Post written by Nonthalee Pausawasdi, MD, from the Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.

This article focuses on practical tips for successful endoscopic-guided nasojejunal tube placement, a valuable technique for patients requiring postpyloric enteral nutrition. Although a common clinical procedure, nasojejunal tube placement can be technically challenging, particularly in patients with gastric outlet obstruction or distorted anatomy.

My goal was to help endoscopists better understand procedural nuances to optimize both success rates and patient safety. Inadequate preparation, inappropriate tube selection, or suboptimal technique often lead to adverse events, failed placement, or tube migration. Therefore, the article provides a step-by-step guide emphasizing key elements such as patient selection, scope choice, sedation, and troubleshooting.

This article highlights that endoscopic placement with fluoroscopic guidance remains the most precise and safe method, especially in those with gut obstruction. However, endoscopic placement alone without fluoroscopy can be performed in cases without obstruction. The guidewire-assisted approach ensures optimal jejunal positioning, and the freehand technique offers a practical alternative when fluoroscopy is unavailable. We also discuss common pitfalls and how to overcome them, supported by illustrative figures and video demonstration.

By combining practical experience with clear visual guidance, this article helps endoscopists refine their technique and improve patient outcomes. Looking ahead, new technologies—such as image-guided and smart feeding tubes—could make the procedure even safer and more efficient. We hope this guide serves as a useful reference for clinicians and trainees aiming to deliver better, safer nutrition care.

A, A nasojejunal tube features a weighted tip. B, A triple-lumen nasojejunal tube consists of a gastric port, jejunal port, and ventilation lumen to regulate pressure during suction.

Read the full article online.

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