A Study Of Nasojejunal Tube Placement And Outcomes In A Tertiary Nhs Trust

Introduction Nutrition is an often neglected but important aspect of inpatient treatment, with malnutrition associated with poorer immunity, impaired wound healing and longer hospital stays.1 Post-pyloric feeding is considered the optimal mode of delivery of nutrition for patients in whom the only other viable alternative would be parenteral nutrition. Nasojejunal feeding tube (NJT) is a common route of post-pyloric feeding, inserted either endoscopically or radiologically. The main disadvantages of NJTs are difficulties with insertion, blockage or displacement.2 There is a lack of evidence supporting one mode of insertion over the other.3 In this study we compared the outcomes of endoscopic and radiologic NJT insertion at a tertiary NHS Trust with Hepatobiliary and Specialist Upper Gastrointestinal Surgical units. Methods Patients who underwent NJT insertion between January 2018 and October 2019 were identified, excluding patients who underwent the procedure under study protocols or privately. Data was collected on the method of insertion and patient outcomes, including complications and the need for repeat procedures. Results 71 patients were included (53 radiologic vs 18 endoscopic NJT insertions). Indications included gastric outlet obstruction (mainly secondary to malignancy), pancreatitis and gastroparesis. Successful NJT insertion was achieved endoscopically in 100% of patients vs 92% radiologically. The rate of complications (including hypoxia, infection and intolerance) was significantly higher in the endoscopic group vs radiologic (83% vs 49%, p=0.01). Patients who first underwent radiologic NJT insertion were less likely to need a repeat procedure, 32% vs 72% (p Conclusions NJT insertion, either endoscopic or radiologic, presents technical challenges and often requires repeat procedures. Endoscopic placement may be complicated by sedation and endoscopy-specific risks, whilst radiological placement confers radiation exposure to the patient. In our large centre experience, radiological insertion of NJTs resulted in fewer complications post procedure, with patients less likely to require a repeat procedure vs endoscopic insertion. Choice of how to site NJT may depend on access and availability of local resources. To avoid multiple tubes, alternative feeding routes (including surgical jejunostomy or percutaneous endoscopic gastro-jejunostomy) may be considered for prolonged feeding. References Barker, et al. Int J Environ Res Public Health 2011; 8(2): 514–27 Phillips LM, et al. JPEN. Journal of Parenteral and Enteral Nutrition 2005; 29(6): 420–424 Stroud, et al. Gut 2003; 52Suppl 7:vii1-vii12.