Introduction Nasojejunal tubes (NJT) are traditionally inserted endoscopically (via oral route with subsequent mouth to nose transfer) or radiologically. The oral route is uncomfortable for patients and is technically more challenging. Transnasal endoscopy (TNE) is an emerging technique, performed with an ultrathin endoscope inserted via nasal passages. This circumvents the need for mouth to nose transfer of NJT, and can be placed with less sedation. It is a safe and effective alternative to traditional or fluoroscopic insertion (1-3). We aim to review the current practice of transnasal insertion of NJT service in South Tyneside District Hospital.
Method We reviewed data retrospectively of transnasal NJT insertion from December 2013 to October 2016. We included 38 procedures, from 25 patients, of which 9 required repeat procedures (2–4 repeat procedures). Patients were aged 22 to 81, and were mostly men (M: 16, F: 9).
Results The main indications for NJT insertion were pancreatitis, gastroparesis and malignancy. Patients received received topical anaesthesia (17), topical anaesthesia in combination with sedation (17), sedation only (3), and no sedation or topical anaesthesia (1). The mean midazolam dose for those under and above 70 was 2 mg. Post pyloric position of NJT was confirmed via AXR or endoscopically, this occurred in 37 cases (97.4%). Successful NJT placement was defined by its post pyloric position. Of all NJT insertions, successful placements occurred in 68.4% (26 of 38) of cases. Successful post pyloric insertion of NJT per patient was 76% overall (19 of 25). Based on indications, our success rate per patient was 91% for pancreatitis (10 of 11), 60% for gastroparesis (3 of 5), 75% for malignancy (3 of 4), 60% for other indications (3 of 5). Our NJT insertion has improved year on year.
Conclusion At present, STDH is the only hospital delivering TNE in the North East of the United Kingdom. As far as we know this is the first attempt at reviewing transnasal placement of NJT in the UK. Our successful post pyloric insertion is comparable to those in the literature when similar indications (pancreatitis) is compared. Our yearly improvement in successful post pyloric insertion of NJT via TNE is encouraging, and proves that transnasal NJT insertion is a valuable service.
. Külling D, Bauerfeind P, Fried M. Transnasal versus transoral endoscopy for the placement of nasoenteral feeding tubes in critically ill patients. Gastrointest Endosc. 2000;52(4):506–10
. Zhihui T, Wenkui Y, Weiqin L, et al. A randomised clinical trial of transnasal endoscopy versus fluoroscopy for the placement of nasojejunal feeding tubes in patients with severe acute pancreatitis. Postgrad Med J2009; 85:59–63
. Qin Hua, Xiao-Yun Lu, Qiu Zhao, et al. Evaluation of a new method for placing nasojejunal feeding tubes. WJG 2012; 18(37): 5295–99
Disclosure of Interest None Declared
- enteral feeding
- Nasojejunal tube
- Post pyloric feeding
- Transnasal endoscopy
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