Recent advances in the placement of tubes for enteral nutrition

Abstract

Enteral nutrition is the preferred route for nutritional support compared with parenteral nutrition if the gastrointestinal tract is functionally preserved. Long-standing nasogastric or nasoenteric feeding tubes are not well tolerated. Alternative routes are gastrostomy and jejunostomy. Percutaneous endoscopic gastrostomy/jejunostomy or those guided by fluoroscopy, sonography or tomography should be the first choices. Laparoscopy or laparotomy gastrostomy/jejunostomy routes should be reserved for specific situations. Insufflation of the stomach with air or saline solution facilitates the placement of nasoenteric feeding tubes or percutaneous sonographic-guided gastrostomy. The gastrostomy button is a safe and aesthetic alternative, at least in children. Comparison between percutaneous endoscopic gastrostomy and surgical gastrostomy performed either via laparotomy or laparoscopy favours the first in terms of costs and risks. Whenever associated intra-abdominal procedures or anatomic difficulties arise, a laparoscopic or an open access becomes necessary. Complications with feeding tubes are not uncommon and should be promptly recognized and treated.

One‐Step Insertion of Low‐Profile Gastrostomy in Pediatric Patients vs Pull Percutaneous Endoscopic Gastrostomy

“…Furthermore, as noted by Humphreys and Najmaldin, 14 laparoscopy enables tube placement by allowing direct visualization of the stomach. In other works, authors conveyed that a laparoscopically placed button may be a feasible alternative to PEG for initiation of enteral feeding when anatomical challenges are present, 15 , 16 such as obstructed oropharynx, esophagus, or gastric cardia 16 . The procedure has been associated with no intraoperative complications (n = 2 patients 17 and n = 240 18 ), minor infections and hypergranulation (n = 11 14 ), and postoperative complications 18 (wound infections, button dislodgement secondary to balloon rupture, and a button not fully placed into the stomach).…”

The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia

“…Nevertheless, complications have been reported [1], and aspiration is one of the most important and controversial ones. In patients on enteral nutrition, aspiration may lead to devastating consequences, interfering with the outcome of medical treatment and sometimes causing death [2].…”

Gastrostomy insertion in children: percutaneous endoscopic or percutaneous image-guided?

“…Since the first description of percutaneous endoscopic gastrostomy (PEG) by Gauderer in 1980 [1], various minimally invasive techniques of gastrostomy insertion have been developed, including image-guided gastrostomy (IG) inserted under fluoroscopic guidance [2,3]. Although both PEG and IG have the benefits of easy insertion and avoidance of a laparotomy incision, complications have been reported with these techniques, including gastrocolic fistula, hemorrhage, and intraabdominal leak with sepsis [4][5][6][7]. In this study, we aim to evaluate the clinical outcome of both procedures and the associated complications.…”