International survey of endoscopic nasojejunal tube insertion practices

Objective We performed an international cross-sectional study to investigate the procedural standards and challenges of endoscopically guided nasojejunal tube (NJT) insertion among healthcare professionals. Methods A 16-item online questionnaire was created on SurveyMonkey and distributed internationally to healthcare professionals engaged in NJT insertion, between 26 March and 10 May 2024, through professional networks, institutional email lists and social media platforms (WhatsApp and X). The questionnaire evaluated (1) NJT insertion and sedation procedures, (2) clinician rankings of their perceived most technically challenging and discomforting steps in through-the-scope (TTS) NJT insertion, (3) sustainability concerns related to the use of single-use instruments during the procedure. ORs were calculated from χ² tests to evaluate associations between procedural steps and perceived technical challenge or patient discomfort . Results From 148 respondents, most were medical endoscopists (87.8%), primarily based in the UK (72.3%), with a mean experience of 8.2 years in NJT insertion, predominantly solely using the TTS method (66.9%), with fewer (10.8%) solely using transnasal endoscopy. Among TTS users, rerouting from mouth to nose was most frequently perceived as the most uncomfortable (80.5%; OR 37.6, p≤0.001) and technically challenging step (52.9%; OR 5.63, p<0.001) of TTS insertion. Furthermore, 81.1% of respondents had environmental concerns about single-use instrumentation. Conclusion The TTS method was the preferred method for NJT insertion; however, its rerouting step was perceived as both discomforting and technically challenging. Broader training in multiple techniques may help optimise insertion to accommodate patient factors, while the development of novel devices may help to mitigate the limitations of rerouting.