Uncommon complication of nasoenteral feeding tube:A case report

BACKGROUND The jejunal nutrition tube has increasingly been used in clinical practice,and the results in frequent complications.CASE SUMMARY We present the case of a 74-year-old male patient who had been admitted to the intensive care unit for aspiration pneumonia and respiratory failure.When confirming the position of the jejunal tube by X-ray,we found that the feeding tube had been placed into the chest.The complications was a disaster,though the misplacement of jejunal feeding tube are uncommon.CONCLUSION We introduced a way of ultrasound-guided jejunum feeding tube placement to avert the disaster,which was convenient and economical.

Endoscopic nasojejunal feeding tube placement in patients with severe hepatopancreatobiliary diseases:a retrospective study of 184 patients

BACKGROUND: Total parenteral nutrition (TPN) has been recognized as the mainstay of nutritional support in patients with severe hepatopancreatobiliary (HPB) diseases for decades. However, recent studies advocate the utilization of endoscopic nasojejunal feeding tube placement (ENFTP), rather than the conventional approach. This study was designed to compare the clinical value of ENFTP and TPN in patients with severe HPB diseases. METHODS: Two groups of patients with severe HPB diseases were analyzed retrospectively. One group of 88 patients received ENFTP, and the other 96 received TPN. Routine blood levels, serum glucose and prealbumin, hepatic and renal function, serum lipid, and calcium were measured at baseline and after 1, 2, and 4 weeks of nutritional support. Also, complication rate, mortality, nutritional support time, mechanical ventilation time, mean length of time in intensive care unit, and duration of hospital stay were analyzed. RESULTS: After 4 weeks of nutritional support, the degree of recovery of red blood cells, prealbumin, and blood glucose was greater in the ENFTP than in the TPN group (P<0.05). Furthermore, the ENFTP group showed a lower incidence of septicemia, multiple organ dysfunction syndrome, peripancreatic infection, biliary infection, and nosocomial infection, in addition to shorter nutritional support time and hospital stay (P<0.05). CONCLUSIONS: ENFTP is much more effective than TPN in assisting patients with severe HPB diseases to recover from anemia, low prealbumin level, and high serum glucose, as well as in decreasing the rates of various infections (pulmonary infection excluded), multiple organ dysfunction syndrome rate, nutrition support time, and length of hospital stay. Therefore, ENFTP is safer and more economical for clinical application.

Placement of a Jejunal Feeding Tube via an Ultrasound-Guided Antral Progressive Water Injection Method

Background： Jejunal feeding tube allows the nutrition of critical care patients more easy and safe. However, its placement remains a challenge. This study aimed to introduce a jejunal feeding tube through an ultrasound-guided antral progressive water injection method and subsequently to examine its efficacy. Methods： Between April 2016 and April 2017, 54 patients hospitalized in the Department of Critical Care Medicine, Peking Union Medical College Hospital, China who needed nutritional support through a jejunal feeding tube were recruited for this study. Patients who applied ultrasound-guided antral progressive water injection method were classified into the experimental group. Patients who applied conventional method were registered as control group. Results： No significant differences were found in age, body mass index, and Acute Physiology and Chronic Health Evaluation score, but a significant difference in operation time was found between the experimental group and the control group. Of the 24 individuals in the control group, 17 displayed clear catheter sound shadows once the tube entered the esophagus. In comparison, of the 30 individuals in the experimental group, all harbored catheter sound shadows through the esophageal gas injection method. Subsequent observation revealed that in the control group （via ultrasonographic observation）, 15 individuals underwent successthl antral tube entry, for a success rate of 63%. In the experimental group （via antral progressive water injection）, 27 individuals underwent successful antral tube entry, for a success rate of 90%. There was a significant difference between the success rates of the two groups （x2 = 5.834, P= 0.022）. Conclusion： The antral progressive water injection method for the placement of a jejunal feeding tube is more effective than the traditional ultrasonic placement method.

