Download PDF
Digestive Disease Interventions 2023; 07(04): 249-255
DOI: 10.1055/s-0043-1771309
Review Article

Enteric Access: GI Perspective

Kais Zakharia 
1   Division of Gastroenterology and Hepatology, UMass Medical School - Baystate Campus, Springfield, Massachusetts
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Enteric access is the main method to obtain nutrition in patients with normally functioning gastrointestinal tract who are otherwise unable to feed orally. Enteric access can be obtained through the nose, mouth, or skin by a nurse, general practitioner, endoscopist, interventional radiologist, or a surgeon. In this article, we review the different types of feeding tubes, indications, contraindications, and potential complications.

Keywords

enteric access - gastrostomy - jejunostomy


Publication History

Received: 18 June 2023

Accepted: 22 June 2023

Article published online:
25 August 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Seres DS, Valcarcel M, Guillaume A. Advantages of enteral nutrition over parenteral nutrition. Therap Adv Gastroenterol 2013; 6 (02) 157-167
    CrossrefPubMedGoogle Scholar
  • 2 Gatt M, MacFie J. Bedside postpyloric feeding tube placement: a pilot series to validate this novel technique. Crit Care Med 2009; 37 (02) 523-527
    CrossrefPubMedGoogle Scholar
  • 3 Wiggins TF, DeLegge MH. Evaluation of a new technique for endoscopic nasojejunal feeding-tube placement. Gastrointest Endosc 2006; 63 (04) 590-595
    CrossrefPubMedGoogle Scholar
  • 4 Stark SP, Sharpe JN, Larson GM. Endoscopically placed nasoenteral feeding tubes. Indications and techniques. Am Surg 1991; 57 (04) 203-205
    PubMedGoogle Scholar
  • 5 Patrick PG, Marulendra S, Kirby DF, DeLegge MH. Endoscopic nasogastric-jejunal feeding tube placement in critically ill patients. Gastrointest Endosc 1997; 45 (01) 72-76
    CrossrefPubMedGoogle Scholar
  • 6 Brandt CP, Mittendorf EA. Endoscopic placement of nasojejunal feeding tubes in ICU patients. Surg Endosc 1999; 13 (12) 1211-1214
    CrossrefPubMedGoogle Scholar
  • 7 Dutta AK, Goel A, Kirubakaran R, Chacko A, Tharyan P. Nasogastric versus nasojejunal tube feeding for severe acute pancreatitis. Cochrane Database Syst Rev 2020; 3 (03) CD010582
    PubMedGoogle Scholar
  • 8 Eatock FC, Chong P, Menezes N. et al. A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. Am J Gastroenterol 2005; 100 (02) 432-439
    CrossrefPubMedGoogle Scholar
  • 9 Singh N, Sharma B, Sharma M. et al. Evaluation of early enteral feeding through nasogastric and nasojejunal tube in severe acute pancreatitis: a noninferiority randomized controlled trial. Pancreas 2012; 41 (01) 153-159
    CrossrefPubMedGoogle Scholar
  • 10 Tong Z, Li W, Wang X, Ye X, Li N, Li J. Duodenal perforation due to a kink in a nasojejunal feeding tube in a patient with severe acute pancreatitis: a case report. J Med Case Reports 2010; 4: 162
    CrossrefPubMedGoogle Scholar
  • 11 Lin CN, Lee PC, Liu KL, Chang CC. An unusual complication of nasojejunal tube placement: jejunal perforation. Am J Gastroenterol 2016; 111 (07) 921
    CrossrefPubMedGoogle Scholar
  • 12 Lu G, Xiang Q, Wang S. et al. Endoscopic- versus X-ray-guidance for placement of nasojejunal tubes in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Am J Transl Res 2022; 14 (04) 2134-2146
    PubMedGoogle Scholar
  • 13 Li G, Lin J, Liu Y. et al. Ultrasound-assisted versus endoscopic nasojejunal tube placement for acute pancreatitis: a retrospective feasibility study. Gastroenterol Res Pract 2021; 2021: 4903241
