Basics in clinical nutrition: Surgical access – Gastrostomy, needle catheter jejunostomy

Abstract

Surgical techniques for enteral feeding are necessary when percutaneous endoscopic placement is not possible. This is most often the case when endoscopy is impossible due to tumor obstruction. However, the majority of surgical gastrostomies and jejunostomies that are currently performed are done as a concomitant procedure at the time of major surgery for trauma or upper gastrointestinal tract disease. More than 100 years ago Albert described the use of a catheter jejunostomy for postoperative alimentation. However, the use of the method has been limited by the mistaken belief in complete postoperative gastrointestinal atony. Since the end of 1960s the results of experimental and clinical studies have shown that postoperative atony primarily affects the stomach and the colon, but the digestive function of the small intestine is almost physiological a couple of hours after abdominal surgery. These observations gave new impetus for early postoperative enteral feeding. Surgical techniques to allow enteral feeding vary, but they can be classified as either temporary or permanent.