Endoscopic enteral accesses: Review article

Abstract

A benefit of enteral nutritional support over the parenteral for acute and chronic diseases has been observed because it is more physiological and is associated with fewer complications. The most frequently used for this purpose are nasoenterals feeding tubes lasting no more than 30 days and percutaneous accesses involving longterm feeding. Prepiloric feeding is appropriate for most critical patients. However, postpiloric feeding, which is achieved with nasojejunal probes, percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) and jejunostomy is indicated for those with regurgitation, aspiration of gastric foods or presence of leaks in the upper tractodigestive. There are several methods for the placement of enteral accesses, the endoscopic being the first choice in most cases, leaving the one performed by radiointervention and surgical for the technically difficult cases. There are advances with new endoscopic techniques such as endoscopic percutaneous jejunostomy by double balloon enteroscopy (PEJ) and endoscopic ultrasound in pacemakers with modified anatomy (Y-Roux) and excluded stomach, as well as the placement of selfexpanding metal prostheses at the duodenal or gastrojejunostomy by endoscopic ultrasound assisted by fluoroscopy guided by double balloon intestinal occlusion in cases of obstruction to the outflow tract by neoplasia. Due to the above, based on patient characteristics and prognosis, there are already more endoscopic options to preserve the enteral route as the main nutritional route in patients with chronic diseases.