Endoscopic nasoenteral feeding tubes introduced using a clip-assisted technique were better placed and less commonly subject to spontaneous migration than standard placement in a recent study.
In a single-center, randomized controlled trial, 143 patients received either clip-assisted (n=71) or standard placement (n=72) of an endoscopic nasoenteral feeding tube at a tertiary referral center in the Netherlands between August 2009 and February 2011. Clip-assisted tubes were introduced into patients via a suture at the tip, picked up with an endoclip in the stomach and attached to the duodenal wall.
Repeat endoscopies were necessary in four patients in the clip-assisted group, compared with 19 in the standard group (RR reduction=0.79; 95% CI, 0.40-0.92). The majority of these endoscopies were performed because of incorrect placement of the initial tube, including three clip-assisted patients and 16 standard-placement patients (RR reduction=0.81; 95% CI, 0.38-0.94). One patient in the clip-assisted group and three in the standard tube group experienced clinically relevant spontaneous retrograde tube migration.
Serious adverse events related to endoscopy occurred in four patients in the clip-assisted group after placement, compared with one in the standard group, but this difference was not substantial (P=.21). Three events resulted from manually removed clip-assisted tubes. Other serious adverse events included upper GI bleeding in one patient who developed a lesion at the endoclip site, and two cases in which the clip-assisted tube became lodged in the nose during removal, requiring endoscopy to free the clip from the tube.
“Although the clip-assisted technique with the currently used endoclips is more expensive, we recommend clip-assisted feeding tube placement instead of transnasal endoscopic tube placement, as this reduces the endoscopic workload and makes fluoroscopic confirmation of the location of the feeding tube redundant,” the researchers wrote.
Disclosure: Researcher Peter D. Siersema, MD, PhD, serves as an advisor for Boston Scientific, which provided the endoclips used in the study.