Abstract
Background
Nasoenteral tube feeding is often required in surgical patients, mainly because of delayed gastric emptying. Bedside electromagnetic (EM)-guided tube placement by specialized nurses might offer several advantages (e.g., reduced patient discomfort and costs) over conventional endoscopic placement. The aim of this study was to compare the success rate of EM-guided to endoscopic placement of nasoenteral feeding tubes in surgical patients.
Materials and Methods
A retrospective cohort study was performed in 267 adult patients admitted to two gastrointestinal surgical wards who received a nasoenteral feeding tube by EM-guidance or endoscopy. Eighteen patients were excluded because of insufficient data. Patients were categorized according to the primary tube placement method. Subgroup analysis was performed in patients with altered upper gastrointestinal anatomy. Primary endpoint was successful tube placement at or beyond the duodenojejunal flexure.
Results
A total of 249 patients were included, of which 90 patients underwent EM-guided and 159 patients underwent endoscopic tube placement. Both groups were comparable for baseline characteristics. Primary tube placement was successful in 74/90 patients (82 %) in the EM-guided group versus 140/159 patients (88 %) in the endoscopic group (P = 0.20). In patients with altered upper gastrointestinal anatomy, success rates were significantly lower in the EM-guided group (58 vs. 86 %, P = 0.004). There were no significant differences in tube-related complications such as dislodgement or tube blockage.
Conclusions
Bedside EM-guided placement of nasoenteral feeding tubes by specialized nurses did not differ from endoscopic placement by gastroenterologists regarding feasibility and safety in surgical patients with unaltered upper gastrointestinal anatomy.
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References
Dong K, Yu XJ, Li B, Wen EG, Xiong W, Guan QL. Advances in mechanisms of postsurgical gastroparesis syndrome and its diagnosis and treatment. Chin J Dig Dis. 2006 Jan;7(2):76–82.
Visser A, Ubbink DT, van Wijngaarden AKS, Gouma DJ, Goslings JC. Quality of care and analysis of surgical complications. Dig Surg. 2012 Jan;29(5):391–9.
Akizuki E, Kimura Y, Nobuoka T, Imamura M, Nagayama M, Sonoda T, Hirata K. Reconsideration of postoperative oral intake tolerance after pancreaticoduodenectomy: prospective consecutive analysis of delayed gastric emptying according to the ISGPS definition and the amount of dietary intake. Ann Surg. 2009 Jun;249(6):986–94.
Welsch T, Borm M, Degrate L, Hinz U, Büchler MW, Wente MN. Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre. Br J Surg. 2010 Jul;97(7):1043–50.
Niv E, Fireman Z, Vaisman N. Post-pyloric feeding. World J Gastroenterol. 2009 Mar 21;15(11):1281–8.
Stevens JE, Jones KL, Rayner CK, Horowitz M. Pathophysiology and pharmacotherapy of gastroparesis: current and future perspectives. Expert Opin Pharmacother. Informa UK, Ltd. London; 2013 Jun 16;14(9):1171–86.
Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013 Jan;108(1):18–37; quiz 38.
Gerritsen A, Besselink MG, Cieslak KP, Vriens MR, Steenhagen E, Van Hillegersberg R, Borel Rinkes IH, Molenaar IQ. Efficacy and complications of nasojejunal, jejunostomy and parenteral feeding after pancreaticoduodenectomy. J Gastrointest Surg. 2012;16(6):1144–51.
Abu-Hilal M, Hemandas AK, McPhail M, Jain G, Panagiotopoulou I, Scibelli T, Johnson CD, Pearce NW. A comparative analysis of safety and efficacy of different methods of tube placement for enteral feeding following major pancreatic resection. A non-randomized study. JOP. 2010 Jan;11(1):8–13.
Wiggins TF, DeLegge MH. Evaluation of a new technique for endoscopic nasojejunal feeding-tube placement. Gastrointest Endosc. 2006 Apr;63(4):590–5.
Brandt CP, Mittendorf EA. Endoscopic placement of nasojejunal feeding tubes in ICU patients. Surg Endosc. 1999 Dec;13(12):1211–4.
Mahadeva S, Malik A, Hilmi I, Qua C-S, Wong C-H, Goh K-L. Transnasal endoscopic placement of nasoenteric feeding tubes: outcomes and limitations in non-critically ill patients. Nutr Clin Pract. 2008;23(2):176–81.
Boulton-Jones JR, Lewis J, Jobling JC, Teahon K. Experience of post-pyloric feeding in seriously ill patients in clinical practice. Clin Nutr. 2004 Feb;23(1):35–41.