Efficacy and safety of placing nasoenteral feeding tube with transnasal ultrathin endoscope in critically ill patients

Background The placement of an enteral feeding tube is the foundation for providing enteral nutrition. But due to the anatomic complexity of the stomach and the duodenum, to a certain degree, there are some technical difficulties in the placement of postpyloric feeding tube, especially in critically ill patients. This study aimed to evaluate the efficacy and safety of placing nasoenteral feeding tube with a transnasal ultrathin endoscope. Methods Totally 49 patients, involving 46 （93.9%） being American Society of Anesthesiologists Physical Status （ASA-PS） grade III （n=3） and grade IV （n=-43）, in whom a nasoenteral feeding tube was placed with a transnasal ultrathin endoscope by using over-the-wire technique. The related clinic information during the procedure including success rate, time required, complications and monitoring results of vital signs was analyzed. Results The tube was placed at or beyond the Treitz＇s ligament in all of the 49 cases and the total tube-placement success rate was 100% including the one-time tube-placement success rate 95.9%. The tube placement was successful in 46 （93.9%） cases by transnasal method and 3 （6.1%） cases by transoral method. In the 47 cases whose one-time tube-placement success was obtained, the average procedure time was （6.2±5.6） minutes. For the 3 patients the endoscope inserted transorally due to the failure of transnasal insertion, the total procedure time was （12.3±2.1） minutes. In the period of nasoenteral tube placement, the average systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR） and average pulse oxygen saturation （SpO2） did not show any significant change. Apart from 3 patients in whom nausea occurred in the procedure and 2 nasal bleeding, no any other acute complications arose. Conclusion The method of placing nasoenteral feeding tube with the transnasal ultrathin endoscope is not only efficient, time-saving, technically simple, and painless to patients, but also safe especially in critically ill patients.

Postoperative complications and weight loss following jejunostomy tube feeding after total gastrectomy for advanced adenocarcinomas

Objective： Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this self- controlled study was to examine the effect of jejunostomy tube feeding （JTF） and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastrectomy for cancer. Methods： All consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy plaeement were included from a prospective single-center database （2003-2014）. Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery. Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastreetomy. Results： Of 113 patients operated in the study period, 65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range （IQR）, 10-55 d]. Jejunostomy-related complieations occurred in 11 （17%） patients, including skin leakage （n=3） and peritoneal leakage （n=2）, luxation （n=3）, occlusion （n=2）, infection （n=l） and torsion （n=l）. In 2 （3%） patients, a reoperation was needed due to jejtmostomy-related complications. The mean preoperative weight of patients was 71.8 kg （100%）, and remained stable during JTF （73.9 kg, 103%, P=0.331）. After JTF was stopped, the mean weight of patients decreased to 64.9 kg （90%） at 12 months after surgery （P〈0.001）. A high preoperative body mass index （BMI） （〉_25 kg/m2） was associated with high postoperative weight loss compared to patients with a low BMI （〈25 kg/m2） （16.3% vs. 8.6%, P=0.016）. Conclusions： JTF can prevent weight loss in the early postoperative phase. However, this is at the prize of possible complications. As weight loss in the long term is not prevented, routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients. Special attention should be paid to patients with a high preoperative BMI, who are at risk of more postoperative weight loss.

Advantages of nasogastric tube feeding during neoadjuvant concurrent chemoradiotherapy for esophageal cancer:A retrospective study

ObjectiveTo compare the effects of oral intake and nasogastric tube(NG)feeding on nutritional status,complications and survival during neoadjuvant chemoradiotherapy for esophageal squamous-cell carcinoma(ESCC)patients.MethodsA total of 61 ESCC cases treated with neoadjuvant chemoradiotherapy from December 2018 to March 2020 were enrolled,including(38 in oral intake group,and 22 in NG feeding group.Disease characteristics and baseline nutritional markers were collected in both groups.Nutritional status,complication and completion rate of chemoradiotherapy in both groups were evaluated.ResultsCompared with the oral intake group,patients in the NG feeding group had a later T stage(P=0.027)and clinical stage(P=0.014).The levels of energy intake(P=0.033),serum prealbumin(P<0.001),albumin(P=0.017)and hemoglobin(P=0.015)before treatment in NG group were significantly lower than those in oral intake group.Furthermore,patient-generated subjective global assessment(PG-SGA)score(P=0.016)and the levels of serum C-reactive protein(P=0.014)of NG feeding group were significantly higher than those of oral intake group.However,at the end of treatment,PG-SGA scores were increased in oral intake group and decreased in NG feeding group.In addition,the NG feeding group had a lower incidence of grade≥2 esophagitis(P=0.037),and higher completion rate of chemotherapy compared with oral intake group(P=0.034).Meanwhile,the proportion of parenteral nutrition(P=0.008)and anti-inflammatory(P=0.022)treatment in NG feeding group was significantly lower than that in oral intake group.Although patients in the NG feeding group had a worse prognosis,there were no statistically significant differences in overall survival(OS)and progression-free survival(PFS)between the two groups(P>0.05).ConclusionsAs a safe and effective enteral nutrition approach to improving nutrition,nasogastric tube feeding could increase treatment completion rate and reduce the incidence of≥grade 2 esophagitis reaction during neoadjuvant chemoradiotherapy.

