Spontaneous transpyloric migration of a ballooned nasojejunal tube: A randomized controlled trial

Background: Spontaneous transpyloric migration of a simple nasojejunal tube (NJT) can be expected in only one-third of insertions. Guidance of the tub e by radiologic or endoscopic maneuvers is usually required. We believed th at locating a 5-mL balloon near the tip of an NJT on which natural peristal sis could act would improve the rate of spontaneous transpyloric migration and facilitate small bowel propagation. Methods: Thirty healthy volunteers were randomly assigned to have an inflated or noninflated, ballooned NJT fa shioned from a modified 9F Hickman line catheter inserted. The pH of aspira tes was measured hourly and the final location of the tube assessed by gast rografin contrast abdominal x-ray (AXR) at the end of 6 hours, at which tim e the tube was removed. Results: After 0 hours, spontaneous transpyloric mi gration occurred in 86.6% of the ballooned and 66.6% of the nonballooned tu bes. The final disposition of the ballooned tubes was: stomach, 2 (13.3%); duodenum, 1 (6.7%); and small bowel, 12 (80%). The final disposition of the nonballooned tubes was: stomach, 5 (33%), NS; duodenum, 9 (60%), p <.05; a nd small bowel, 1 (6.7%, p <.05. Conclusions: Ballooned NJT have a higher r ate of spontaneous transpyloric migration and are significantly more likely to achieve an optimal small bowel location.