Enteral Feeding Tubes: What Every Fellow Should Know

Abstract

GI fellows rapidly discover that they must become intimately familiar with the role of feeding tubes in patients with GI disease as gastroenterologists are called upon daily to select which type of tube is best, where it should be placed, and how it should be placed. The evaluation of a patient for enteral nutrition is best performed by the gastroenterologist who combines the cognitive expertise in nutrition and gastroenterology together with the endoscopic skills to place the appropriate type of feeding tube. Enteral feeding is the preferred method of nutrition support when oral feeding is inadequate and a functional gastrointestinal tract is present. Endoscopic directed access for enteral nutrition may be established for nasoenteric tubes (NET), percutaneous endoscopic gastrostomy (PEG), percutaneous gastrojejunostomy(PEGJ), or direct percutaneous endoscopic jejunostomy (DPEJ). This chapter will detail the most effective endoscopic methods of feeding tube placement using the most recent technologies including the drag and clip for NET and PEGJ and balloon enteroscopy for DPEJ. The most recent guidelines for peri-procedural anticoagulation management and the ethics of feeding tube therapy are reviewed as well. The GI fellow should have a variety of tools and techniques in his armamentarium for successful and safe enteral feeding tube placement. This chapter will cover the placement, management and troubleshooting of endoscopic feeding tubes.