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At least 703 records · Page 39Linked to original sources
PubMedDate not supplied

Transnasal endoscopic placement of feeding tubes in the intensive care unit.

BACKGROUND: There is an increasing demand for enteral feeding in intensive care unit (ICU) patients. However, gastroparesis is common, and jejunal placement with gastric decompression leads to delays in feeding. In an attempt to minimize delays, we describe our technique and results with transnasal endoscopic placement of double-lumen gastric aspiration, jejunal feeding tubes (DLFT). METHODS: Fifty-one consecutive ICU patients referred for nutrition support were studied; 29% had respiratory failure, 28% acute head injury, and 33% acute pancreatitis. A 5.8-mm ultraslim video endoscope was used to place a guidewire through the nose terminating beyond the Ligament of Treitz. After withdrawal of the endoscope, a DLFT was passed over the wire. Final position of the tube was checked and adjusted under direct vision by reendoscopy though the opposite nasal passage. RESULTS: Initial placement of the guidewire and DLFT was successful in 46 of 51 patients. Massive gastric dilatation and acute pancreatitis complicated by duodenal compression impeded full duodenoscopy in 5 patients, necessitating fluoroscopy for correct guidewire deployment. In confirming correct tube placement, there was near perfect concordance between reendoscopy and x-ray (45/46). Previously unrecognized upper gastrointestinal tract pathology was detected in most patients, with acute gastritis in 47, superficial gastric ulceration in 24, and erosive esophagitis in 5. CONCLUSIONS: Transnasal endoscopic placement of feeding tubes in the ICU is quick, effective, and minimally disruptive of intensive therapy. In addition, it can reveal unrecognized pathology, which potentially could lead to improvements in overall medical care.

Acute Disease↗
PubMed2001

Nasogastric tube insertion using flexible fibreoptic nasoendoscope.

The insertion of a nasogastric tube, especially a fine bore feeding tube, can occasionally be problematic because of an anatomical variation or pathology. A method of passing an nasogastric tube under direct vision using a flexible fibreoptic nasoendoscope introduced through the nostril is described, which is reserved for cases where traditional methods of insertion failed.

Endoscopes, Gastrointestinal↗
PubMed2004

Enteral administration of naloxone for treatment of opioid-associated intragastric feeding intolerance.

Intragastric enteral feeding intolerance, common in the intensive care setting, is attributed to many causes. Opioid antagonists such as naloxone may have a role in reversing the intolerance when it is associated with intravenous opioid infusions. A 38-year-old woman hospitalized for acute respiratory distress syndrome was supported with low tidal volume mechanical ventilation. She required lorazepam and morphine administered by continuous intravenous infusion to achieve ventilator synchrony and pain control. While receiving these therapies, the patient developed persistent intolerance to intragastric feeding. Intravenous metoclopramide and laxatives did not decrease gastric volume residuals, and insertion of a jejunal tube was deemed unsafe due to worsening of her respiratory status. Total parenteral nutrition was begun to meet her caloric needs, but she experienced repeated catheter-related bloodstream infections. Naloxone 2 mg by gastric tube every 8 hours for 8 days was started; the dosage then was increased to 4 mg every 8 hours. Tube feeding was restarted, which provided the patient with more than 90% of her daily caloric needs and allowed for discontinuation of parenteral nutrition. With this dosage of naloxone, tolerance to intragastric feeding was maintained until the patient's death due to refractory respiratory failure. Enterally administered naloxone is an effective, noninvasive means of reversing intolerance to intragastric feeding associated with opioids.

Adult↗
PubMed1983

Pseudo-obstruction of the colon. A postoperative complication in orthopaedic patients.

Pseudo-obstruction of the colon is a problem of bowel motility that predominantly involves the large intestine and that can mimic the clinical and radiographic features of mechanical obstruction of the colon. It must not be confused with the much more common and less dangerous complication of post-operative ileus. Although it is most often seen in elderly patients who are confined to bed, it can occur in younger patients. Cecal dilation can develop rapidly to dangerous proportions, and recognition by thorough physical examination and early abdominal radiographs is essential if operative intervention is to be avoided. Nasogastric suction, intravenous fluids, and frequent turning of the patient are often successful if begun early, but are unlikely to be of benefit once cecal dilation approaches fourteen centimeters on plain radiographs. In these advanced cases, tube cecostomy or colostomy may be the only way to avoid necrosis of the bowel wall, perforation, and sepsis.

Adult↗
PubMedDate not supplied

Comparison of complications of percutaneous endoscopic versus surgically placed gastrostomy tubes in 42 dogs and 52 cats.

Dogs and cats that had a percutaneous endoscopic gastrostomy (PEG) tube or surgically placed gastrostomy (SPG) tube inserted were retrospectively analyzed to compare complication rates and the severity of complications. Complication rates and severity scores were not significantly different when the PEG tube group was compared to the SPG tube group in either dogs or cats. Only when data from dogs and cats were combined did PEG tubes have a significantly higher complication rate and significantly greater complication severity scores.

Animals↗
PubMed1999

[Long nasojejunal feeding tube: endoscopic method for placing and its use for enteral nutrition in acute pancreatitis].

