Gastroenteric tube feeding: Techniques, problems and solutions

Abstract

Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction, and patients who are critically ill. However, despite the benefits and widespread use of enteral tube feeding, some patients experience complications. This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding, together with associated complications and special aspects. We conducted an extensive literature search on PubMed, Embase and Medline using index terms relating to enteral access, enteral feeding/nutrition, tube feeding, percutaneous endoscopic gastrostomy/jejunostomy, endoscopic nasoenteric tube, nasogastric tube, and refeeding syndrome. The literature showed common routes of enteral access to include nasoenteral tube, gastrostomy and jejunostomy, while complications fall into four major categories: mechanical, e.g., tube blockage or removal; gastrointestinal, e.g., diarrhea; infectious e.g., aspiration pneumonia, tube site infection; and metabolic, e.g., refeeding syndrome, hyperglycemia. Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route, gastrointestinal complications are without doubt the most common. Complications associated with enteral tube feeding can be reduced by careful observance of guidelines, including those related to food composition, administration rate, portion size, food temperature and patient supervision.

Keywords: Enteral tube feeding, Percutaneous endoscopic gastrostomy, Refeeding syndrome, Enteral nutrition, Buried bumper syndrome, Nasoenteral tubes, Colocutaneous fistulae

Core tip: Keeping up with new developments in the fast-moving field of enteral nutrition is a challenge for any gastroenterologist. While enteral tube feeding plays a major role in the care of critically ill patients and those with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction, mechanical, gastrointestinal, infectious and metabolic complications can lead to serious conditions or death. We have undertaken a comprehensive review of current literature assessing the safety and effectiveness of various endoscopic, sonographic, radiologic, electromagnetic and fluoroscopic application techniques. In addition, we address prophylactic measures to prevent complications, problem solutions and special aspects.