Short Report Electromagnetic-guided postpyloric tube placement in children: Pilot study of its use as a rescue therapy Bart G.P. Koot a, * , Renée Westerhout a , Marc A. Benninga a , Anne C.E.M. Duflou a, b , Lydia C.M. Singels a, b , Rick R. van Rijn c , Elisabeth M.H. Mathus-Vliegen b a Department of Pediatric Gastroenterology and Nutrition, Academic Medical Center Amsterdam, The Netherlands b Department of Gastroenterology, Academic Medical Center Amsterdam, The Netherlands c Department of Pediatric Radiology, Academic Medical Center Amsterdam, The Netherlands article info Article history: Received 15 September 2010 Accepted 31 January 2011 Keywords: Postpyloric tube feeding Electromagnetic-guided tube placement Rescue therapy Child Pilot study summary Background & aims: Postpyloric feeding is frequently indicated in clinical practice. Postpyloric enteral tube placement can be cumbersome, necessitating use of fluoroscopy and/or endoscopy. Guiding devices have been developed to facilitate bedside tube placement. We aimed to evaluate the feasibility and safety of postpyloric enteral tube placement in children using an electromagnetic-guided system as a rescue strategy in case blind tube insertion failed. Method: In a prospective pilot study in 10 children postpyloric enteral tube placement using an elec- tromagnetic-guided placement was attempted after blind placement failure. Results: Postpyloric enteral tube placement was successful in 6 of the 10 included patients. No adverse events occurred and it was well tolerated. Conclusion: This pilot study suggests that electromagnetic-guided placement as a rescue technique for postpyloric enteral tube placement can prevent the use of fluoroscopy and/or endoscopic placement in a substantial portion of patients. Ó 2011 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. 1. Introduction Postpyloric enteral tube (PET) feeding is frequently used in children who are unable to tolerate gastric feeding. In most practices the standard way of PET placement is without visualization of the path of the tube (‘blind placement’). In case, blind placement fails, radiology-assisted placement is the next step, ultimately followed by endoscopic placement. Radiological and endoscopic placement of PETs are unpleasant for the patient, expensive and needs to be performed by a radiologist or gastroenterologist. Moreover, radio- logical placement involves exposure to a significant dose of ionizing radiation, which induces a cancer risk particularly in children. 1 A decade ago, the first report on the use of an electromagnetic (EM)-guided system for PET placement was published. 2 This path finding system has been evaluated as a primary technique in adult patients in different settings with reported success rates between 78% and 84%. 3,4 Recently, a study in children in an intensive care setting reported a similar success rate of 82%. 5 However, its use as the primary technique for PET placement has drawbacks. A trained operator is required but 24 h availability presents difficulties. In addition, EM-tubes are more expensive than the tubes used for blind insertion. The objective of this prospective pilot study was to eval- uate the feasibility and safety of EM-guided PET placement in ten children as a rescue therapy in cases where blind placement failed. 2. Materials and methods All patients were prospectively included in the Emma Children’s Hospital/AMC, a tertiary pediatric clinic in The Netherlands between May 2009 and April 2010. Inclusion criteria failed blind PET placement age 0e18 years and weight above 3.0 kg. Children with a known or later diagnosed upper gastrointestinal stenosis, abnormal anatomy after surgery or an implanted automatic defi- brillator were excluded. Blind PET placement was tried for at least 30 min by an expe- rienced nurse in fasted patients placed in right lateral position and using infusion of cold water to pass the pylorus. No prokinetic drugs were used. Abbrevations: PET, postpyloric enteral tube; EM, electromagnetic. * Corresponding author. Academic Medical Center, Room H7-250, Department of Pediatrics, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. Tel.: þ31 205663053; fax: þ31 206917735. E-mail address: b.g.koot@amc.nl (B.G.P. Koot). Contents lists available at ScienceDirect e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism journal homepage: http://www.elsevier.com/locate/clnu 1751-4991/$36.00 Ó 2011 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.eclnm.2011.01.011 e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism 6 (2011) e74ee76