BACKGROUND: Enteral nutrition can be useful for the feeding of patients with acute pancreatitis, specially in the later phases of the disease. AIM: To describe an endoscopic placement method for long nasojejunal tubes and assess its efficacy. To communicate a preliminary experience with enteral nutrition in patients with acute pancreatitis. PATIENTS AND METHODS: An endoscopic placement method for nasojejunal tubes is described. In 24 patients with acute pancreatitis, 28 tubes were placed using this method, after the second week of evolution. In 15 patients with brain damage, traditional nasojejunal feeding tubes were placed without endoscopy. The position of both types of tubes was determined by fluoroscopy with the aid of contrast media. RESULTS: The endoscopic placement method was simple and the tube was placed beyond the ligament of Treitz in all patients. No traditional tube was placed in the jejunum and contrast media filled the duodenum in all cases. In patients with acute pancreatitis, enteral nutrition was well tolerated, 5 patients had a higher stool frequency and one, had an asymptomatic increase in serum amilase levels. CONCLUSIONS: Long nasojejunal tubes can be easily placed beyond the ligament of Treitz with endoscopic aid and can be used for enteral feeding in patients with acute pancreatitis.

Acute Disease↗
PubMed1999

The herbal medicine Dai-Kenchu-Tou stimulates upper gut motility through cholinergic and 5-hydroxytryptamine 3 receptors in conscious dogs.

BACKGROUND: The herbal medicine Dai-Kenchu-To, composed of zanthoxylum fruit, ginseng root, and dried ginger rhizome, is clinically effective for uncomplicated postoperative adhesive intestinal obstruction. We investigated the effect of Dai-Kenchu-To and each ingredient on upper gastrointestinal motility and its mechanism of action. METHODS: Five mongrel dogs were equipped with 4-strain gauge-force transducers on the gastric body, antrum, duodenum, and jejunum to measure contractile activity of the circular muscle. Dai-Kenchu-To (1.5 g) or the separate ingredients zanthoxylum fruit, ginseng root, or dried ginger rhizome (1.0 g each) were administered by bolus into the gastric lumen. The effect of atropine, hexamethonium, phentolamine, propranolol, and ondansetron on intragastric Dai-Kenchu-To-induced contractions was studied. RESULTS: Intragastric Dai-Kenchu-To induced phasic contractions in the antrum, duodenum, and jejunum. Zanthoxylum fruit elicited phasic contractions mainly in the duodenum and jejunum, whereas dried ginger rhizome induced phasic contractions in the antrum. Ginseng root had no effect. Phasic contractions induced by intragastric Dai-Kenchu-To were inhibited by atropine and hexamethonium at all sites, although ondansetron inhibited these contractions in the antrum and duodenum. CONCLUSIONS: Intragastric Dai-Kenchu-To stimulates upper gastrointestinal motility through cholinergic and 5-hydroxytryptamine 3 receptors.

Animals↗
PubMed1976

Intraperitoneal and intragastric norepinephrine instillation in massive gastrointestinal bleeding--clinical study. Preliminary report.

Intraperitoneal and intragastric instillation of norepinephrine in high concentration can arrest bleeding of various origins in the gastrointestinal tract. Of the 21 cases studied, the hemorrhage was controlled in 80% of cases. This form of therapy is simple, prompt, safe and can be performed as a bed-side therapeutic procedure to stop life-threatening gastrointestinal tract bleeding. Intraperitoneal instillation of norepinephrine should not be used more than once, if the bleeding is not controlled. Intragastric norepinephrine instillations may be repeated any number of times if required.

Adolescent↗
PubMed1976

Manometric studies of the human pylorus.

The human gastroduodenal junction was investigated by means of simultaneous measurements of pressure and potential difference between skin and mucosa. An accurate and circumferentially sensitive miniature transducer assembly failed to reveal a zone of elevated pressure at the gastroduodenal junction of 8 fasting, healthy, young subjects. Additional studies were carried out with a six-lumen perfused catheter system, in which three of the pressure-transmitting catheters had openings arranged circumferentially at the same axial level. Measurements of pressure and potential difference were obtained basally during intraduodenal infusion of hydrochloric acid and after intraduodenal instillation of olive oil. In only 1 of 10 subjects was a tonic elevation in pressure recorded simultaneously by all three leads at the gastroduodenal junction. The normal human pylorus, therefore, is not reliably demonstrable as a high pressure zone.

Adult↗
PubMed1976

Manometric studies on the human pyloric sphincter. Effect of cigarette smoking, metoclopramide, and atropine.

Pyloric sphincter pressure was assessed with water-perfused polyvinyl tubes. Smoking one cigarette significantly decreased the basal pyloric pressure, whereas 10 mg of metoclopramide as an intravenous bolus increased the pyloric pressure in normal subjects and in patients with gastric ulcer with low basal pressure. Duodenal acidification with 0.1 N HCl significantly increased pyloric pressure. Atropine 15 mug per kg, subcutaneously prevented the rise of pyloric pressure in response to acid infusion into the duodenum.

Adult↗