ORIGINAL ARTICLE: Clinical Endoscopy Transnasal endoscopy for the placement of nasoenteral feeding tubes: does the working length of the endoscope matter? Stephan M. Wildi, MD, Christoph Gubler, MD, Stephan R. Vavricka, MD, Michael Fried, MD, Peter Bauerfeind, MD Zurich, Switzerland Background: Transnasal endoscopy with a small-caliber endoscope has been shown to be helpful for the place- ment of nasoenteral feeding tubes in patients who are critically ill. Success rates were limited by the short work- ing length of the small-caliber endoscopes. Objective: To compare the success rate of a 133-cm-long, small-caliber, prototype videoendoscope with a stan- dard 92-cm-long, small-caliber, fiberoptic endoscope for the transnasal placement of feeding tubes. Design: Randomized controlled study. Setting: University Hospital of Zurich, Switzerland. Patients: Patients who were critically ill were randomly assigned to transnasal feeding tube placement with the standard 92-cm-long, small-caliber, fiberoptic endoscope, or with a new 133-cm-long, small-caliber, prototype videoendoscope. Patient characteristics, procedure time, technical difficulties, patient tolerance, and radiologic tube position were assessed. Main Outcome Measurements: Success rates of endoscopic placement of enteral feeding tubes. Results: A total of 157 patients were analyzed in 2 groups. The 2 groups were similar with regard to patient characteristics, body length, technical difficulty, and patient tolerance. The 133-cm-long instrument was superior with respect to successful placement of the nasoenteral feeding tube (93.6% vs 74.4%, P Z .0008). Patient tol- erance, procedure times, and overall technical difficulty were the same in both treatment groups, whereas pas- sage through the duodenum was more difficult with the 133-cm-long instrument (P ! .0001). Limitations: In rare cases, the randomization list could not be followed correctly. Conclusions: This study demonstrated that placement of a nasoenteral feeding tube with a 133-cm-long, small- caliber videoendoscope is feasible, safe, and distinctly more successful than with a 92-cm-long, small-caliber stan- dard instrument. (Gastrointest Endosc 2007;66:225-9.) Early enteral nutrition constitutes a major component of the metabolic support for the patient who is critically ill and may improve outcome. 1,2 The use of enteral feed- ing tubes in an intensive care unit (ICU) setting has be- come routine for many reasons, including nutrition, drug administration, and gastric decompression. These patients have many factors that predispose to feeding- tube–related complications, such as altered mental status, decreased ability to cooperate, and minimal ability to report chest discomfort or dyspnea after tube insertion. Therefore, control of feeding-tube position is an impor- tant issue. Because gastric dysmotility is frequent in such patients, gaining postpyloric access is often required. But proper positioning of the feeding tube can be prob- lematic, especially when gastric distention is distinct. Endoscopic placement of nasoenteric feeding tubes with the Seldinger technique was previously described. 3 This generally required an oral-nasal transfer, which was more time consuming than the rest of the procedure. More recently, a transnasal technique by using a small- caliber fiberoptic endoscope was used for placement of nasoenteral feeding tubes. 4-6 These reports demonstrate that transnasal endoscopy allows accurate placement of Copyright ª 2007 by the American Society for Gastrointestinal Endoscopy 0016-5107/$32.00 doi:10.1016/j.gie.2006.12.054 www.giejournal.org Volume 66, No. 2 : 2007 GASTROINTESTINAL ENDOSCOPY 225