Han-Geurts IJM, Hop WC, Verhoef C, Tran KTC, Tilanus HW. Randomized clinical trial comparing feeding jejunostomy with nasoduodenal tube placement in patients undergoing oesophagectomy. Br J Surg. 2007 Jan;94(1):31–5.
Phang J, Marsh W, Prager R. Feeding tube placement with the aid of a new electromagnetic transmitter. JPEN J Parenter Enteral Nutr. 2006;30:S48–S49.
Gray R, Tynan C, Reed L, Hasse J, Kramlich M, Roberts S, Suneson J, Thompson J, Neylon J. Bedside electromagnetic-guided feeding tube placement: an improvement over traditional placement technique? Nutr Clin Pract. 2007 Aug 1;22(4):436–44.
Hemington-Gorse SJ, Sheppard NN, Martin R, Shelley O, Philp B, Dziewulski P. The use of the Cortrak Enteral Access System™ for post-pyloric (PP) feeding tube placement in a Burns Intensive Care Unit. Burns. 2011 Mar;37(2):277–80.
Powers J, Luebbehusen M, Spitzer T, Coddington A, Beeson T, Brown J, Jones D. Verification of an electromagnetic placement device compared with abdominal radiograph to predict accuracy of feeding tube placement. JPEN J Parenter Enteral Nutr. 2011 Jul;35(4):535–9.
Rivera R, Campana J, Hamilton C, Lopez R, Seidner D. Small bowel feeding tube placement using an electromagnetic tube placement device: accuracy of tip location. JPEN J Parenter Enteral Nutr. 2011 Sep;35(5):636–42.
Holzinger U, Brunner R, Miehsler W, Herkner H, Kitzberger R, Fuhrmann V, Metnitz PGH, Kamolz L-P, Madl C. Jejunal tube placement in critically ill patients: A prospective, randomized trial comparing the endoscopic technique with the electromagnetically visualized method. Crit Care Med. 2011 Jan;39(1):73–7.
Kaffarnik MF, Lock JF, Wassilew G, Neuhaus P. The use of bedside electromagnetically guided nasointestinal tube for jejunal feeding of critical ill surgical patients. Technol Health Care. 2013 Jan;21(1):1–8.
Koopmann MC, Kudsk KA, Szotkowski MJ, Rees SM. A team-based protocol and electromagnetic technology eliminate feeding tube placement complications. Ann Surg. 2011 Feb;253(2):287–302.
Mathus-Vliegen EMH, Duflou A, Spanier MBW, Fockens P. Nasoenteral feeding tube placement by nurses using an electromagnetic guidance system (with video). Gastrointest Endosc. 2010 Apr;71(4):728–36.
Schröder S, van Hülst S, Claussen M, Petersen K, Pich B, Bein B, von Spiegel T. [Postpyloric feeding tubes for surgical intensive care patients. Pilot series to evaluate two methods for bedside placement]. Anaesthesist. 2011 Mar;60(3):214–20.
Taylor SJ, Manara AR, Brown J. Treating delayed gastric emptying in critical illness: metoclopramide, erythromycin, and bedside (cortrak) nasointestinal tube placement. JPEN J Parenter Enteral Nutr. 2010;34(3):289–94.
Windle EM, Beddow D, Hall E, Wright J, Sundar N. Implementation of an electromagnetic imaging system to facilitate nasogastric and post-pyloric feeding tube placement in patients with and without critical illness. J Hum Nutr Diet. 2010 Feb;23(1):61–8.
Meer JA. A new nasal bridle for securing nasoenteral feeding tubes. JPEN J Parenter Enteral Nutr. 13(3):331–4.
Hakkaart-van Roijen L, Tan S, Bouwmans C. Handleiding voor kostenonderzoek, methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. 2010.
OECD. Purchasing power parity exchange rates [Internet]. Div. b 0.826. 2013 [cited 2014 May 21]. Available from: http://stats.oecd.org/Index.aspx?datasetcode=SNA_TABLE4
Conflict of Interest
AG received an unrestricted grant from IPSEN Pharmaceuticals NL B.V. For the remaining authors, none were declared.
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Thijs de Rooij and Marcel J. van der Poel contributed equally to this work.
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Gerritsen, A., de Rooij, T., van der Poel, M.J. et al. Endoscopic Versus Bedside Electromagnetic-Guided Placement of Nasoenteral Feeding Tubes in Surgical Patients. J Gastrointest Surg 18, 1664–1672 (2014). https://doi.org/10.1007/s11605-014-2582-5
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DOI: https://doi.org/10.1007/s11605-014-2582-5