Gastrointestinal and nutritional care in pediatric neuromuscular disorders

Neuromuscular diseases(NMDs)affect the development and growth of the neuromuscular system in children.The pathology can occur anywhere along the neuromuscular pathway,from the brain to the nerves to the muscle fibers.These diseases have a profound impact on the quality of life not only of children but also of their families.The predominant manifestation in NMDs is hypotonia,which leads to muscle weakness and fatigue,reduced mobility,and decreased physical performance.However,multiple organ systems can be affected,with resulting orthopedic,cardiac,infectious,respiratory,and nutritional problems.Children with NMD present an increased risk for several dietary and feeding difficulties because of their neuromuscular diagnosis,presentation,and severity.These problems include chronic gastrointestinal issues(constipation,dysphagia,gastroesophageal reflux,and diarrhea),dysphagia,malnutrition,and body composition alterations.As a result,compared to the overall pediatric population,infants and children with NMD are more likely to be malnourished,ranging from failure to thrive to overweight or obesity.Disease-specific guidelines vary in level of detail and recommendations for dietary management.Overall,nutritional data available are sparse,with the exception of Duchenne muscular dystrophy,spinal muscular atrophy,and congenital muscular dystrophy.The purpose of this review is to describe the spectrum of nutritional challenges in children with NMD and to summarize the main dietary and gastrointestinal recommendations for each neuromuscular disorder to provide guidance for daily clinical practice.

Laparoscopic Janeway gastrostomy as preferred enteral access in specific patient populations:A systematic review and case series

BACKGROUND Nutrition is one of the fundamental needs of both patient and non-patient populations.General trends promote enteral feeding as a superior route,with the most common enteral access being the percutaneous endoscopic gastrostomy(PEG)as the first-line procedure,with surgical access including Witzel gastrostomy,Stamm Gastrostomy,Janeway gastrostomy(JG)as secondary means.AIM To describe cases and technique of laparoscopic Janeway gastrostomy(LJG)and perform a systematic review of the data.METHODS We successfully performed two LJG procedures,after which we conducted a literature review of all documented cases of LJG from 1991 to 2022.We surveyed these cases to show the efficacy of LJG and provide comparisons to other existing procedures with primary outcomes of operative time,complications,duration of gastrostomy use,and application settings.The data were then extracted and assessed on the basis of the Reference Citation Analysis(https://www.referencecitationanalysis.com/).RESULTS We presented two cases of LJG,detailing the simplicity and benefits of this technique.We subsequently identified 26 articles and 56 cases of LJG and extrapolated the data relating to our outcome measures.We could show the potential of LJG as a viable and preferred option in certain patient populations requiring enteral access,drawing reference to its favorable outcome profile and low complication rate.CONCLUSION The LJG is a simple,reproducible procedure with a favorable complication profile.By its technical ease and benefits relating to the gastric tube formed,we propose this procedure as a viable,favorable enteral access in patients with the need for permanent or palliative gastrostomy,those with neurologic disease,agitation or at high risk of gastrostomy dislodgement,or where PEG may be infeasible.

Nasogastric or nasojejunal feeding in pediatric acute pancreatitis: a randomized controlled trial

Background The aim of this study was to compare nasogastric(NG)feeding with nasojejunal(NJ)feeding when treating pediatric patients with acute pancreatitis(AP)..Methods We performed a single-center,prospective,randomized,active-controlled trial involving 77 pediatric patients with AP from April 2014 to December 2017.The patients were randomized into two groups:the NG tube feeding group(34 patients)and the NJ tube feeding group(33 patients).The primary outcome measures included the enteral nutrition intoler-ance,the length of tube feeding time,the recurrent pain of pancreatitis and complications.Results A total of 62 patients with AP(31 patients for each group)came into the final analysis.No differences were found in baseline characteristics,pediatric AP score and computed tomography severity score between the lwo groups.Three(9.7%)patients in the NG group and one(3.2%)patient in the NJ group developed intolerance(relative risk=3.00,95%confidence interval 0.33-27.29,P=0.612).The tube feeding time and length of hospital stay of the NG group were significantly shorter than those of the NJ group(P=0.016 and 0.027,respectively).No patient died in the trial.No significant differences were found in recurrent pain,complications,nutrition delivery efficacy,and side effects between the two groups.Conclusions NG tube feeding appears to be effective and safe for acute pediatric pancreatitis compared with NJ tube feeding.In addition,high qualifed,large sample sized,randomized controlled trials in pediatric population are needed.