AIM:To assess the rate of spontaneous tube migration and to compare the effects of naso-gastric and nasointestinal(NI)(beyond the ligament of Treitz) feeding in severe acute pancreatitis(SAP).METHODS:After bedside int...AIM:To assess the rate of spontaneous tube migration and to compare the effects of naso-gastric and nasointestinal(NI)(beyond the ligament of Treitz) feeding in severe acute pancreatitis(SAP).METHODS:After bedside intragastric insertion,tube position was assessed,and enteral nutrition(EN) started at day 4,irrespective of tube localization.Patients were monitored daily and clinical and laboratory parameters evaluated to compare the outcome of patients with nasogastric(NG) or NI tube.RESULTS:Spontaneous tube migration to a NI site occurred in 10/25(40%) prospectively enrolled SAP patients,while in 15(60%) nutrition was started with a NG tube.Groups were similar for demographics and pancreatitis aetiology but computed tomography(CT) severity index was higher in NG tube patients than in NI(mean 6.2 vs 4.7,P=0.04).The CT index seemed a risk factor for failed obtainment of spontaneous distal migration.EN trough NG or NI tube were similar in terms of tolerability,safety,clinical goals,complications and hospital stay.CONCLUSION:Spontaneous distal tube migration is successful in 40% of SAP patients,with higher CT severity index predicting intragastric retention;in such cases EN by NG tubes seems to provide a pragmatic alternative opportunity with similar outcomes.展开更多
This paper describes a rare complication of enteral feeding,esophageal obstruction due to feeding formula bezoar,and reviews the published cases. An attempt to re-insert the nasogastric tube in a chronically ventilate...This paper describes a rare complication of enteral feeding,esophageal obstruction due to feeding formula bezoar,and reviews the published cases. An attempt to re-insert the nasogastric tube in a chronically ventilated 80-year-old female fed via a nasogastric tube with Jevity failed. An esophagogastroduodenoscopy revealed an 18 cm-long concretion of the feeding formula,fi-lling most of the esophageal lumen,which was removed endo scopically. Forty-two cases of feeding formula esophageal bezoars have been reported in the literature. The formation of feeding formula bezoars is triggered by acidic gastroesophageal reflux. The acidic pH in the esophagus causes clotting of the casein in the formula. Predisposing factors for bezoar formation are:mechanical ventilation,supine position,neurological diseases,diabetes mellitus,hypothyroidism,obesity and history of partial gastrectomy. Diagnosis and removal of the bezoar is done endoscopically. Feeding in a semi-recumbent position,administration of prokinetic agents and proton pump inhibitors may prevent this complication.展开更多
文摘AIM:To assess the rate of spontaneous tube migration and to compare the effects of naso-gastric and nasointestinal(NI)(beyond the ligament of Treitz) feeding in severe acute pancreatitis(SAP).METHODS:After bedside intragastric insertion,tube position was assessed,and enteral nutrition(EN) started at day 4,irrespective of tube localization.Patients were monitored daily and clinical and laboratory parameters evaluated to compare the outcome of patients with nasogastric(NG) or NI tube.RESULTS:Spontaneous tube migration to a NI site occurred in 10/25(40%) prospectively enrolled SAP patients,while in 15(60%) nutrition was started with a NG tube.Groups were similar for demographics and pancreatitis aetiology but computed tomography(CT) severity index was higher in NG tube patients than in NI(mean 6.2 vs 4.7,P=0.04).The CT index seemed a risk factor for failed obtainment of spontaneous distal migration.EN trough NG or NI tube were similar in terms of tolerability,safety,clinical goals,complications and hospital stay.CONCLUSION:Spontaneous distal tube migration is successful in 40% of SAP patients,with higher CT severity index predicting intragastric retention;in such cases EN by NG tubes seems to provide a pragmatic alternative opportunity with similar outcomes.
文摘This paper describes a rare complication of enteral feeding,esophageal obstruction due to feeding formula bezoar,and reviews the published cases. An attempt to re-insert the nasogastric tube in a chronically ventilated 80-year-old female fed via a nasogastric tube with Jevity failed. An esophagogastroduodenoscopy revealed an 18 cm-long concretion of the feeding formula,fi-lling most of the esophageal lumen,which was removed endo scopically. Forty-two cases of feeding formula esophageal bezoars have been reported in the literature. The formation of feeding formula bezoars is triggered by acidic gastroesophageal reflux. The acidic pH in the esophagus causes clotting of the casein in the formula. Predisposing factors for bezoar formation are:mechanical ventilation,supine position,neurological diseases,diabetes mellitus,hypothyroidism,obesity and history of partial gastrectomy. Diagnosis and removal of the bezoar is done endoscopically. Feeding in a semi-recumbent position,administration of prokinetic agents and proton pump inhibitors may prevent this complication.
