THE DIFFICULT-TO-PLACE FEEDING TUBE - SUCCESSFUL ENDOSCOPIC PLACEMENTUSING A MUCOSAL CLIP

Background: Delivery of enteral feeding beyond the ligament of Treitz is often desirable, as it diminishes enterogastric reflux and potentia l for pulmonary aspiration of enteral feeding solution. However, stand ard or fluoroscopically guided techniques often fail. We describe thre e such cases in which enteral feeding tube placement was achieved endo scopically and secured using an endoscopic clip-fixing device. Methods : A standard feeding tube attached to a mucosal clip by a silk suture was advanced endoscopically into the small. intestine. Using a through -the-endoscope clip-fixing device, the tube was attached to the bowel wall. Results: Three patients underwent the above procedure: a postgas trectomy patient with a functionally obstructed jejunal pouch and a pr eviously failed fluoroscopically guided placement had a nasojejunal fe eding tube successfully placed beyond the obstruction; a cancer patien t with duodenal obstruction due to SMA syndrome, a surgical gastrostom y, and a previously failed fluoroscopic attempt had a dual lumen perga strostomy feeding tube placed beyond the obstruction; and a patient wi th a refractory benign esophageal stricture underwent esophageal dilat ion followed by successful feeding tube placement into the proximal je junum. In all patients, the tube functioned well without subsequent oc clusion or dislodgement. Conclusions: Endoscopic placement of feeding tubes using a clip-fixing device is a useful technique in patients wit h normal and abnormal anatomy in whom reliable delivery of enteral fee ding beyond the ligament of Treitz is desired.