Efficacy of metoclopramide as an adjunct to duodenal placement of small‐bore feeding tubes: a randomized, placebo‐controlled, double‐blind study

Abstract

We examined whether metoclopramide would improve the success rate of transpyloric intubation of a weighted Corpak feeding tube when fluoroscopic guidance is not used. Seventy patients were randomized in a prospective, double-blind fashion to receive either placebo (n = 35) or metoclopramide, 10 mg (n = 35) parenterally, administered immediately after the feeding tube was inserted. Tube location was determined independently by two observers who examined radiographs obtained after barium was instilled via the tube. There was no significant increase in the success rate of duodenal intubation in the total group following metoclopramide, 60%, compared to placebo, 49%. However, analysis of subgroups among the placebo-treated patients revealed that diabetes mellitus, but not other medical conditions, decreased the success rate for duodenal intubation, 20 vs 60% (p less than 0.05). Among diabetic patients, metoclopramide resulted in a significant increase in duodenal placement compared to placebo (p less than 0.05). We conclude that parenteral metoclopramide significantly increases the frequency of transpyloric intubation with small feeding tubes without fluoroscopic guidance in diabetic patients but not in nondiabetic patients.

A Randomized Controlled Trial Comparing Three Different Techniques of Nasojejunal Feeding Tube Placement in Critically Ill Children

“…Results using metoclopramide have varied success rates from 54% to 93%. 17,18 In the adult diabetic population, metoclopramide resulted in a significant increase in the placement of transpyloric feeding tubes compared with placebo. 17 Chellis et al 14 had a 93% success rate using metoclopramide with unweighted feeding tubes in 90 PICU patients.…”

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

“…[61][62][63] Moreover, intravenous administration of metoclopramide was more effective than placebo for enhancing gastric emptying in patients with morphine-induced gastric dysfunction, 44,64 head injury, 65 diabetic gastroparesis, 27 and preterm infants; 66 however, only two of these studies 27,44 utilized the acetaminophen absorption model to assess gastric motility.…”

How to Promote Bedside Placement of the Postpyloric Feeding Tube

“…A total of 545 citations were identified from the literature search. Fourteen studies 5 ‐ 7 , 20 ‐ 30 involving 753 patients met our inclusion criteria. The other studies were excluded for various reasons (Figure 1).…”