Simplify the technique of nasoenteric feeding tube placement with a modified suture tie

Endoscopic placement of nasoenteric feeding tubes is a common technique used in clinical practice. However, use of the endoscopic "drag and pull" method to pull the tube into position by grasping the feeding tube with a biopsy forceps requires considerable skill. In this paper, we describe a modified suture, which markedly diminishes the technical difficulty for nasoenteric feeding tube placement. Patients admitted to the intensive care unit, with evidence of impaired gastric emptying, referred for placement of a nasoenteric tube, were included in this study. A modification of the feeding tube was made by securing two strands of nylon suture to the tip of a 12-Fr feeding tube. Three knots were made along the sutures on both sides. The feeding tube was introduced through the nose and passed into the stomach. Then, placement of the nasoenteric tube was attempted by an endoscopic "drag and pull" method. Eighty-six patients (49% male, mean age of 60 years) underwent 94 procedures for attempted nasoenteric feeding tube placement. Feeding tubes were placed successfully in 91 of 94 (97%) procedures in these patients. The procedures required an average time of range 5 to 14 minutes, and no major complications were incurred. These results indicate that a modified suture tied to the tip of a nasoenteric feeding tube reduces the technical difficulty of the procedure and facilitates rapid successful placement into the small bowel.