Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Gastrointest Endosc. 2015 Apr;81(4):836-47.e2. doi: 10.1016/j.gie.2014.10.040. Epub 2015 Feb 4.
Nasoenteral tube feeding is frequently required in hospitalized patients to either prevent or treat malnutrition, but data on the optimal strategy of tube placement are lacking.
To compare the efficacy and safety of bedside electromagnetic (EM)-guided, endoscopic, and fluoroscopic placement of nasoenteral feeding tubes in adults.
Systematic review of the literature.
Adult hospitalized patients requiring nasoenteral feeding.
EM-guided, endoscopic, and/or fluoroscopic nasoenteral feeding tube placement.
Success rate of tube placement and procedure- or tube-related adverse events.
Of 354 screened articles, 28 studies were included. Data on 4056 patients undergoing EM-guided (n = 2921), endoscopic (n = 730), and/or fluoroscopic (n = 405) nasoenteral feeding tube placement were extracted. Tube placement was successful in 3202 of 3789 (85%) EM-guided procedures compared with 706 of 793 (89%) endoscopic and 413 of 446 (93%) fluoroscopic procedures. Reinsertion rates were similar for EM-guidance (270 of 1279 [21%] patients) and endoscopy (64 of 394 [16%] patients) or fluoroscopy (10 of 38 [26%] patients). The mean (standard deviation) procedure time was shortest with EM-guided placement (13.4 [12.9] minutes), followed by endoscopy and fluoroscopy (14.9 [8.7] and 16.2 [23.6] minutes, respectively). Procedure-related adverse events were infrequent (0.4%, 4%, and 3%, respectively) and included mainly epistaxis. The tube-related adverse event rate was lowest in the EM-guided group (36 of 242 [15%] patients), followed by fluoroscopy (40 of 191 [21%] patients) and endoscopy (115 of 384 [30%] patients) and included mainly dislodgment and blockage of the tube.
Heterogeneity and limited methodological quality of the included studies.
Bedside EM-guided placement of nasoenteral feeding tubes appears to be as safe and effective as fluoroscopic or endoscopic placement. EM-guided tube placement by nurses may be preferred over more costly procedures performed by endoscopists or radiologists, but randomized studies are lacking.
鼻肠管喂养在住院患者中经常需要，无论是预防还是治疗营养不良，但缺乏关于管放置最佳策略的数据。
比较床旁电磁（EM）引导、内镜和透视引导成人鼻肠喂养管放置的疗效和安全性。
文献系统评价。
需要鼻肠喂养的成年住院患者。
EM 引导、内镜和/或透视鼻肠喂养管放置。
管放置成功率和与操作或管相关的不良事件。
在 354 篇筛选文章中，纳入了 28 项研究。共纳入 4056 例患者，分别行 EM 引导（n=2921）、内镜（n=730）和/或透视（n=405）鼻肠喂养管放置。3789 例 EM 引导操作中，3202 例（85%）管放置成功，793 例内镜操作中 706 例（89%），446 例透视操作中 413 例（93%）。EM 引导（1279 例患者中有 270 例[21%]）和内镜（394 例患者中有 64 例[16%]）或透视（38 例患者中有 10 例[26%]）的再插入率相似。EM 引导的操作时间最短（13.4[12.9]分钟），其次是内镜和透视（分别为 14.9[8.7]和 16.2[23.6]分钟）。与操作相关的不良事件发生率较低（分别为 0.4%、4%和 3%），主要包括鼻出血。EM 引导组的管相关不良事件发生率最低（242 例患者中有 36 例[15%]），其次是透视组（191 例患者中有 40 例[21%]）和内镜组（384 例患者中有 115 例[30%]），主要包括管移位和堵塞。
纳入研究的异质性和方法学质量有限。
床边 EM 引导鼻肠喂养管放置似乎与透视或内镜放置一样安全有效。护士进行 EM 引导置管可能优于由内镜医生或放射科医生进行的成本更高的操作，但缺乏随机研究。
