Electromagnetic guided bedside or endoscopic placement of nasoenteral feeding tubes in surgical patients (CORE trial): study protocol for a randomized controlled trial (original) (raw)
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Gastrointestinal Endoscopy, 2015
Background: Nasoenteral tube feeding is frequently required in hospitalized patients to either prevent or treat malnutrition, but data on the optimal strategy of tube placement are lacking. Objective: To compare the efficacy and safety of bedside electromagnetic (EM)-guided, endoscopic, and fluoroscopic placement of nasoenteral feeding tubes in adults. Design: Systematic review of the literature. Patients: Adult hospitalized patients requiring nasoenteral feeding. Interventions: EM-guided, endoscopic, and/or fluoroscopic nasoenteral feeding tube placement. Main Outcome Measurements: Success rate of tube placement and procedure-or tube-related adverse events. Results: Of 354 screened articles, 28 studies were included. Data on 4056 patients undergoing EM-guided (n Z 2921), endoscopic (n Z 730), and/or fluoroscopic (n Z 405) nasoenteral feeding tube placement were extracted. Tube placement was successful in 3202 of 3789 (85%) EM-guided procedures compared with 706 of 793 (89%) endoscopic and 413 of 446 (93%) fluoroscopic procedures. Reinsertion rates were similar for EM-guidance (270 of 1279 [21%] patients) and endoscopy (64 of 394 [16%] patients) or fluoroscopy (10 of 38 [26%] patients). The mean (standard deviation) procedure time was shortest with EM-guided placement (13.4 [12.9] minutes), followed by endoscopy and fluoroscopy (14.9 [8.7] and 16.2 [23.6] minutes, respectively). Procedure-related adverse events were infrequent (0.4%, 4%, and 3%, respectively) and included mainly epistaxis. The tube-related adverse event rate was lowest in the EM-guided group (36 of 242 [15%] patients), followed by fluoroscopy (40 of 191 [21%] patients) and endoscopy (115 of 384 [30%] patients) and included mainly dislodgment and blockage of the tube. Limitations: Heterogeneity and limited methodological quality of the included studies. Conclusion: Bedside EM-guided placement of nasoenteral feeding tubes appears to be as safe and effective as fluoroscopic or endoscopic placement. EM-guided tube placement by nurses may be preferred over more costly procedures performed by endoscopists or radiologists, but randomized studies are lacking. (Gastrointest Endosc 2015;81:836-47.
Pancreas, 2016
Background: Current evidence supporting the utility of electromagnetic (EM)-guided method as the preferred technique for post-pyloric feeding tube placement is limited. We conducted a meta-analysis to compare the performance of EM-guided versus endoscopic placement. Methods: We searched several databases for all randomised controlled trials evaluating the EM-guided vs. endoscopic placement of post-pyloric feeding tubes up to 28 July 2020. Primary outcome was procedure success rate. Secondary outcomes included reinsertion rate, number of attempts, placement-related complications, tuberelated complications, insertion time, total procedure time, patient discomfort, recommendation scores, length of hospital stay, mortality, and total costs. Results: Four trials involving 536 patients were qualified for the final analysis. There was no difference between the two groups in procedure success rate (RR 0.97; 95% CI 0.91-1.03), reinsertion rate (RR 0.84; 95% CI 0.59-1.20), number of attempts (WMD − 0.23; 95% CI − 0.99-0.53), placement-related complications (RR 0.78; 95% CI 0.41-1.49), tube-related complications (RR 1.08; 95% CI 0.82-1.44), total procedure time (WMD − 18.09 min; 95% CI − 38.66-2.47), length of hospital stay (WMD 1.57 days; 95% CI − 0.33-3.47), ICU mortality (RR 0.80; 95% CI 0.50-1.29), inhospital mortality (RR 0.87; 95% CI 0.59-1.28), and total costs (SMD − 1.80; 95% CI − 3.96-0.36). The EM group was associated with longer insertion time (WMD 4.3 min; 95% CI 0.2-8.39), higher patient discomfort level (WMD 1.28; 95% CI 0.46-2.1), and higher recommendation scores (WMD 1.67; 95% CI 0.24-3.10). Conclusions: No significant difference was found between the two groups in efficacy, safety, and costs. Further studies are needed to confirm our findings. Systematic review registration: PROSPERO (CRD42020172427)
Gastrointestinal Endoscopy, 2007
Background: Transnasal endoscopy with a small-caliber endoscope has been shown to be helpful for the placement of nasoenteral feeding tubes in patients who are critically ill. Success rates were limited by the short working length of the small-caliber endoscopes. Objective: To compare the success rate of a 133-cm-long, small-caliber, prototype videoendoscope with a standard 92-cm-long, small-caliber, fiberoptic endoscope for the transnasal placement of feeding tubes.
