Original Articles
Transnasal versus transoral endoscopy for the placement of nasoenteral feeding tubes in critically ill patients☆,☆☆

Presented at the annual meeting of the American Society for Gastrointestinal Endoscopy, May 21-24, 2000, San Diego, California.
https://doi.org/10.1067/mge.2000.107729Get rights and content

Abstract

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 without the need for a mouth-to-nose wire transfer. Methods: Critically ill patients requiring nasoenteral feeding tube placement 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, endoscopic findings, as well as overall technical difficulty and patient tolerance. The transnasal technique required less procedure time (median 8.0 versus 12.0 minutes, p < 0.001) and less relaxant medication (p = 0.029). Furthermore, it caused fewer circulatory (p = 0.040) and respiratory (p = 0.016) alterations regardless of the application of sedative or relaxant medication. The transnasal endoscope was inferior with respect to passage through the pylorus (p = 0.003) and duodenum (p = 0.020). These differences were significant in univariate hypothesis testing. Bonferroni correction for multiple testing of data removed the significance at p > 0.0031. Both techniques achieved similar rates of successful tube placement in the small bowel (86% versus 84%, p = 0.82). Conclusion: Transnasal endoscopy allows accurate placement of nasoenteral feeding tubes in critically ill patients and is superior to transoral endoscopy in terms of procedure time, medication requirement, and safety. (Gastrointest Endosc 2000;52:506-10.)

Section snippets

Patients and methods

Over a 13-month period, patients referred for endoscopic placement of a nasoenteral feeding tube were assigned consecutive numbers. The feeding tubes were placed using the transnasal or the transoral technique according to a randomization list that was prepared by a physician not directly involved in the study. All patients were critically ill with adequate cardiopulmonary monitoring in various intensive care units (internal medicine, general surgery, trauma surgery, thoracic surgery, and

Results

A total of 160 nasoenteric feeding tubes were placed in 145 patients (82 men, 63 women) by the transnasal (n = 80) or transoral (n = 80) technique (Table 1).The two groups were similar with regard to age (median 57.0 years for transnasal group vs. 60.0 years for transoral group) and gender, type of feeding tube used, presence of baseline sedation (78% vs. 79%, p = 1.0) and relaxant (13% vs. 18%, p = 0.50) medication, as well as presence of abnormal findings at endoscopy (36% vs. 39%, p = 0.87)

Discussion

The present study demonstrated that transnasal endoscopy is an appropriate method with significant advantages compared with the transoral route for the placement of nasoenteral feeding tubes in critically ill patients.

There was a substantial benefit with the transnasal technique with regard to the time required for the procedure. The shorter time is explained mainly by eliminating the cumbersome guidewire transfer with the transnasal approach. The mouth-to-nose wire transfer caused technical

Disclosure statement

The authors have no financial or other interest in the manufacture or distribution of any device mentioned in the manuscript.

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Reprint requests: Daniel Külling, MD, Division of Gastroenterology, Department of Internal Medicine, University Hospital of Zürich, Rämistr. 100, CH-8091 Zürich, Switzerland; e-mail: [email protected].

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Gastrointest Endosc 2000;52:506-10.

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Copyright © 2000 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.