    PubMedGoogle Scholar
  • 14 Kolbeinsson HM, Veldkamp J, Paauw JD. Fluoroscopic placement of nasojejunal feeding tubes in COVID-19 patients in the prone position. JPEN J Parenter Enteral Nutr 2022; 46 (03) 556-560
    CrossrefPubMedGoogle Scholar
  • 15 DeLegge MH. Small bowel endoscopic enteral access. Gastrointest Endosc Clin N Am 2007; 17 (04) 663-686
    CrossrefPubMedGoogle Scholar
  • 16 Neumann DA, DeLegge MH. Gastric versus small-bowel tube feeding in the intensive care unit: a prospective comparison of efficacy. Crit Care Med 2002; 30 (07) 1436-1438
    CrossrefPubMedGoogle Scholar
  • 17 Alkhawaja S, Martin C, Butler RJ, Gwadry-Sridhar F. Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults. Cochrane Database Syst Rev 2015; 2015 (08) CD008875
    PubMedGoogle Scholar
  • 18 Jafri NS, Mahid SS, Minor KS, Idstein SR, Hornung CA, Galandiuk S. Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy. Aliment Pharmacol Ther 2007; 25 (06) 647-656
    CrossrefPubMedGoogle Scholar
  • 19 DeLegge MH. Enteral access and associated complications. Gastroenterol Clin North Am 2018; 47 (01) 23-37
    CrossrefPubMedGoogle Scholar
  • 20 Thornton FJ, Fotheringham T, Haslam PJ, McGrath FP, Keeling F, Lee MJ. Percutaneous radiologic gastrostomy with and without T-fastener gastropexy: a randomized comparison study. Cardiovasc Intervent Radiol 2002; 25 (06) 467-471
    CrossrefPubMedGoogle Scholar
  • 21 Dewald CL, Hiette PO, Sewall LE, Fredenberg PG, Palestrant AM. Percutaneous gastrostomy and gastrojejunostomy with gastropexy: experience in 701 procedures. Radiology 1999; 211 (03) 651-656
    CrossrefPubMedGoogle Scholar
  • 22 Wollman B, D'Agostino HB, Walus-Wigle JR, Easter DW, Beale A. Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature. Radiology 1995; 197 (03) 699-704
    CrossrefPubMedGoogle Scholar
  • 23 Leeds JS, McAlindon ME, Grant J, Robson HE, Lee FK, Sanders DS. Survival analysis after gastrostomy: a single-centre, observational study comparing radiological and endoscopic insertion. Eur J Gastroenterol Hepatol 2010; 22 (05) 591-596
    CrossrefPubMedGoogle Scholar
  • 24 Vincenzi F, De Caro G, Gaiani F. et al. Risk of tumor implantation in percutaneous endoscopic gastrostomy in the upper aerodigestive tumors. Acta Biomed 2018; 89 (8-S, 8-S) 117-121
    PubMedGoogle Scholar
  • 25 Fan AC, Baron TH, Rumalla A, Harewood GC. Comparison of direct percutaneous endoscopic jejunostomy and PEG with jejunal extension. Gastrointest Endosc 2002; 56 (06) 890-894
    CrossrefPubMedGoogle Scholar
  • 26 Despott EJ, Gabe S, Tripoli E, Konieczko K, Fraser C. Enteral access by double-balloon enteroscopy: an alternative method of direct percutaneous endoscopic jejunostomy placement. Dig Dis Sci 2011; 56 (02) 494-498
    CrossrefPubMedGoogle Scholar
  • 27 Maple JT, Petersen BT, Baron TH, Gostout CJ, Wong Kee Song LM, Buttar NS. Direct percutaneous endoscopic jejunostomy: outcomes in 307 consecutive attempts. Am J Gastroenterol 2005; 100 (12) 2681-2688
    CrossrefPubMedGoogle Scholar
  • 28 Zopf Y, Rabe C, Bruckmoser T, Maiss J, Hahn EG, Schwab D. Percutaneous endoscopic jejunostomy and jejunal extension tube through percutaneous endoscopic gastrostomy: a retrospective analysis of success, complications and outcome. Digestion 2009; 79 (02) 92-97
    CrossrefPubMedGoogle Scholar
  • 29 Overhagen Hv, Schipper J. Percutaneous jejunostomy. Semin Intervent Radiol 2004; 21 (03) 199-204
