The early initiation of enteral nutrition is considered to be standard care in patients
with severe acute pancreatitis. Enteral nutrition was always delivered through a nasojejunal
tube that had been placed endoscopically or radiographically [1]. However, variable success rates have been reported for different techniques for
placing nasojejunal tubes [2]
[3]
[4]. Without any direct or indirect visualization, it is difficult to know when the
nasojejunal tube has traversed the pylorus. We here describe a simple way of placing
a nasojejunal tube in a patient with acute biliary pancreatitis, who had undergone
an endoscopic retrograde cholangiopancreatography and a nasobiliary drainage procedure
1 week previously.
A silk ring was tied through the tip of the nasojejunal tube (Flocare Bengmark Naso-intestinal
Tubes; Nutracia HealthCare S.A., Domdidier, Switzerland). The ring could be released
smoothly by pulling the guide wire in the nasojejunal tube. The nasojejunal tube was
then fixed to the nasobiliary catheter (Leung nasal biliary drainage catheter; Wilson
Cook Medical, Winston-Salem, North Carolina, USA), using the ring, and inserted via
the patient’s nose. When the nasojejunal tube reached the duodenal bulb, the guide
wire in the tube was pulled out for 1 cm, releasing the ring and separating the tube
from the nasobiliary catheter. The nasojejunal tube was pushed alone for 20 cm and
placed successfully in the superior segment of the jejunum (Figure [1]). Fluoroscopy showed that the spiral of the tube was located in the jejunum. (Figure
[2]).
Figure 1 a - f The procedure of Li’s method (NBC, nasobiliary catheter; NJT, nasojejunal tube).
Figure 2 Plain abdominal radiography showed that the spiral of the nasojejunal tube was correctly
located.
In conclusion the above method is simple, safe, and highly effective, and can be done
quickly in patients with a nasobiliary catheter.
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