Enteral Access

Marcus D Jarboe, MD, K. Elizabeth Speck, MD, Farokh Demehri, MD, Adam C. Alder, MD, MSCS, Tom Black, Yigit Guner, MD
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Introduction

Enteral access is a common need in the pediatric surgical population. Gastrostomy (G) tubes, jejunostomy (J) tubes and combined gastrojejunostomy (GJ) tubes are all frequently used methods of enteral feeding access. Each type of access has its benefits and problems. Furthermore, there are a myriad of ways of creating each of these types of access.

What are the advantages of feeding through a gastrostomy or jejunostomy?

Other enteral feeding options include oro- or nasogastric or transpyloric tubes. Each of these alternatives is prone to dislodgement and the need for replacement. They are uncomfortable, unsightly, can cause epistaxis or sinusitis, hinder the patient from participating in routine activities and make eating and swallowing uncomfortable. Transcutaneous gastrostomy and jejunostomy tubes avoid or greatly minimize all of these concerns - particularly if a button is placed rather than a tube.

Compared to enteral feeds, parenteral nutrition requires placement of a central venous catheter, has an associated risk of sepsis, is more difficult to administer by nonmedical caregivers, is not as physiologically suitable and is much more expensive. Prolonged parenteral feeding results in atrophy and increased permeability of the gut mucosa. The lack of peristalsis results in the stagnation of bowel contents and changes in the intestinal microflora.

Disadvantages of the placement of enteral feeding tubes include the need for a surgical procedure, the need for care of the stoma site, potential for site infection, leaking from the site and scar formation.

Content in this topic is referenced in SCOREEsophagoscopy overview

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Introduction

Enteral access is a common need in the pediatric surgical population. Gastrostomy (G) tubes, jejunostomy (J) tubes and combined gastrojejunostomy (GJ) tubes are all frequently used methods of enteral feeding access. Each type of access has its benefits and problems. Furthermore, there are a myriad of ways of creating each of these types of access.

What are the advantages of feeding through a gastrostomy or jejunostomy?

Other enteral feeding options include oro- or nasogastric or transpyloric tubes. Each of these alternatives is prone to dislodgement and the need for replacement. They are uncomfortable, unsightly, can cause epistaxis or sinusitis, hinder the patient from participating in routine activities and make eating and swallowing uncomfortable. Transcutaneous gastrostomy and jejunostomy tubes avoid or greatly minimize all of these concerns - particularly if a button is placed rather than a tube.

Compared to enteral feeds, parenteral nutrition requires placement of a central venous catheter, has an associated risk of sepsis, is more difficult to administer by nonmedical caregivers, is not as physiologically suitable and is much more expensive. Prolonged parenteral feeding results in atrophy and increased permeability of the gut mucosa. The lack of peristalsis results in the stagnation of bowel contents and changes in the intestinal microflora.

Disadvantages of the placement of enteral feeding tubes include the need for a surgical procedure, the need for care of the stoma site, potential for site infection, leaking from the site and scar formation.

Content in this topic is referenced in SCOREEsophagoscopy overview

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Last updated: January 20, 2022