Advances in nutritional delivery interventions

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, percutaneous endoscopic gastrostomy, percutaneous gastrojejunostomy, or direct percutaneous endoscopic jejunostomy. This article would review the most common endoscopic methods with emphasis on helpful expert tips as well as recent innovations to facilitate placement success and decrease complications. Recent innovations include the modified drag technique and pull technique and electromagnetic sensor–guided placement of nasoenteric tubes. The introducer method using gastropexy and transnasal endoscopy can be useful in certain situations for percutaneous endoscopic gastrostomy. The drag and clip technique and transgastrostomy endoscopy for percutaneous gastrojejunostomy, and balloon-assisted enteroscopy for direct percutaneous endoscopic jejunostomy can improve success and efficiency for jejunal access. Finally new techniques for stoma fistula closure, periprocedural anticoagulation management and indications for radiologic placement of feeding tubes are detailed as well. The expert endoscopist should have a variety of tools and techniques in his armamentarium for successful and safe enteral feeding tube placement.