Ins and Outs of Enteral Access: Part 2—Long Term Access—Esophagostomy and Gastrostomy

Abstract

Access techniques for long-term enteral nutrition (over 4 to 6 weeks) includes cervical esophagostomy and pharyngostomy, gastrostomy, and jejunostomy. Cervical esophagostomy and pharyngostomy are rarely used since the advent of better long-term enteral access techniques that are easier to care for and have fewer complications; they are briefly reviewed only for historical completeness and to condemn their use. The different techniques of gastrostomy tube insertion and their indications, contraindications, advantages, and disadvantages are discussed. Part III (to be published in a later issue) of this series will review feeding jejunostomy.

Head and Neck Cancer Tumor Seeding at the Percutaneous Endoscopic Gastrostomy Site

“…There are 3 methods of PEG placement: Gauderer‐Ponsky pull, Sachs‐Vine push, and the Russell push method, which can be placed in interventional radiology, endoscopic suite, or at the bedside . In the event that PEG placement is contraindicated, a gastrostomy tube can be surgically placed.…”

“…The Gauderer‐Ponsky pull method was first described in 1980 . The gastrostomy tube is placed via complete esophagogastroduodenoscopy (EGD).…”

Enteral Access in Mechanically Ventilated Patients

“…Disadvantages include the need to use smaller-caliber tubes that are prone to occlusion, the need to transport the patient in order for the procedure to be performed, and the need for a radiologist familiar with enteral access placement. 31,63 Radiographic Gastrojejunostomy After successful gastrostomy placement, a jejunal catheter can be inserted through the previous gastrostomy site and into the jejunum. Gray et al 64 first described the technique by which a guidewire was inserted through the previous gastrostomy site and passed into the jejunum under fluoroscopy.…”

“…63 Disadvantages include the need for general anesthesia, longer recovery, and expense. Complications include wound infections, gastrointestinal bleeding, and tube dislodgement with peritoneal contamination.…”

“…Vanek 49,63 offers a thorough explanation of the surgical techniques available for gastrostomy and jejunostomy in articles published in prior issues of Nutrition in Clinical Practice.…”