Cardona Eva, Mehta Shameer
GI Services Division, University College London Hospital, London, UK.
GI Services Division, University College London Hospital, London, UK.
Nutrition. 2021 Jun;86:111195. doi: 10.1016/j.nut.2021.111195. Epub 2021 Feb 11.
Postpyloric enteral feeding tubes (PPTs) are often placed endoscopically. This carries cost and capacity implications for hospitals with additional strain on endoscopy units during the SARS-CoV-2 pandemic. The Kangaroo Feeding Tube with IRIS Technology (IRIS) uses optical visualization to guide bedside placement, obviating the need for endoscopy. We describe a case series of bedside postpyloric enteral feeding tube placement using the IRIS tube.
This was a prospective, single-center case series over 12 mo. Conscious and sedated adult participants were included. Exclusion criteria were altered anatomy and need for endoscopy for other indications. IRIS placement was confirmed by contrast radiograph.
Twenty attempts were made in 19 participants (13 women). The primary indication was intolerance of gastric feeding. The overall success rate was 75%. In sedated participants, 5 (83%) of 6 tubes were successful in 5 participants. In conscious participants, 10 (71%) of 14 tubes were successful in 14 participants. Placement failure in conscious participants was due to intolerance of the camera tip during nasal passage. The median procedure time was 13.5 min. In all cases, correct position as deemed by the operator was confirmed with contrast radiograph. No complications were observed.
To our knowledge, this is the largest single series of bedside postpyloric enteral feeding tube placement using the IRIS tube to date. The success rate and safety profile reported here, together with the potential benefits (reduced feeding delays, costs, and need for endoscopy) suggest that further, large-scale studies are warranted.
幽门后肠内喂养管（PPTs）通常通过内镜放置。这给医院带来了成本和容量方面的影响，在新冠疫情期间还会给内镜科室带来额外压力。带有IRIS技术的袋鼠喂养管（IRIS）利用光学可视化来指导床边放置，无需内镜检查。我们描述了一系列使用IRIS管进行床边幽门后肠内喂养管放置的病例。
这是一项为期12个月的前瞻性单中心病例系列研究。纳入有意识和接受镇静的成年参与者。排除标准为解剖结构改变以及因其他指征需要进行内镜检查。通过造影X线片确认IRIS管的放置。
对19名参与者（13名女性）进行了20次尝试。主要指征是不耐受胃内喂养。总体成功率为75%。在接受镇静的参与者中，6根管子中有5根（83%）在5名参与者中放置成功。在有意识的参与者中，14根管子中有10根（71%）在14名参与者中放置成功。有意识参与者放置失败是由于鼻道插入摄像头尖端时不耐受。中位操作时间为13.5分钟。在所有病例中，经造影X线片确认操作者认为的正确位置。未观察到并发症。
据我们所知，这是迄今为止最大的一系列使用IRIS管进行床边幽门后肠内喂养管放置的单组病例。此处报告的成功率和安全性，以及潜在益处（减少喂养延迟、成本和内镜检查需求）表明有必要进行进一步的大规模研究。