Digestive diseases and sciences, 1986
Recent technical refinement of feeding tubes and formula infusion pumps has led to widespread clinical use of long-term nasoenteric alimentation. We evaluated 340 hospitalized adults after placement of flexible, small-bore feeding tubes. These debilitated or critically ill patients were intubated transnasally at their bedside without fluoroscopic guidance, but portable radiographs of the chest and abdomen were obtained routinely for tube localization before administering liquid nutrients. Various complications were detected in 26 cases (7.6%). Tube malposition into the airways (seven patients) or within the pharynx and esophagus (eight patients) was the most common problem; it occurred in 4.4% of all cases. Radiographic findings in 11 other patients included tube-induced perforation of the lung (one case), massive aspiration (three), malfunction of knotted tubes (three), and rupture of their mercury capsule within the gastrointestinal tract (four). Our observations indicate a need for careful radiographic localization of the feeding tubes at the time of insertion and their periodic monitoring throughout the course of nasoenteric alimentation. Adequate nutritional support must be provided to patients whose physical or mental disability interferes with oral intake of food. This group includes premature infants, critically ill or comatose patients, victims of severe burns or trauma, and those who are prone to aspirate because of pharyngoesophageal dysfunction or obstruction. In such cases, nasoenteric tube feeding is the preferred method for preventing and correcting malnutrition (1-3). It represents a more physiologic and economic approach than the two main alternatives: central venous hyperalimentation and percutaneous feeding gastrostomy or enterostomy (2, 4-6). The conventional nasogastric and nasojejunal tubes are not suitable for long-term usage in patients who require continuous enteral feeding. These tubes are made of pliable synthetic com-Manuscript
Feeding tubes in endoscopic and clinical practice: the longer the better?
Gastrointestinal Endoscopy, 1993
In an attempt to combine successful distal feeding tube positioning and a more prolonged stay without interfering with tube patency and feeding regimens, commercially available 105-cm polyurethane feeding tubes were compared with experimental tubes 125 cm and 145 cm long. The technique for endoscopic positioning at the bedside of the patient was standardized. Forty-five patients who required intraduodenal or intrajejunal enteral feeding in the intensive care unit were randomly assigned to one of the three tube-length groups. Even the 105-cm short feeding tubes were able to be introduced beyond the duodenojejunal junction, although insufficient tube length remained for tube fixation at the nose. The longer variants, however, were positioned significantly (p < 0.01) deeper in the intestine, with enough spare tube length for slack formation in the stomach and fixation at the nose. Tubes were electively removed in 29% of the patients. Irrespective of tube length, premature removal by the patient (in 36%) or by the nurse (in 11%) was rather high. Tube blockage was irremediable in 9%. Feeding tubes survived on average 10.6 days in all three tube-length groups, despite the fact that many drugs were administered by tube as well. The successful, easy, and fast endoscopic positioning of feeding tubes far into the intestine and at the patient's bedside may further expand the possibility for enteral feeding. Moreover, polyurethane materials are well tolerated, and increasing the tube length does not interfere with tube patency or feeding plans. (Gastrointest Endosc 1993;39:537-42.)
The American Journal of Gastroenterology, 2009
The American Journal of GASTROENTEROLOGY nature publishing group ORIGINAL CONTRIBUTIONS 1271 NUTRITION/OBESITY Di erent methods have been evaluated in the past: auscultation for bubbling heard in the epigastrium with insu ation of air, aspiration, and air insu ation (1) , sampling of pH aspirates from feeding tubes (2) , combination of auscultation with aspirate pH (3) , capnometry (4) , visual characteristics of the aspirate from feeding tubes (5) , and serum paracetamol concentration a er administration through the feeding tube (6). Sampling of pH aspirates, visual characteristics of aspirates, and serum paracetamol concentration are reported to be helpful in di erentiating between gastric and intestinal positions. None of these methods, however, have been established in the daily