Trans-nasal endoscopy for feeding tube placement in critically ill patients

Background: Early enteral feeding may improve outcome in critically ill patients, but placement of post-pyloric feeding tubes can be difficult in an intensive care unit (ICU). Methods: Trans-nasal endoscopy was performed at the bedside of ICU patients to place naso-enteric feeding tubes, using a 5.5 mm fiberoptic endoscope. After reaching the second duodenum a guidewire was passed through the endoscope and advanced into the small bowel. The endoscope was removed, and an 8 Fr naso-jejunal tube or a two lumen 9Fr/16Fr naso-gastrojejunal tube was passed over the guidewire. Tube position was verified radiographically, and also by immediate endoscopy through the other nares in some patients. Placement was considered successful if the feeding tube tip was in the small bowel. Results: A naso-enteric tube was placed successfully in 13 of 14 patients (93%). Mean patient age was 49 years. Twelve patients were mechanically ventilated and some had recent thoracic or abdominal trauma, or marked coagulopathy. Indications included inability to blindly place a feeding tube, high gastric residuals, and pneumonia in 6, 7, and 3 patients respectively. There were no complications; tube placement required about 20 minutes. Tubes were used for a mean of 16 days. 3 patients subsequently died, and 2 required percutaneous gastrostomy. Conclusion: Trans-nasal endoscopy permits easy, rapid, and safe placement of naso-enteric feeding tubes at the bedside of ICU patients.