Endoscopic findings during placement of postpyloric feeding tubes in intensive care patients: A retrospective observational study

Objective: To investigate the prevalence and clinical significance of upper gastrointestinal (UGI) findings during endoscopic placement of postpyloric feeding tubes in intensive care patients. Design and setting: A retrospective observational case study conducted at the intensive care unit in a single tertiary teaching hospital in New Zealand. Participants: Intensive care patients who underwent postpyloric feeding tube insertion under endoscopic guidance, January 2008 - August 2011. Main outcome measures: Endoscopic findings at tube placement and risk factors for UGI abnormalities. UGI abnormalities were considered to be clinically significant if recommendations for patient management or follow-up endoscopy were made. Results: 19 patients underwent feeding tube placement during the study period and 17 endoscopy reports could be retrieved. UGI abnormalities were diagnosed in 16/17 patients: erosions from nasogastric tube (7), gastritis (4), oesophagitis (2), gastric ulcer (1) and duodenal ulcer (1). Seven patients had clinically significant endoscopic findings that prompted treatment recommendations. Risk factors for UGI abnormalities included previous UGI abnormalities in six patients and antiplatelet treatment in seven patients. In addition, our patient series was characterised by a high median Acute Physiology and Chronic Health Evaluation II score (24.5; interquartile range [IQR], 17.8-28.3) and Sequential Organ Failure Assessment score (9; IQR, 6-12). Conclusion: Endoscopic placement of postpyloric feeding tubes resulted in the identification of a significant number of patients with previously undiagnosed UGI abnormalities.