Background and Aims To introduce and evaluate a new endoscopic nasojejunal feeding tube insertion method. In 2010, we attempted to insert an elemental diet tube (ED) using an endoscope at the bedside of a patient in whom blind nasogastric tube insertion was impossible. This process unexpectedly led to jejunal feeding tube insertion (JFI), and endoscopic insertion was subsequently performed at the bedside in patients with aspiration, those at risk of aspiration, or those in whom blind ED insertion was difficult. As most patients underwent jejunal insertion, this study was initiated based on the belief that JFI would be possible by maximally inserting the ED using this method. Methods Success rates and problems associated with the JFI method were evaluated. Multiple silk threads were tied to the ED, which was positioned in the pylorus using an endoscope. The thread was grasped using endoscopic forceps to push the ED. When the grasping portion reached the pylorus, the oral-side thread was grasped and pushed, which continued reciprocally until the full length could be inserted, or the ED stopped advancing. Results Between 2011 and 2024, 97 insertions were performed at our hospital using this insertion method (92 jejunal and 5 duodenal insertions). All procedures were performed at the bedside, and most were performed easily. In a small number of patients, insertion was challenging owing to friction in the esophagus, requiring a switch to a slim endoscope or the use of an improvised handmade sheath. Conclusions The ED insertion method is effective and practical. For further improvement, the development of a dedicated sheath and improvements in tube properties are desirable.
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