A critical appraisal of indications for endoscopic placement of nasojejunal feeding tubes.

BACKGROUND: Postpyloric feeding is indicated whenever nutritional intake is compromised because of impaired gastric emptying. Although guidelines concerning this feeding modality are available it remains unclear whether these are applied in clinical practice. We therefore evaluated the indications provided by applicants for endoscopic placement of nasojejunal feeding tubes at our centre. METHODS: A prospective study was conducted in patients who were referred for endoscopic nasojejunal-feeding tube placement in a 950-bed Dutch university hospital. State-of-the-art criteria for nasojejunal tube placement comprised severe gastro-oesophageal reflux, gastroparesis leading to aspiration, gastric stasis not responding to prokinetics, gastroduodenal obstruction or proximal enteric fistulae. The study endpoint was met if the feeding tube was no longer needed or had to be replaced, or if the patient was discharged from the hospital or died. RESULTS: During a four-month observation period, 131 patients were enrolled, of whom 57% came from intensive care units. Tube placement only met at least one of the mentioned criteria in the hospital protocol in 59% of all cases, while in intensive care patients a lower proportion was observed (50%, p.