Long-term bedside dynamic monitoring of jejunal mucosa via an indwelling visualized nasojejunal tube in a neurocritical patient: a case report and proposal for a novel scoring system.

Background: Enteral nutrition (EN) intolerance is a prevalent challenge in neurocritical care. Traditional markers, such as gastric residual volume, remain controversial due to their low specificity. While visualized nasojejunal tubes (NJT) facilitate placement, their application as an indwelling monitoring tool for observing real-time mucosal dynamics remains unexplored. Case description: We report a case of a 62-year-old male with cerebral hemorrhage who required post-pyloric feeding due to high aspiration risk and initial gastric feeding intolerance. An indwelling hydrophilic-coated visual NJT with a distal tip camera was deployed. Serial bedside monitoring was performed on Days 1, 7, 14, and 21 over a 22-day indwelling period. We established a novel "Bedside Visual Mucosal Scoring System" to semi-quantitatively assess mucosal color, villi morphology, and luminal contents. Serial monitoring revealed a distinct transition from an initial edematous and hyper-secretory state to a healthy state with distinct villi architecture. Notably, the visual improvement of mucosal integrity coincided chronologically with the patient's clinical stabilization, including decreased inflammatory markers and successful weaning from mechanical ventilation. The patient achieved full caloric targets without catheter-related complications. Conclusion: This case demonstrates the feasibility and safety of using hydrophilic-coated visual NJT for long-term, bedside dynamic monitoring of jejunal mucosa. This technique offers a promising alternative from indirect assessment to direct visualization, highlighting the potential for mucosa-directed precision nutrition strategies in critically ill patients.