Endoscopically placed nasoenteral feeding tubes. Indications and techniques.

We reviewed indications, techniques, and results for endoscopic placement of nasoenteral feeding tubes by analyzing records of 29 hospitalized patients who had undergone 41 tube placements. Indications included gastric stasis after gastric surgery (11 patients), gastroparesis and reflux or both in critically ill trauma patients (10), stricture secondary to vertical banded gastroplasty (3), and partial gastric outlet obstruction (5). Two endoscopic techniques were used. The guidewire method in which a flexible, Silastic feeding tube is advanced over the guidewire to the desired site had 82 per cent success (22 of 27). Adjunct fluoroscopy achieved a 94 per cent success rate (17 of 18); success without fluoroscopy was 56 per cent (5 of 9). The pull-along method attached a suture to the feeding tube tip which was grasped with forceps and moved to the correct location (93% success; 13 of 14). Fluoroscopy was not used with this method. Feeding tubes were successfully placed in 35 of 41 attempts (85%) in 27 of 29 patients. Failures were caused by an inability to intubate the efferent limb of a gastrojejunostomy (2) and unrecognized guidewire movement (4). Tube use ranged from one day to six months. We conclude that endoscopic placement of nasoenteral feeding tubes is an effective means to establish a route for enteral nutrition in selected patients.