Accurate localization of the position of the tip of a naso/orogastric tube in children; where is the location of the gastro-esophageal junction?

Abstract

Background: Abdominal radiographs are used to determine the location of the tip of a newly placed nasogastric tube. The precise location of the gastroesophageal junction has not been well described in the radiology literature.

Objective: To improve interpretation of radiographs taken to evaluate the location of the tip of a nasogastric tube. Using UGI barium studies, we determined the anatomical location and variability of the position of the gastroesophageal (GE) junction and the pylorus

Materials and methods: We reviewed 200 upper gastrointestinal barium studies (50 in each of 4 age groups). We measured the vertebral levels and distance of the gastroesophageal junction and the pylorus from the spine, the vertical distance of the gastroesophageal junction from the dome of the diaphragm and the distance from the gastroesophageal junction to the pylorus.

Results: There is a constant location of the GE junction with no significant variation between age groups. There is a moderately constant location of the pylorus. The other measurements were very variable.

Conclusion: The location of the GE junction is very constant, irrespective of age. Tube tips below the level of the vertebral disc between the 11th and 12th thoracic vertebra and/or more than 16 mm from the left side of the spine lie in the stomach and not the lower esophagus. Our results should help in accurate radiographic description of the location of the tip of an NG tube.