Endoscopic placement of enteral feeding tubes

Table 1 Enteral feeding indications[74]

Unconscious patient: Head injury, ventilated patient

Swallowing disorder: MS, MND, bulbar and pseudobulbar palsies, huntington’s disease, post-stroke (early feeding < 7 d beneficial)

Physiological anorexia: Liver disease

Partial intestinal failure: Postoperative ileus, IBD, short bowel syndrome

Increased nutritional requirements: Cystic fibrosis, renal disease

Psychological problems: Severe depression, anorexia nervosa

Table 2 Enteral feeding relative contraindications[75]^a

Intestinal obstruction

Ileus

High output small bowel fistula

High doses positive inotropic agents

Hypotension

^aPatients with intestinal failure due to ileus, dysmotility, or subacute obstruction and who cannot tolerate oral intake are recognized to be suitable to receive some form of enteral nutrition.

Table 3 Management of post-pyloric NETs

Flushed immediately after each intermittent feeding bolus infusion

Flushed every 6 to 8 h during continuous feeding

Flushed immediately after installation of any medications

Only use liquid/completely dissolved medications

Table 4 Endoscopic methods of peroral post-pyloric NET placement

Drag and pull	Sutured distal end of NET is pulled down small bowel using grasping forceps
Over the guidewire	Guidewire placed in small bowel and NET placed over guidewire. Involves difficult oro-pharyngeal exchange
Push technique	NET stiffened using guidewire(s). Grasping forceps used to push into small bowel
Through scope	240 cm NET used to allow exchange. Involves oro-pharyngeal exchange

Table 5 Principles/techniques of post-pyloric NET placement[67]

Decompress stomach to reduce gastroscope looping within stomach

Liberal lubrication needs to be applied to lower friction between guidewire/NET/gastroscope

A stiff shaft guidewire will help direct NET insertion along longitudinal axis

Table 6 Types of endoscopic placed feeding tubes

Short-term enteral feeding
Pre-pyloric endoscopic NET placement	Peroral pre-pyloric NET
	Transnasal pre-pyloric NET
Post pyloric endoscopic NET placement	Peroral post-pyloric NET
	Transnasal post-pyloric NET
Long-term enteral feeding
Pre-pyloric feeding	Endoscopic PEG
Post-pyloric feeding	Endoscopic PEGJ
	Endoscopic D-PEJ