning of transpyloric feeding tubes in critically ill infants

Early presenting hypertrophic pyloric stenosis with transient antroduodenal dysmotility in a preterm neonate: A case report

Abstract Hypertrophic pyloric stenosis (HPS) is one of the most common gastrointestinal disorders that require surgical intervention in early infancy. Clinical presentation, diagnosis, and treatment have been well established in typical cases. We herein describe an unusual case of early presenting HPS with transient postoperative feeding intolerance after complete myotomy in a preterm newborn. An ex-31-week preterm newborn (birth weight, 1760 g) with persistent feeding intolerance since the first feeding was referred for surgery on the 7th day of life. Abdominal ultrasonography (USG) revealed an elongated pyloric channel (11 mm) with thickened pyloric muscle (2.1 mm). Laparotomy was performed and confirmed suspected HPS. Pylomyotomy was successful, but feeding intolerance persisted until postoperative day 12. USG on postoperative day 12 noted antroduodenal dysmotility, and transpyloric tube feeding was started. Full feeds were reached 8 days after tube feeding, which was then converted to full oral feeding. HPS should be considered in patients who show feeding intolerance shortly after birth. USG criteria for HPS in preterm infants has not yet been established. Transient antroduodenal dysmotility could be a reason for persistent feeding intolerance after complete myotomy in preterm infants, and transpyloric tube feeding could be a treatment in such cases.

Metoclopramide for post-pyloric placement of naso-enteral feeding tubes.

Enteral nutrition by feeding tube is a common and efficient method of providing nutritional support to prevent malnutrition in hospitalised patients who have adequate gastrointestinal function but who are unable to eat. Gastric feeding may be associated with higher rates of food aspiration and pneumonia than post-pyloric naso-enteral tubes. Thus, enteral feeding tubes are placed directly into the small intestine rather than the stomach, and the use of metoclopramide, a prokinetic agent, has been recommended to achieve post-pyloric placement, but its efficacy is controversial. Moreover, metoclopramide may include adverse reactions, which with high doses or prolonged use may be serious and irreversible. To determine the effect of intravenous metoclopramide on post-pyloric placement of the naso-enteral tube in adults. Trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10) which includes the CUGPD group's specialised register of trials, MEDLINE (1996 to 21 October 2014), EMBASE (1988 to 21 October 2014), LILACS (2005 to 21 October 2014) We did not confine our search to English language publications. Searches in all databases were updated originally in January 2005, then in November 2008 and again in October 2014. No new studies were found in 2008 or in 2014. We selected randomised controlled trials of adults needing enteral nutrition, who received intravenous or intramuscular metoclopramide to aid placement of transpyloric naso-enteral feeding tubes, compared to placebo or no intervention. We used standard methodological procedures expected by The Cochrane Collaboration. All analyses were performed according to the intention-to-treat method. We present risk ratios (RR) with 95% confidence intervals (CI). Four studies, with a total of 204 participants were included and analysed. The trials compared metoclopramide with placebo (two trials) or with no intervention (two trials). Metoclopramide was investigated at doses of 10 mg (two trials) and 20 mg (two trials). There was no statistically significant difference between metoclopramide versus placebo or no intervention administered to promote tube placement (RR 0.82, 95% CI 0.61 to 1.10). Metoclopramide at doses of 10 mg (RR 0.82, 95% CI 0.60 to 1.11) and 20 mg (RR 0.62, 95% CI 0.15 to 2.62) were equally ineffective in facilitating post-pyloric intubation when compared with placebo or no intervention. In this review, we found only four studies that fitted our inclusion criteria. These were small, underpowered studies, in which metoclopramide was given at doses of 10 mg and 20 mg. Our analysis showed that metoclopramide did not assist post-pyloric placement of naso-enteral feeding tubes.Ideally randomised clinical trials should be performed that have a significant sample size, administering metoclopramide against control, however, given the lack of efficacy revealed by this review it is unlikely that further studies will be performed.

