Post written by Justin Ryan L. Tan, MD, from Chinese General Hospital and Medical Center, Manila, Philippines.

Gastric outlet obstruction (GOO) is an incapacitating condition in which the patient becomes malnourished while constantly being at risk of aspiration. A dual lumen nasojejunal tube allows simultaneous postpyloric feeding and drainage of the obstructed proximal segment.

The paucity and cost of commercially available dual and triple lumen feeding tubes motivated our team to develop a similar device using readily available materials. This video demonstrates a step-by-step procedure for creating an improvised dual lumen nasojejunal feeding tube and its successful use in 2 patients with GOO.

The first case was a 55-year-old woman with GOO secondary to large B-cell lymphoma who had recurrent vomiting. The improvised nasojejunal tube was inserted to provide nutrition and decompression during the duration of her chemotherapy. The obstruction resolved completely after chemotherapy, and the patient no longer required surgical intervention.

The second case was a 56-year-old man who underwent biliary bypass surgery for pancreatic malignancy. The bypass site was edematous, causing vomiting and prolonged use of total parenteral nutrition. The tube was again inserted, and the patient was able to feed via the improvised tube.

This novel device can be useful in patients who are under palliative care and those who need nutritional build-up before surgery. The length of the tube also can be modified based on the site of the obstruction, anatomical variation, or length of the stomach.

Unintentional tube dislodgement and feeding tube blockage are some limitations. Hence, regular flushing of the feeding tube is done to prevent blockage.  

Patient 1 with diffuse large B-cell lymphoma: improvised dual lumen nasal jejunal tube inserted up to the first portion of the jejunum, while the gastric decompression tube was inserted up to the pylorus.

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