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Approximately 1 million enteral tubes are placed through the nose or mouth in adults and children in the United States annually. Previous studies found gastric tube placement errors to be common. A primary issue in ensuring safe and effective gastric feeding by tube is achieving optimal tube position on insertion. The purpose of this study is to use 24 variables to develop a clinical prediction rule for gastric tube insertion distance in adults, using the internal-nares-to-distal-lower esophageal-sphincter distance. A three-variable model using gender, weight, and nose-umbilicus-flat was selected. This new model, validated using nonparametric bootstrap cross-validation, correctly predicted gastric tube insertion distance 85.3% of the time. This new model is compared to two other methods, one evidence based and one commonly used in practice, and was found to be superior. Two nomograms, one for each gender, are drawn to make this new model easier to use.

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Objectives In adults with unexplained pancreatitis, the yield of complete gene versus select exosome sequencing on mutation detection and distinguishing clinical characteristics associated with mutations requires clarification. We sought to: 1) compare frequency of mutations identified using difference techniques and 2) compare clinical characteristics between adults with and without mutations. Methods Cohort study of adults with unexplained pancreatitis who underwent genetic testing between 1/2008-12/2012. We compare probabilities of having a positive mutation with complete gene sequencing versus alternatives, and describe differences in characteristics among patients with and without mutations. Results Of 370 patients, 67 (18%) had a genetic mutation; 24 (6%) were high-risk. Mutations were significantly more prevalent with use of complete sequencing (42%) versus other approaches (8%, p<0.0001). The majority (44/67, 66%) with a mutation had no family history. Those with high-risk mutations were more likely to have and family history of chronic pancreatitis (21% v. 4%, p=0.002). Patients with pancreas divisum were more likely to have mutations (27% v. 14%, p=0.0007). Conclusion Among individuals with adult-onset pancreatic disease, the probability of finding any mutation, including high-risk, is significantly higher using complete gene sequencing. The impact on patients and providers requires further investigation.