Transpyloric versus gastric tube feeding for preterm infants

Enteral feeding tubes for preterm infants may be placed in the stomach (gastric tube feeding) or in the upper small bowel (transpyloric tube feeding). There are potential advantages and disadvantages to both routes. To determine the effect of feeding via the transpyloric route versus feeding via the gastric route on feeding tolerance, growth and development, and adverse consequences (death, gastro-intestinal disturbance including necrotising enterocolitis, aspiration pneumonia, chronic lung disease, pyloric stenosis) in preterm infants. We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 3), MEDLINE, EMBASE, and CINAHL (to June 2012), conference proceedings, and previous reviews. Randomised or quasi-randomised controlled trials comparing transpyloric with gastric tube feeding in preterm infants. We extracted data using the standard methods of the Cochrane Neonatal Review Group with separate evaluation of trial quality and data extraction by two review authors. We synthesised data using a fixed-effect model and reported typical risk ratio (RR), risk difference (RD), and mean difference (MD). We found nine eligible trials in which a total of 359 preterm infants participated. All of the trials contained methodological weaknesses with lack of allocation concealment, absence of blinding of caregivers or assessors, and incomplete follow-up being the major potential sources of bias. The included trials did not detect any statistically significant effects on feeding tolerance or in-hospital growth rates. Meta-analyses found that infants allocated to receive transpyloric feeding had a higher risk of gastro-intestinal disturbance (typical RR 1.48 (95% confidence interval (CI) 1.05 to 2.09); typical RD 0.09 (95% CI 0.02 to 0.17); number needed to treat for an additional harmful outcome (NNTH) 10 (95% CI 6 to 50); six studies, 245 infants) and all-case mortality (typical RR 2.46 (95% CI 1.36 to 4.46); typical RD 0.16 (95% CI 0.07 to 0.26); NNTH 6 (95% CI 4 to 14); six studies, 217 infants). However, the trial that contributed most weight to these findings was likely to have been affected by selective allocation of the less mature and sicker infants to transpyloric feeding. We did not find any statistically significant differences in the incidence of other adverse events, including necrotising enterocolitis, intestinal perforation, and aspiration pneumonia. The available data do not provide evidence of any beneficial effect of transpyloric feeding for preterm infants. Some evidence of harm exists, including a higher risk of gastrointestinal disturbance and mortality, but these findings should be interpreted and applied cautiously because of methodological weaknesses in the included trials.

Recombinant Parathyroid Hormone Therapy for Severe Neonatal Hypoparathyroidism

Hypoparathyroidism-retardation-dysmorphism (HRD) syndrome (OMIM 241410), also known as SanjadSakati syndrome, is a rare autosomal recessive disorder characterized by hypoparathyroidism, growth failure, developmental delay, and characteristic facies. We describe the effective short-term use (tapered over 12 days) of recombinant parathyroid hormone (PTH) (teriparatide) in an unusual genetic condition characterized by hypoparathyroidism. Standard treatment for hypoparathyroidism involves oral vitamin D analogues and calcium, often in large doses to achieve sufficient intestinal calcium transport to overcome the hypercalciuria and concomitant malabsorption. 1 Despite its known physiological benefits, 2 recombinant PTH is not usually considered in the treatment algorithm for hypoparathyroidism in the pediatric population. Case Report Approval for this case report was obtained from the Human Research Ethics Committee of The Children’s Hospital at Westmead. Informed consent was obtained from the family. A female infant was born to first-cousin Iraqi parents at 31 weeks gestation, after an antenatal course that included oligohydramnios and fetal growth restriction. The parents had previously experienced 2 first-trimester miscarriages and fetal death at 30 weeks, and the current pregnancy was conceived after in vitro fertilization. She had a birth weight of 1190 g (SDS, 1.02), length of 36.5 cm (SDS, 1.77), and head circumference of 25.4 cm (SDS, 1.61). Dysmorphic features included deep-set eyes, large ears with hypoplastic posterior helices, and a thin nose (Figure 1). The newborn period was complicated by respiratory distress syndrome, treated with surfactant, mechanical ventilation, and continuous positive airway pressure. Significant feeding intolerance and vomiting were present from the first week of life. Upper gastrointestinal studies showed gastric hypomotility and delayed passage into the duodenum with no mechanical obstruction. Transpyloric tube feeding was started at 4 weeks after birth. Fat malabsorption was confirmed by fecal fat analysis and low serum vitamin A and E levels. Results of a sweat test were normal. Pancreatic enzyme replacement and fat-soluble

