Spontaneous transpyloric migration of a ballooned nasojejunal tube: a randomized controlled trial

Spontaneous transpyloric migration of a simple nasojejunal tube (NJT) can be expected in only one-third of insertions. Guidance of the tube by radiologic or endoscopic maneuvers is usually required. We believed that locating a 5-mL balloon near the tip of an NJT on which natural peristalsis could act would improve the rate of spontaneous transpyloric migration and facilitate small bowel propagation.

Thirty healthy volunteers were randomly assigned to have an inflated or noninflated, ballooned NJT fashioned from a modified 9F Hickman line catheter inserted. The pH of aspirates was measured hourly and the final location of the tube assessed by gastrografin contrast abdominal x-ray (AXR) at the end of 6 hours, at which time the tube was removed.

After 6 hours, spontaneous transpyloric migration occurred in 86.6% of the ballooned and 66.6% of the nonballooned tubes. The final disposition of the ballooned tubes was: stomach, 2 (13.3%); duodenum, 1 (6.7%); and small bowel, 12 (80%). The final disposition of the nonballooned tubes was: stomach, 5 (33%), NS; duodenum, 9 (60%), p < .05; and small bowel, 1 (6.7%), p < .05.

Ballooned NJT have a higher rate of spontaneous transpyloric migration and are significantly more likely to achieve an optimal small bowel location.