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NEW YORK (Reuters Health) – A new feeding tube that’s inserted while attached to an ultra-thin gastroscope will avoid the potentially disastrous consequences of blind tube placement, researchers report in a December 28th on-line publication in Chest.
"The inadvertent placement of feeding tubes into the lungs kills thousands of patients each year," Dr. Peter Belafsky told Reuters Health by email. This statistic, he said, amounts to "about 1 patient every 3 months in each major medical center in the US.”
He added, “These errors are underreported and nobody wants to acknowledge the mistakes."
Instead of accepting the risks, Dr. Belafsky of the University of California, Davis and his colleagues at the University of California, Davis Medical Center in Sacramento "devised a simple solution by pairing a feeding tube to an ultrathin endoscope."
Then, they tested their so-called Davis feeding tube in 50 patients who required transpyloric enteral feeding. Most (86%) of the tubes were placed transnasally. Sixty-six percent of patients also had endotracheal tubes or tracheotomies.
The feeding tube was secured to a 5.1mm-caliber transnasal gastroscope. Atomized lidocaine and phenylephrine was administered in each nasal cavity, and the device was lubricated with a 2% lidocaine gel and passed through a nostril or the mouth. A 1.8mm biopsy forceps was sometimes placed through the working channel of the scope to make it more rigid and facilitate passage into the small intestine.
Intravenous midazolam and fentanyl were given to the 72% of patients who requested sedation.
The tube was placed successfully in all patients. Post-pyloric success was achieved in all but 2 patients (96%), who had pyloric antrum placement because of pyloric stenosis.
Dr. Belafsky pointed out that although other endoscopic approaches to feeding tube placement have been studied, "We had a transpyloric success rate of 96% which is better than previously reported techniques."
"With this technology, confirmatory x-rays are no longer required, which will reduce unnecessary cost and patient radiation exposure," he said. The paper points out, however, that for purposes of the study, confirmatory x-rays were obtained for each patient.
Also, Dr. Belafsky said, "because the feeding tube can also be placed directly into the small bowel under direct vision, patient starvation times can be reduced as well as the risk of aspiration from regurgitated stomach contents and the associated risk of pneumonia."
Chest 2009.
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