Use of a Noninvasive Electromagnetic Device to Place Transpyloric Feeding Tubes in Critically Ill Children

The start of transpyloric feedings is often delayed because of challenges in reliably placing tubes blindly at the bedside. To determine whether tube placement with the guidance of a noninvasive computerized electromagnetic device shortens the time needed to achieve accurate placement of transpyloric feeding tubes in critically ill children. In a prospective, randomized trial in a tertiary-care, university-affiliated pediatric intensive care unit, 49 children requiring transpyloric feeding tube placement were randomized to have their tube placed by using conventional blind technique or with the assistance of a noninvasive electromagnetic device. Twenty-seven patients were randomized to blind placement, and 22 were randomized to the electromagnetic device group. The time required to place the tubes successfully was significantly longer (P < .03) in the electromagnetic device group (median, 9.5 minutes; 95% confidence interval, 7-13 minutes) compared with the conventional placement group (median, 5 minutes; 95% confidence interval, 4.0-7.0 minutes). Placement of transpyloric feeding tubes with the guidance of a noninvasive electromagnetic device significantly increases the time required for accurate placement. Because placement of transpyloric feeding tubes in critically ill children is common practice in many pediatric intensive care units, technology that delays satisfactory placement may be counterproductive in experienced hands.

Endoscopic Placement of a Novel Feeding Tube

Complications of blind feeding tube (FT) placement include pneumothorax, pneumonia, empyema, and death. A safe and effective method of FT placement is desired. The Davis FT is a novel device that detachably couples to an ultrathin transnasal gastroscope. The objective of this study was to evaluate the safety and efficacy of Davis FT placement. Fifty consecutive patients requiring transpyloric enteral tube feeding underwent placement of the Davis FT. Placement efficacy was evaluated with postplacement radiographs. Patient demographics, route of tube placement, use of sedation, and complications were abstracted. The Davis FT was placed successfully in 50 patients. The mean age of the cohort was 52 (+/- 18) years. Sixty-two percent (31/50) were men. The success rate of nonpulmonary placement was 100% (50/50), and the postpyloric success rate was 96% (48/50). IV sedation was used in 72% (36/50) of placements. Eighty-six percent (43/50) of tubes were placed transnasally. The majority (62%) of esophagogastroduodenoscopies and Davis FT placements was performed by a pulmonologist. Forty-four percent (22/50) of patients had an endotracheal tube, 20% (10/50) had a tracheotomy, and 36% (18/50) had no breathing tube at the time of Davis FT placement. There were no complications. Transpyloric placement of the Davis FT is safe (100%) and effective (96%). The tube can be placed transorally or transnasally with or without sedation. The data suggest that postplacement radiographs are not necessary to confirm placement. Pulmonologists were successful in performing EGD and Davis FT placement.

