New Method
Nasogastric feeding tube placement in patients with esophageal cancer: application of ultrathin transnasal endoscopy

https://doi.org/10.1016/j.gie.2005.12.036Get rights and content

Background

Patients with esophageal cancer often present with dysphagia and malnutrition. Obstructive symptoms may improve after radiotherapy and chemotherapy. Nutrition support via a nasogastric tube (NG) or gastrostomy is very important during treatment. The newly developed ultrathin endoscope (Olympus, GIF-N230, outer diameter: 6 mm) has a smaller diameter than the standard endoscope and can be introduced into the esophagus via the nasal cavity. This article reports on the use of an ultrathin endoscope for NG placement for patients with esophageal cancer who presented with dysphagia and failed traditional NG tube placement.

Methods

A consecutive series of 40 patients with esophageal cancer were referred to our hospital from November 2001 to October 2002 for endoscopic placement of NG tubes due to failure of traditional methods of NG placement. An ultrathin endoscope was used to advance the guidewire into the stomach via the nasal cavity. After withdrawal of the scope, the NG tube was inserted over the guidewire under fluoroscopy.

Observations

A total of 71 procedures were performed in 40 patients (37 males, 3 females), age 57 ± 15 years (range, 37-91 y). Seventy procedures (99%) were successful in completing NG tube placement by using an ultrathin transnasal endoscope. Only one procedure failed because the esophageal lumen was completely occluded and the guidewire was not able to be passed through the obstructed site. The average duration that the NG tube was left in place was 49 ± 35 days (range, 2-144 days). No procedure-related complications, such as bleeding or perforation, occurred.

Conclusions

Using ultrathin transnasal endoscopy to place an NG tube for esophageal cancer patients is effective and safe. It simplifies the procedures and increases the success rate.

Section snippets

Patients

Consecutive patients with esophageal cancer were referred to our hospital from November 2001 to October 2002 for ultrathin-endoscopic–guided NG-tube placement because traditional NG-tube–placement methods failed. NG-tube placement for nutrition was attempted at the bedside but failed because of an inability to pass the tubes beyond the obstructing esophageal lesions. Written informed consent was obtained from each patient. Exclusion criteria included patients with facial and basilar skull

Results

A total of 71 NG feeding tubes were placed in 40 patients (37 men, 3 women; age 57 ± 15 years; range, 37-91 years), including 39 patients with squamous-cell carcinoma of the esophagus and 1 patient with adenocarcinoma. Several of the patients (17/40, 43%) had a middle third lesion (between 27 and 35 cm from the incisors). The tumor was located in the upper third of the esophagus (between upper esophageal sphincter and 27 cm level from the incisors) in 10 cases (10/40, 25%) and the lower third

Discussion

The negative impact of weight loss on morbidity and mortality of patients with cancer is well known. Weight loss may decrease the response to chemotherapy, as well as tolerance to both radiotherapy and chemotherapy.27 Total parenteral nutrition may cause metabolic problems and mechanical and infectious complications related to the insertion of intravenous catheters and keeping them in place. The natural access to the body, the large assortment of tube feedings, and the low frequency of

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