Enteral nutritional support is economical, simple, safe, and
effective, and is an essential component of the treatment of patients with
severe diseases [1]. The most common method of enteral
nutrition is through nasojejunal tube placement [2]
[3]. There are several methods of nasojejunal feeding tube
placement (NFTP) [4], with endoscopic placement currently
the most common because it is effective, quick, and comparatively successful
[5].
To avoid a second endoscopy for NFTP in patients undergoing
endoscopic nasobiliary drainage (ENBD), we studied an improved NFTP method. For
patients undergoing ENBD, we placed a nasojejunal feeding tube (NFT) as
follows. After a line of silk suture was placed around the NFT guide wire ([Fig. 1 a]), the guide wire was inserted into
the top of the NFT ([Fig. 1 b]) to connect
the nasobiliary tube and NFT loosely using a loop of the line ([Fig. 1 c, d]). The NFT was inserted
into the duodenum along the nasobiliary tube. After the guide wire was removed,
the loop was retained at the nasobiliary tube, thereby removing the connection
between the NFT and nasobiliary tube ([Fig. 1 e]). The NFT was partially inserted
again; if bile could not be extracted from the NFT and a small amount of saline
could be injected without resistance, the NFT was fixed. If necessary, the
location of the NFT could be confirmed by radiographic imaging ([Fig. 2]).
Fig. 1 The steps in the
placement of the nasojejunal feeding tube (NFT). a The
line is placed around the NFT guide wire. b The guide
wire is inserted into the top of the NFT. c The line
surrounds the nasobiliary tube and NFT guide wire. d The
nasobiliary tube and NFT guide wire are fixed together by looping the line.
e The guide wire retaining the line surrounding the
nasobiliary tube is removed to lose the connection with the NFT.
Fig. 2 Visualization by
radiograph of the location of the nasojejunal feeding tube (NFT) and
nasobiliary tube.
Improved NFTP can be applied to ENBD patients who are unable or
unwilling to take food by mouth, especially those with severe pancreatitis due
to bile duct disease who require long-term fasting, or patients with
postoperative bile leakage or common biliary duct stones, and cardiac
dysfunction patients who refuse food. For patients with ENBD, the improved
method is a safer, easier, more effective and practical method of enteral
nutrition than the endoscopic method, and deserves general adoption in clinical
work.
Acknowledgement
We thank Medjaden Bioscience Limited for assisting in the
preparation of this manuscript.
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