Transpyloric tube feeding in very low birthweight infants with suspected gastroesophageal reflux: impact on apnea and bradycardia

OBJECTIVEOur aim was to assess safety and efficacy of transpyloric tube feeding as a therapeutic option to reduce apnea and bradycardia in hospitalized very low birthweight infants with clinical signs suggestive of gastroesophageal reflux.PATIENTS AND METHODSThis was a retrospective single center cohort study of VLBW infants hospitalized from 2001–2004 with signs of GER who received transpyloric enteral tube feedings. Apnea (>10 sec) and bradycardia (<100 bpm) episodes were compared before and after the initiation of transpyloric feedings. The Wilcoxon signed-rank test was used to compare differences between cardio-respiratory episodes before and after treatment at 1-day and combined 3-day intervals. Events recorded to assess safety of transpyloric feedings included death, sepsis, and necrotizing enterocolitis.RESULTS72 VLBW infants with a median birth weight of 870 grams (range 365–1435g) and gestational age of 26 weeks (23–31weeks) were identified. Median weight at initiation of transpyloric feedings was 1297 grams (820–3145g) and infants received transpyloric feeds for median duration of 18 days (1–86days). After initiation of transpyloric feedings, a reduction in apnea episodes from 4.0 to 2.5 (P=0.02) and a decrease in bradycardia episodes from 7.2 to 4.5 (P<0.001) was observed when comparing total number of episodes for the 3 days before and after treatment. Five (6.9%) of the infants developed necrotizing enterocolitis while receiving transpyloric feedings. None of the infants receiving human milk (P=0.07) and 36% of those receiving hydrolysate based formula (P<0.01) during transpyloric feeds developed NEC. No infants had late-onset culture proven sepsis. Seven (9.7%) infants died prior to hospital discharge.CONCLUSIONSTranspyloric feedings, especially when limited to human milk, may safely reduce episodes of apnea and bradycardia in preterm infants with suspected gastroesophageal reflux. Prospective randomized studies are needed to determine the biologic impact of bypassing the stomach, as well as the safety and efficacy of this intervention. Results of such studies could modify the current prevailing safety concerns regarding transpyloric feeding in this population.

Transpyloric feeding tube placement by gastric air insufflation technique in pediatric intensive care patients

The aim of the study was to evaluate the success rate of transpyloric tube (TPT) placement using air gastric insufflation technique in patients hospitalized in the Pediatric Intensive Care Unit. POPULATION, MATERIALS AND METHODS: The data were collected retrospectively from a prospective filled database. TPT positioning was defined as successful by evaluation of its distal end in the abdominal X-ray. Demographic information, success rate, duration of the procedure were registered. Descriptive statistics was used to analyze the data. There were 37 procedures in 33 patients and 84% of them were on mechanical ventilation. The percentage of success in TPT placement was 89% (33/37) and the mean duration of the procedure was 12.8 min +/- 5.3. No complications were registered. TPT placement through the insufflation of air in the stomach is a short, simple, effective, and well tolerated procedure that can be done at bedside.

Transpyloric tube feeding in very low birthweight infants with suspected gastroesophageal reflux: impact on apnea and bradycardia

Transpyloric tube feeding in very low birthweight infants with suspected gastroesophageal reflux: impact on apnea and bradycardia

特別な補助手段を用いないで, ベッドサイドで簡便に幽門後方に経腸栄養チューブを挿入する方法

背景 : 補助手段を用いずに, 幽門後方への経腸栄養チューブ挿入をベッドサイドで簡便に行える方法を検討した。対象 : 2003年4月1日～2005年5月31日の間に横浜市立大学附属病院ICU, または同附属市民総合医療センターGICUに入室し, 幽門後方栄養が必要な患者。方法 : アーガイル™のニューエンテラルフィーディングチューブを使用した。3cm進めるごとに手を離し, 跳ね返りがあれば引き抜き, なければさらに進めた。その挿入抵抗と, 空気注入音が変化すれば手技を終了し, X線写真で確認した。結果 : 64人に71回の挿入を行い, 幽門後方への留置に成功したのは56回 (78.9%)。所要時間は成功例21.6 ± 4.8分, 失敗例51.3 ± 33分であったが, 有意差はなかった (P = 0.050)。重大な合併症はなかった。結語 : この方法は, 成功率と所要時間において, 実用的である。

Systematic review of transpyloric versus gastric tube feeding for preterm infants

Aim: To determine if enteral tube feeding by the transpyloric versus the gastric route improves feeding tolerance, and growth and development, without increasing adverse events, in preterm infants. Methods: Systematic...

