Guidelines For Clinical Practice
Copyright ©2010 Baishideng.
World J Gastrointest Endosc. May 16, 2010; 2(5): 155-164
Published online May 16, 2010. doi: 10.4253/wjge.v2.i5.155
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
High output small bowel fistula
High doses positive inotropic agents
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 pullSutured distal end of NET is pulled down small bowel using grasping forceps
Over the guidewireGuidewire placed in small bowel and NET placed over guidewire. Involves difficult oro-pharyngeal exchange
Push techniqueNET stiffened using guidewire(s). Grasping forceps used to push into small bowel
Through scope240 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 placementPeroral pre-pyloric NET
Transnasal pre-pyloric NET
Post pyloric endoscopic NET placementPeroral post-pyloric NET
Transnasal post-pyloric NET
Long-term enteral feeding
Pre-pyloric feedingEndoscopic PEG
Post-pyloric feedingEndoscopic PEGJ
Endoscopic D-PEJ