Computed tomography-derived nasojejunal tube tip-to-gastric antrum path length and short-term outcomes in severe acute pancreatitis

doi:10.4329/wjr.125149

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World Journal of Radiology

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1949-8470

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Radiol. Oct 28, 2026; 18(10): 125149
Published online Oct 28, 2026. doi: 10.4329/wjr.125149

Computed tomography-derived nasojejunal tube tip-to-gastric antrum path length and short-term outcomes in severe acute pancreatitis

Wen Ye, Kai-Fan Xie, Yuan-Hui Zhang, Qiu-Jie Huang, Hui Yao, Jian Yang, Shi-Yang Yuan

Wen Ye, Qiu-Jie Huang, Hui Yao, Jian Yang, Shi-Yang Yuan, Department of Intensive Care Medicine, Nanping First Hospital Affiliated to the Fujian Medical University, Nanping 353000, Fujian Province, China

Kai-Fan Xie, Department of Respiratory and Critical Care Medicine, The 907^th Hospital of the Chinese Joint Logistics Support Force, Nanping 353000, Fujian Province, China

Yuan-Hui Zhang, Department of Medical Imaging, Nanping First Hospital Affiliated to Fujian Medical University, Nanping 353000, Fujian Province, China

Co-first authors: Wen Ye and Kai-Fan Xie.

Author contributions: Ye W and Xie KF designed the research study, analyzed the data and drafted the manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Ye W, Xie KF, Huang QJ, Yao H, and Yang J enrolled patients and collected the clinical data; Zhang YH contributed to computed tomography reconstruction and imaging measurement; Yuan SY supervised the study and critically revised the manuscript; and all authors interpreted the data, read, and approved the final manuscript.

AI contribution statement: The authors declare that no AI tools were used in the development or writing of this manuscript and take full responsibility for its integrity, accuracy, and originality.

Supported by Startup Fund for Scientific Research, Fujian Medical University No. 2020QH1321 and No.2023QH1255.

Institutional review board statement: This study was approved by the Medical Ethics Committee of Nanping First Hospital Affiliated to Fujian Medical University, approval No. NPSY202101017.

Clinical trial registration statement: Not applicable.

Informed consent statement: Consent has been obtained from each patient or subject after full explanation of the purpose and nature of all procedures used.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: The data supporting the findings of this study are available from the corresponding author on reasonable request, subject to applicable institutional and ethical requirements.

Corresponding author: Shi-Yang Yuan, Master of Medicine, Attending Physician, Department of Intensive Care Medicine, Nanping First Hospital Affiliated to Fujian Medical University, No. 317 Zhongshan Road, Yanping District, Nanping 353000, Fujian Province, China. 19905996761@163.com

Received: July 2, 2026
Revised: August 19, 2026
Accepted: October 12, 2026
Published online: October 28, 2026
Processing time: 118 Days and 22.4 Hours

Abstract

BACKGROUND

Nasojejunal (NJ) feeding is commonly used in severe acute pancreatitis (SAP), but whether deeper tube advancement improves clinical outcomes is uncertain. Computed tomography (CT)-based three-dimensional reconstruction can quantify the in-situ tube trajectory.

AIM

To determine whether CT-derived NJ tube path length is associated with short-term outcomes in patients with confirmed SAP.

METHODS

This prospective single-center observational cohort included 63 patients with confirmed SAP. CT-based three-dimensional reconstruction measured the curved path length from the gastric antrum-pylorus junction to the tube tip. The primary outcome was intensive care unit (ICU) length of stay. Associations were assessed using Spearman correlation and Acute Physiology and Chronic Health Evaluation II-adjusted median regression. Firth penalized logistic regression evaluated the exploratory composite outcome. Anatomical tube-tip position was independently classified on multiplanar CT.

RESULTS

Median path length was 17.55 cm (interquartile range, 14.35-22.27 cm). Path length was not associated with ICU stay by Spearman analysis (rho = 0.055, P = 0.671) or adjusted median regression (difference per 5-cm increase = 0.192-day, 95% confidence interval: -0.922 to 1.305, P = 0.732). Post-CT ICU stay showed a similar null association. Anatomical position was duodenal in 28 patients, at the duodenojejunal flexure in 18, and jejunal in 17; path length correlated strongly with independently measured flexure-relative distance (rho = 0.997, P < 0.001). The exploratory composite outcome occurred in 17 patients, and path length remained non-significant in Firth regression.

CONCLUSION

CT-derived NJ tube path length was not associated with ICU outcomes but closely reflected distal anatomical tube position. These findings do not establish an optimal advancement target.

Keywords: Severe acute pancreatitis; Nasojejunal tube; Gastric antrum; Enteral nutrition; Computed tomography; Prognosis

Core Tip: This prospective single-center observational cohort used computed tomography-based three-dimensional reconstruction to quantify the curved path length from the gastric antrum-pylorus junction to the nasojejunal tube tip. Path length strongly corresponded to independently assessed distal tube-tip anatomy but was not associated with intensive care unit length of stay in unadjusted, Acute Physiology and Chronic Health Evaluation II-adjusted, or post-computed tomography analyses. These findings support the metric as an imaging-derived surrogate of tube advancement but do not establish a prognostic or therapeutic depth target.