Feasibility of Self‐Propelling Nasojejunal Feeding Tube in Patients With Acute Pancreatitis

Joubert, C.; Tiengou, Laurent-Eric; Hourmand-Ollivier, Isabelle; Dao, Manh-Thong; Piquet, Marie-Astrid

doi:10.1177/0148607108322396

Cited by 10 publications

(14 citation statements)

References 9 publications

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“…According to our calculations, the cost associated with our protocol is 16.2% lower than the cost in the study by Joubert et al 32 study (same tube model with different insertion protocol, accruing 61% of success), 27.9% lower than the cost in the study by Piciucchi et al 33 study (10‐Fr weighted tube, accruing 40% of migration success), and 53.9% lower than the cost of using PN for all patients. The latter percentage is consistent with the range of saving rate computed for Louie et al 57 (47.3%) and Gupta et al 60 (81.5%).…”

Section: Discussionmentioning

confidence: 61%

“…A prokinetic drug is often administered to facilitate the passage of an NJT through the pylorus. The most commonly used is metoclopramide, and in some studies, 31 – 33 it was used with variable dosage. However, a Cochrane review 39 found no clear benefit from metoclopramide and advises against using it for this purpose.…”

Section: Discussionmentioning

confidence: 99%

“…To isolate and illustrate the effect on cost‐effectiveness of implementing a placement procedure that allows for a migration success rate of 82.1%, we calculated the theoretical costs in our hospital of attaining the success rates that previously have been described in the literature. One of those studies 32 used the same tube model, applying an endoscopic procedure whenever the tube did not migrate; if this also failed, the patient received PN. The other study 33 used a weighted NJT, feeding the patient via a parenteral route whenever the tube did not migrate.…”

Section: Methodsmentioning

confidence: 99%

“…It also contains a comparison with the theoretical costs that would be incurred in our hospital if we were to use PN in all patients or if our migration success rates were lower and identical to those of 2 previously published studies (Figure 4B–D). In one of these studies, 32 the type of tube was identical to the one used in the present study, whereas in the second study, 33 a weighted tube was used. In this theoretical cost model, to isolate the effect of improving migration success rates, the average cost of providing nutrition treatment to patients with migration success and migration failure respectively is assumed to be fixed and equal to the costs in our hospital.…”

Section: Methodsmentioning

confidence: 99%

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Experience in Bedside Placement, Clinical Validity, and Cost‐Efficacy of a Self‐Propelled Nasojejunal Feeding Tube

et al. 2015

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Background: The procedures needed to insert nasojejunal tubes (NJTs) are often invasive or uncomfortable for the patient and require hospital resources. The objectives of this study were to describe our experience in inserting a self-propelling NJT with distal pigtail end and evaluate clinical validity and cost efficacy of this enteral nutrition (EN) approach compared with parenteral nutrition (PN). Materials and Methods: Prospective study from July 2009 to December 2010, including hospitalized noncritical patients who required short-term jejunal EN. The tubes were inserted at bedside, using intravenous erythromycin as a prokinetic drug. Positioning was considered correct when the distal end was beyond the ligament of Treitz. Migration failure was considered when the tube was not positioned into the jejunum within 48 hours postinsertion. Results: Fifty-six insertions were recorded in 47 patients, most frequently in severe acute pancreatitis (69.6%). The migration rates at 18 and 48 hours postinsertion were 73.2% and 82.1%, respectively. There was migration failure in 8.9% of cases, and 8.9% were classified null (the tube was no longer in the gastrointestinal tract at 18 hours). There were no reported or observed complications. The mean duration of the EN was 12 ± 10.8 days. Five different types of EN formula were used. The total study cost was 53.9% lower compared with using PN in all patients. Conclusions: Our study demonstrated that bedside insertion of a self-propelling NJT is a safe, cost-effective, and successful technique for postpyloric enteral feeding in at least 73% of the patients, and only 18% of patients could eventually need other placement techniques. It can avoid the need for more aggressive or expensive placement techniques or even PN if we cannot achieve enteral access.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Experience in Bedside Placement, Clinical Validity, and Cost‐Efficacy of a Self‐Propelled Nasojejunal Feeding Tube

et al. 2015

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“…As a specific antagonist of D 2 (dopamine) receptors, metoclopramide was frequently introduced in the procedure of post-pyloric placement in recent studies [17–21]. Given that the effect of metoclopramide has been established in post-pyloric placement of NETs in a previous study, we deemed that patients enrolled should not be left untreated according to ethical principles.…”

Section: Discussionmentioning

confidence: 99%

Erythromycin versus metoclopramide for post-pyloric spiral nasoenteric tube placement: a randomized non-inferiority trial

Ouyang

Lei

et al. 2018

Intensive Care Med

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PurposeTo determine whether erythromycin is non-inferior to metoclopramide in facilitating post-pyloric placement of self-propelled spiral nasoenteric tubes (NETs) in critically ill patients.MethodsA prospective, multicenter, open-label, parallel, and non-inferiority randomized controlled trial was conducted comparing erythromycin with metoclopramide in facilitating post-pyloric placement of spiral NETs in critically ill patients admitted to intensive care units (ICUs) of eight tertiary hospitals in China. The primary outcome was procedure success defined as post-pyloric placement (spiral NETs reached the first portion of the duodenum or beyond confirmed by abdominal radiography 24 h after tube insertion).ResultsA total of 5688 patients were admitted to the ICUs. Of these, in 355 patients there was a plan to insert a nasoenteric feeding tube, of whom 332 were randomized, with 167 patients assigned to the erythromycin group and 165 patients assigned to the metoclopramide group. The success rate of post-pyloric placement was 57.5% (96/167) in the erythromycin group, as compared with 50.3% (83/165) in the metoclopramide group (a difference of 7.2%, 95% CI − 3.5% to 17.9%), in the intention-to-treat analysis, not including the prespecified margin of − 10% for non-inferiority. The success rates of post-D1 (reaching the second portion of the duodenum or beyond), post-D2 (reaching the third portion of the duodenum or beyond), post-D3 (reaching the fourth portion of the duodenum or beyond), and proximal jejunum placement and the incidence of any adverse events were not significantly different between the groups.ConclusionsErythromycin is non-inferior to metoclopramide in facilitating post-pyloric placement of spiral NETs in critically ill patients. The success rates of post-D1, post-D2, post-D3, and proximal jejunum placement were not significantly different.

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Nutrition and the Pancreas

2015

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Feasibility of Self‐Propelling Nasojejunal Feeding Tube in Patients With Acute Pancreatitis

Abstract: Use of a self-propelling nasojejunal tube is a simple technique that can be successfully performed in the majority of patients with acute pancreatitis. The utility of this procedure in the most severe cases of acute pancreatitis continues to pose a challenge.

Cited by 10 publications

References 9 publications

Experience in Bedside Placement, Clinical Validity, and Cost‐Efficacy of a Self‐Propelled Nasojejunal Feeding Tube

Experience in Bedside Placement, Clinical Validity, and Cost‐Efficacy of a Self‐Propelled Nasojejunal Feeding Tube

Erythromycin versus metoclopramide for post-pyloric spiral nasoenteric tube placement: a randomized non-inferiority trial

Nutrition and the Pancreas

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