Transnasal versus transoral endoscopy for the placement of nasoenteral feeding tubes in critically ill patients

Background: Nasoenteral feeding tube placement with the Seldinger technique using transoral endoscopy is a tedious procedure. This study compared the transoral approach with a new technique that uses a transnasal endoscope wi thout the need for a mouth-to-nose wire transfer. Methods: Critically ill patients requiring nasoenteral feeding tube placeme nt were randomly assigned to the transoral technique using a standard upper endoscope (n = 80) or the transnasal method using a 5.3 mm fiberscope (n = 80). Procedure time, medication requirement, technical difficulty, patient tolerance, and radiologic tube position were assessed. Results: The two groups were similar with regard to baseline medication, en doscopic findings, as well as overall technical difficulty and patient tole rance. The transnasal technique required less procedure time (median 8.0 ve rsus 12.0 minutes, p < 0.001) and less relaxant medication (p = 0.029). Fur thermore, it caused fewer circulatory (p = 0.040) and respiratory (p = 0.01 6) alterations regardless of the application of sedative or relaxant medica tion. The transnasal endoscope was inferior with respect to passage through the pylorus (p = 0.003) and duodenum (p = 0.020). These differences were s ignificant In univariate hypothesis testing. Bonferroni correction for mult iple testing of data removed the significance at p > 0.0031. Both technique s achieved similar rates of successful tube placement in the smart bower (8 6% versus 84%, p = 0.82). Conclusion: Transnasal endoscopy allows accurate placement of nasoenteral f eeding tubes in critically ill patients and is superior to transoral endosc opy in terms of procedure time, medication requirement, and safety.