Transnasal endoscopy for enteral feeding tube placement in critically ill patients

OBJECTIVE: Early enteral feedings may improve outcomes in critically ill pa tients. Recently, transnasal endoscopy with an ultrathin transnasal endosco pe has been shown to be of value for diagnostic endoscopy without conscious sedation. We developed a technique for the placement of postpyloric feedin g tubes in critically ill patients using transnasal endoscopy. We describe our initial experience in a consecutive series of patients. METHODS: We collected data on consecutive intensive care unit patients unde rgoing bedside transnasal endoscopy for nasoenteric feeding tube placement: using a standardized technique. Tube position was confirmed in all patient s with a plain abdominal radiograph. Tube placement was deemed successful i f the feeding tube traversed the pylorus. RESULTS: Transnasal endoscopy was completed in all fourteen patients, as wa s placement of a feeding tube. Feeding tubes were successfully placed in th e jejunum or duodenum in 13 of the 14 patients (93%). Tubes remained in pla ce from 3 to 45 days (mean 16 days). Two patients required conscious sedati on during tube placement, and two ultimately required percutaneous gastrost omy. CONCLUSIONS: Transnasal endoscopy allows simple and successful postpyloric feeding tube placement at the bedside of critically ill patients. This meth od can facilitate early enteral feeding in intensive care units. (C) 1999 b y Am. Coll. Gastroenterology.