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EM-guided Nasoenteral Feeding Tube Placement Comparably Safe, Effective
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Bedside electromagnet-guided placement of nasoenteral feeding tubes demonstrated similar safety and efficacy compared with endoscopic and fluoroscopic placement, according to recent study data.
Researchers from the Netherlands performed a systematic review of relevant literature published from 2006 to January 2014 to compare the safety and efficacy of bedside electromagnet (EM)-guided, endoscopic and fluoroscopic nasoenteral feeding tube placement in adults. The final analysis included 28 studies involving 4,056 patients who underwent at least one EM-guided (n = 2,921), endoscopic (n = 730) and/or fluoroscopic (n = 405) nasoenteral feeding tube placements.
Tube placement was successful in 85% of patients who received EM-guided placement, 89% of those who received endoscopic placement and 93% of those who received fluoroscopic placement, and reinsertion rates were 21%, 16% and 26%, respectively. EM guidance had the shortest procedure time (mean, 13.4 minutes) followed by endoscopy (mean, 14.9 minutes) and then fluoroscopy (mean, 16.2 minutes). Procedure-related adverse events occurred in 0.4% of EM-guided, 4% endoscopic and 3% fluoroscopic procedures, the most frequent of which were epistaxis, intractable retching and sinusitis. Tube-related adverse events occurred in 15% of EM-guided, 21% of fluoroscopic and 30% of endoscopic procedures, the most frequent of which were dislodgement and tube blockage.
"EM-guided nasoenteral feeding tube placement in adult patients appears to be as safe and effective as fluoroscopic or endoscopic placement while offering some distinct advantages,” the researchers concluded. “However, the moderate quality of the available evidence, selection of populations, limited comparison with conventional placement techniques, and a lack of data on patient-related outcomes and cost-effectiveness endorse the importance of [a randomized controlled trial] with an adequate sample size to assess the true effectiveness and benefits, such as patient-reported outcomes and costs, of EM-guided nasoenteral feeding tube placement. Currently, such a multicenter trial is underway in the Netherlands (CORE trial).” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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