Endoscopic Techniques for Enteral Nutrition: Standards and Innovations

Abstract

Enteral nutrition has been increasingly used in clinical practice during the past decades. Today, nasogastric, nasoenteric, and transcutaneous gastric or enteral feeding tubes are well established as a routine endoscopic intervention. After clinical introduction of percutaneous endoscopic gastrostomy (PEG) in 1980, the sutureless ‘pull’ PEG has become a widespread endoscopic technique for transcutaneous gastric long-term nutrition. Multiple new techniques have been introduced since then, and today even long-term jejunal nutrition can be achieved with modified techniques. The introducer PEG (first reported in 1984) has not become an established procedure, but new techniques with an endoscopic gastropexy might be a more effective approach. To increase the qualitiy of life of the patients, skin-level devices were designed and successfully introduced in 1984. A new development has been the one-step feeding tubes which provide the patients with a permanent tube. The standard techniques for long-term enteral feeding, new developments of feeding tubes, and future concepts are discussed in this review.

Acceptability and outcomes of percutaneous endoscopic gastrostomy (PEG) tube placement and patient quality of life

“…Borgaonkar and Dormann (16,17) found that the evaluation of QOL is quite difficult due to the health status of the patients. The physician's view is crucial, but the patient's interpretation regarding his/her condition can be important.…”

Endoscopic Palliation and Nutritional Support in Advanced Gastric Cancer

“…The types of tubes have different indications, advantages and complications. Specifi c details of insertion have been described before [38] .…”

“…In gastric tumors, nasogastric feeding is often ineffective and the risk of aspiration pneumonia is high in patients with delayed gastric emptying [37] . The indication for nasoenteral feeding should primarily be given in cases with malignant outlet stenoses [38,39] . In these patients, two or three lumen tubes should be preferred because they increase the tolerance of enteral feeding by simultaneous gastric decompression [39] .…”

“…Endoscopic or fl uoroscopic guidance are essential to place nasoenteric tubes and both techniques are often combined [40,41] . Endoscopic positioning can be achieved by pulling the tube into the jejunum beneath the scope (BTS) or pushing it over a wire (OTW) which was initially placed under endoscopical control [38] ( fi g. 4 ).…”

Endoscopic foreign body retrieval using laparoscopic shears after gastrostomy

“…Hence, conservative medical management was instituted. A week later, percutaneous endoscopic gastrostomy was performed with the Funada-style loop fixture II (Create Medic, Yokohama, Japan) to avoid collapse of the stomach wall (4,5). Laceration of the lower esophagus had almost healed.…”