A randomised clinical trial of transnasal endoscopy versus fluoroscopy for the placement of nasojejunal feeding tubes in patients with severe acute pancreatitis

Objectives: To compare transnasal endoscopy with fluoroscopy for the placement of nasojejunal feeding tubes (NJTs) in patients with severe acute pancreatitis. Methods: 100 patients were randomised to receive NJTs by transnasal endoscopy or fluoroscopy. Successful placement was confirmed by abdominal radiograph. Results: The success rate was 96% using transnasal endoscopy and 94% using fluoroscopy (p>0.05). The mean (SEM) time to perform a successful procedure was 12.7 (5.1) min for transnasal endoscopy and 7.9 (5.9) min for fluoroscopy (p<0.05). No complications were reported using fluoroscopy, whereas there was one case of tachypnoea and four cases of abdominal distension related to transnasal endoscopy (p<0.05). For transnasal endoscopy, the mean ( SEM) visual analogue scale comfort score was 3.2 (1.3) before, 8.7 (1.5) during, and 3.6 (1.3) after a successful procedure. The corresponding values for fluoroscopy were 3.1 (1.2), 5.4 (1.6) and 3.7 (1.4). The difference in scores during the procedure was significant (p<0.05). Conclusions: Transnasal endoscopic and fluoroscopic placement of NJTs can safely and accurately be performed in patients with severe acute pancreatitis. The results of this study show no significant difference in success and complication rates between the two procedures. However, the procedure time for fluoroscopic placement was shorter than for transnasal endoscopic placement, and patients experienced less discomfort.