Nasogastric tube insertion in difficult cases with the aid of a flexible nasendoscope

Objective: Nasogastric tube insertion is often difficult, due to a variety of reasons, e.g. skewed laryngeal anatomy. We present a previously unreported method of facilitating nasogastric tube insertion, using a flexible nasendoscope. Method: The nasogastric tube is anchored to a flexible nasendoscope using sodium alginate dressing ties. The nasendoscope is then passed into the upper oesophagus, along with the nasogastric tube. Once the nasogastric tube has passed the cricopharyngeus, gentle traction on the nasendoscope releases it from the nasogastric tube. The nasendoscope can then be withdrawn. A previous safety study of sodium alginate ingestion showed no adverse effects. Conclusion: This method enables nasogastric tube insertion under direct vision, and allows the tube to be guided past the larynx and into the upper oesophagus.