Transpyloric Feeding Tube Placement in Critically Ill Patients Using Electromyogram and Erythromycin Infusion

Transpyloric feeding is desirable in critically ill patients who often have gastroparesis; however, correct placement is difficult, requiring fluoroscopy, endoscopy, or time-consuming blind attempts. This study evaluated the success rate and time required to place transpyloric tubes using erythromycin infusion and GI electromyogram (EMG) signal. Observational trial. University hospital medical ICU. Thirty-nine patients receiving mechanical ventilation for respiratory failure (n = 13), pancreatitis (n = 9), ARDS (n = 8), neurologic disease (n = 4), major surgery (n = 3), and GI disease (n = 2) were enrolled (25 men and 14 women; mean age, 48.4 years; range, 21 to 82 years). Unweighted Flexiflo 10F feeding tubes were modified by the placement of an electrode 4 to 8 cm from the tip to record electromyogram (EMG) signals (Ross Products Division; Columbus, OH). Gastric signals are high amplitude with a frequency of 3 cycles per minute, while the duodenum and jejunum are low amplitude and 11 to 13 cycles per minute. Erythromycin was infused at a dose of 3 mg/kg to enhance gastric motor activity and emptying. The transpyloric tube was placed in the stomach, and its position was confirmed by EMG, then slowly advanced until duodenal EMG was detected. Tube position was determined by abdominal radiography. Thirty-one of 39 placements were immediately successful (initial success rate, 80%), 23 jejunal and 8 duodenal, requiring an average 7.8 min (range, 3 to 31 min). Six attempts in five patients were initial failures but were repeated, reaching the duodenum in one patient and the jejunum in four patients. Erythromycin infusion and EMG guidance can facilitate rapid transpyloric feeding tube placement in critically ill patients at the bedside.

Transpyloric versus gastric tube feeding for preterm infants.

Enteral feeding tubes for preterm infants may be placed in the stomach (gastric tube feeding) or in the upper small bowel (transpyloric tube feeding). There are potential advantages and disadvantages to both routes. In preterm infants who require enteral tube feeding, does feeding via the transpyloric route versus the gastric route improve feeding tolerance, and growth and development, without increasing adverse consequences? The standard search strategy of the Cochrane Neonatal Review Group was used. This included electronic searches of MEDLINE and EMBASE (up to December 2001) and of The Cochrane Controlled Trials Register in The Cochrane Library (Issue 3, 2001), and searches of the references in previous reviews including cross references. Randomised or quasi-randomised controlled trials comparing transpyloric with gastric tube feeding in preterm infants. Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk and weighted mean difference. Data from eight trials were available. We did not find any evidence of an effect on growth rates: short term weight gain, weighted mean difference -0.7 g/week (95% confidence interval -25.2, 23.8); short term increase in crown heel length, weighted mean difference -0.7 mm/week (95% confidence interval -2.4, 1.0); short term increase in head circumference, weighted mean difference 0.6 mm/wk (95% confidence interval -0.9, 2.1). Longer term growth was reported in one study. There were not any statistically significant differences between the groups in the mean body weight or occipitofrontal head circumference at three months or at six months corrected age. None of the included studies provided data on neurodevelopmental outcomes during infancy or beyond. Transpyloric feeding was associated with a greater incidence of gastro-intestinal disturbance, RR 1.45, 95% CI 1.05, 2.09. There was some evidence that feeding via the transpyloric route increased mortality, RR 2.46, 95% CI 1.36, 4.46; however, the outcomes of the study that contributed most to this finding were likely to have been affected by selective allocation of the less mature and sicker infants to transpyloric feeding. We did not detect any statistically significant differences in the incidence of other adverse events, including necrotising enterocolitis, intestinal perforation, and aspiration pneumonia. We did not find any evidence of benefit, but did find evidence of adverse effects, of transpyloric feeding in preterm infants. Feeding via the transpyloric route cannot be recommended for preterm infants.

