65 The silk road: a new and simple trick for inserting transpyloric tubes
Mahmoud Kaddah, Naser Al Mefleh, Muhammad Eyad Ba'Ath
Bab Alhawa Hospital, Edleb, Syrian Arab Republic


Introduction: Trans-pyloric (TP) tube feeding is used in a multitude of conditions and it can help reduce the vomiting associated with gastro-oesophageal reflux disease (GORD). In low resource environments, severe GORD/non-bilious vomiting represents a diagnostic and therapeutic dilemma. We here describe a new simple method to insert TP tubes.

Methods: Regular 6 French tube is measured as for naso-gastric tubes (nose to xiphisternum). Another 7 cm of length is then added and 3-5 silk (4-0) ties are applied to the end of the tube spaced 0.5-1 cm apart. The knots are placed in different radial directions and multiple throws are placed on each knot so as to add bulkiness (figure 1). The idea is that the knots serve as a latching point for peristalsis to pull the tube forward. The tube is then inserted transnasally to the pre-measured length and secured. The child is given a single dose of metoclopramide 0.1 mg/kg IV/IM and placed on his right side for 4 hours. A plain abdominal x-ray is then performed after filling the tube with water soluble contrast material to confirm adequate TP placement. Following correct placement the patient is tube fed with small volumes every 15-20 minutes. Descriptive data was prospectively collected.

Results: 12 patients were recruited, median age 4 months. All presented with vomiting and 10 had failure to thrive while 2 had significant aspirations. All had successful TP tube placement from the first attempt. In all patients the vomiting almost stopped completely and 6 of the 7 patients with known follow-up had weight gain improvement. 2 patients went on to have fundoplication while one had PEG placement.

Conclusion: The silk tie technique is a safe and simple way to treat persistent vomiting and may prove useful in low resourced environments.