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Yang ZQ, Shin JH, Song HY. et al. Fluoroscopically guided percutaneous jejunostomy: outcomes in 25 consecutive patients. Clin Radiol 2007; 62 (11) 1061-1065 , discussion 1066–1068
    CrossrefPubMedGoogle Scholar
  • 31 Pritchard TJ, Bloom AD. A technique of direct percutaneous jejunostomy tube placement. J Am Coll Surg 1994; 178 (02) 173-174
    PubMedGoogle Scholar
  • 32 Zaloga GP. Bedside method for placing small bowel feeding tubes in critically ill patients. A prospective study. Chest 1991; 100 (06) 1643-1646
    CrossrefPubMedGoogle Scholar
  • 33 Lai CW, Barlow R, Barnes M, Hawthorne AB. Bedside placement of nasojejunal tubes: a randomised-controlled trial of spiral- vs straight-ended tubes. Clin Nutr 2003; 22 (03) 267-270
    CrossrefPubMedGoogle Scholar
  • 34 Cardona E, Mehta S. Bedside postpyloric enteral tube placement using Kangaroo IRIS technology: a single-center case series. Nutrition 2021; 86: 111195
    CrossrefPubMedGoogle Scholar
  • 35 Taylor SJ, Sayer K, White P. Nasointestinal tube placement: techniques that increase success. J Intensive Care Soc 2023; 24 (01) 62-70
    CrossrefPubMedGoogle Scholar
  • 36 Gerritsen A, Duflou A, Ramali M. et al. Electromagnetic-guided versus endoscopic placement of nasojejunal feeding tubes after pancreatoduodenectomy: a prospective pilot study. Pancreas 2016; 45 (02) 254-259
    CrossrefPubMedGoogle Scholar
  • 37 Stecher SS, Barnikel M, Drolle H. et al. The feasibility of electromagnetic sensing aided post pyloric feeding tube placement (CORTRAK) in patients with thrombocytopenia with or without anticoagulation on the intensive care unit. JPEN J Parenter Enteral Nutr 2022; 46 (05) 1183-1190
    CrossrefPubMedGoogle Scholar
  • 38 Lord LM, Weiser-Maimone A, Pulhamus M, Sax HC. Comparison of weighted vs unweighted enteral feeding tubes for efficacy of transpyloric intubation. JPEN J Parenter Enteral Nutr 1993; 17 (03) 271-273
    CrossrefPubMedGoogle Scholar
  • 39 Joubert C, Tiengou LE, Hourmand-Ollivier I, Dao MT, Piquet MA. Feasibility of self-propelling nasojejunal feeding tube in patients with acute pancreatitis. JPEN J Parenter Enteral Nutr 2008; 32 (06) 622-624
    CrossrefPubMedGoogle Scholar
  • 40 Puiggròs C, Molinos R, Ortiz MD. et al. Experience in bedside placement, clinical validity, and cost-efficacy of a self-propelled nasojejunal feeding tube. Nutr Clin Pract 2015; 30 (06) 815-823
    CrossrefPubMedGoogle Scholar
  • 41 Li J, Gu Y, Zhou R. Rhubarb to facilitate placement of nasojejunal feeding tubes in patients in the intensive care unit. Nutr Clin Pract 2016; 31 (01) 105-110
    CrossrefPubMedGoogle Scholar
  • 42 DeLegge MH, Patrick P, Gibbs R. Percutaneous endoscopic gastrojejunostomy with a tapered tip, nonweighted jejunal feeding tube: improved placement success. Am J Gastroenterol 1996; 91 (06) 1130-1134
    PubMedGoogle Scholar
  • 43 Berger WL, Shaker R, Dean RS. Percutaneous endoscopic gastrojejunal tube placement. Gastrointest Endosc 1996; 43 (01) 63-66
    CrossrefPubMedGoogle Scholar
  • 44 Adler DG, Gostout CJ, Baron TH. Percutaneous transgastric placement of jejunal feeding tubes with an ultrathin endoscope. Gastrointest Endosc 2002; 55 (01) 106-110
    CrossrefPubMedGoogle Scholar
  • 45 Sibille A, Glorieux D, Fauville JP, Warzée P. An easier method for percutaneous endoscopic gastrojejunostomy tube placement. Gastrointest Endosc 1998; 48 (05) 514-517
    CrossrefPubMedGoogle Scholar
  • 46 Roberto Simons-Linares C, Milano R, Bartel MJ. PEG J tube placement with optimization of J tube insertion. VideoGIE 2020; 6 (03) 112-113
    CrossrefPubMedGoogle Scholar