Bedside placement of postpyloric feeding tubes.

Postpyloric placement of feeding tubes into the duodenum or jejunum is often recommended to support early feeding, improve tolerance of enteral nutrition, and decrease the risk of aspiration pneumonia. Achieving small bowel feeding tube placement can be a difficult, time-consuming, and costly process that may delay the initiation of enteral nutrition. Various bedside techniques, including air insufflation, pH assisted, and spontaneous passage with or without motility agents are available to facilitate transpyloric feeding tube passage. A discussion of these methods is presented in this article, including a hospital-based quality initiative project designed to facilitate early enteral nutrition.

Validation of a blind transpyloric feeding tube placement technique in pediatric intensive care: Rapid, simple, and highly successful

Nasogastric feeding in intensive care is poorly tolerated as a result of gastroparesis. Transpyloric (TP) feeding has been limited by difficulty in tube placement. This study was to independently validate the success rate of a previously published bedside TP feeding tube (FT) placement technique. Prospective interventional study. Tertiary pediatric intensive care unit (PICU) in a university hospital. Children whose intensivist requested TP feeding, and who were without known fundoplication, pharyngeal trauma, or gastric ulceration. After informed consent, an unweighted polyurethane feeding tube with a flexible wire stylet was inserted using a standard technique with metoclopramide, right lateral position, and air insufflation during advancement until <2 mL air could be aspirated after insufflation of 5-10 mL air. The tubes were inserted by one of the authors, whose training was only to observe one insertion, then perform one insertion with supervision. Patient demographics, procedural data, and success rate based on radiography were prospectively recorded. There were 71 insertions on 38 patients from February 1999 to October 1999. Patients were aged 56 +/- 69.8 months, weighed 17.8 +/- 18 kg, 69% were ventilated, and 56% received procedural sedation. Success rate for TP-FT placement was 63/71 insertions (88.7%) in an average of 7.43 +/- 6.85 mins (median, 5 mins; range, <1-45 mins); of 38 patients, 36 had a successful TP- FT (95%). Insertion was well tolerated. Of the successful TP-FTs, on day 1 (n = 63) the FT was in distal duodenum or jejunum in 51% and by days 3-5 (n = 51), this increased to 75%. Bedside placement of a TP-FT with this technique is simple, rapid, well tolerated, and highly successful with little training. Immediate radiograph to confirm TP placement may not always be necessary. In our experience, this technique has obviated the need to search for another method to achieve a transpyloric feeding tube.

A multicenter, prospective study of the placement of transpyloric feeding tubes with assistance of a magnetic device. The Magnet-Guided Enteral Feeding Tube Study Group.

Placement of feeding tubes in the transpyloric position can be helpful in the management of enterally fed patients with pancreatitis, gastric atony, enterocutaneous fistulae, or pulmonary aspiration risk. The attainment of transpyloric position is difficult, and numerous techniques have been proposed to help in achieving this location. Recently, the use of a magnet-tipped feeding tube, dragged into proper position with an external magnet, has been described with an excellent success rate. At 10 participating institutions, practitioners were trained in the use of the device. Successful tube placement was determined by abdominal radiograph. One hundred fifty-six tube placements were attempted. Transpyloric position was obtained in 60%. Placement into the third portion of the duodenum or distal was obtained in only 32%. Analysis of the data did not reveal a learning curve at the institutions, and 7 of 10 had a 50% or lower success rate. Placement of feeding tubes with the assistance of a magnetic device was infrequently successful at the majority of institutions where it was attempted. We report a lower success rate than the original article, which described an 88% success rate of transpyloric intubation. Although this technique has a high failure rate, some individuals seem to be very successful using it, which could reduce the need for endoscopy or transport for the placement of feeding tubes.