Optimizing Endoscopic Transpyloric Feeding Tube Placement in Low Birth Weight Infants: Practical Insights from...

Background and Objectives: Transpyloric (TP) feeding tube placement is a viable nutritional strategy in low birth weight infants (LBWIs) with severe gastroesophageal reflux or feeding intolerance. However, technical challenges are encountered in patients of this age group due to their small body size and the limited availability of appropriately sized equipment. Materials and Methods: We retrospectively reviewed 15 endoscopic TP tube placements performed in 12 LBWIs weighing less than 2.5 kg between May 2017 and March 2025. Emphasis was placed on procedural techniques, equipment selection, and troubleshooting strategies for successful bedside execution. Results: All procedures were performed without the use of additional accessories, by advancing a feeding tube preloaded with a guidewire under direct visualization provided by a 5.5 mm outer diameter endoscope. All procedures were technically successful, including 14 performed at the bedside using a portable endoscope. A 6 or 8 Fr feeding tube loaded with a soft-tipped guidewire was advanced through the pylorus under direct endoscopic visualization. The average body weight at the time of the procedure was 1950 ± 296 g. No complications such as mucosal injury, perforation, or tube dislodgement occurred during the procedure. The average enteral feeding volume increased from 33.4 ± 52.8 cc/kg to 92.0 ± 44.4 cc/kg within 7 days. Full enteral nutrition was achieved in all surviving patients within three weeks. The feeding tube remained in place for a mean duration of 26.1 ± 19.2 days. Conclusions: Endoscopic TP tube placement in LBWIs can be safely and reliably performed at the bedside with appropriate technical modifications. It facilitates earlier advancement to full enteral nutrition and may serve as a viable option for LBWIs unresponsive to standard feeding methods.