12.15 : Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding

Enteral nutrition encompasses various methods of delivering nutrition directly to the gastrointestinal (GI) tract, bypassing traditional oral intake. It is particularly beneficial for patients who cannot eat by mouth but have a functioning digestive system. Key methods include nasointestinal feeding, gastrostomy, and jejunostomy, each suited to different clinical scenarios based on the patient's needs and condition.

Nasointestinal Feeding

Nasointestinal feeding involves placing a tube through the nose into the small intestine, either the duodenum (nasoduodenal feeding) or the jejunum (nasojejunal feeding). This approach is appropriate for shorter periods, generally less than four weeks, due to discomfort, risk of tube dislodgement, and need for regular adjustment. Radiographic confirmation is often used for accurate tube placement and is particularly useful in conditions where it is essential to bypass the stomach:

1. Nasoduodenal Feeding: Targets the duodenum and is often used for patients with conditions like gastroparesis (delayed gastric emptying) or severe gastroesophageal reflux disease (GERD), where bypassing the stomach can reduce symptoms and improve nutrient absorption.
2. Nasojejunal Feeding: Extends further into the jejunum, suitable for conditions such as pancreatitis, where it is crucial to limit the stimulation of the pancreas that food passing through the stomach might cause.

Gastrostomy Feeding

Gastrostomy involves creating an opening from the abdomen directly into the stomach (stoma) to insert a feeding tube. This method provides a more permanent solution for enteral feeding. It is indicated for patients with long-term nutritional support needs, such as those with neurological conditions leading to dysphagia (difficulty swallowing) from a stroke. Gastrostomy tubes can be placed using surgical, radiological, or endoscopic techniques, each with its indications, benefits, and considerations. This route is favored for its stability, patient comfort, and suitability for long-term use.

Jejunostomy Feeding

Jejunostomy feeding involves placing a tube directly into the jejunum through the abdominal wall. This method is selected when feeding into the stomach is not possible or advisable, such as in patients with chronic aspiration risk due to severe reflux or those with gastroparesis where even the duodenum's bypass is necessary. Jejunostomy can be performed surgically or endoscopically and is reserved for long-term nutrition in patients whose condition precludes the use of the stomach for feeding.

Additional Considerations

Careful monitoring and management are crucial for all enteral feeding methods to ensure proper nutrition, avoid complications, and address common issues such as tube displacement, infection at the insertion site, and dietary intolerances. Coordination with a multidisciplinary team, including dietitians, pharmacists, and physicians, is essential to tailor the nutrition plan to each patient's needs, monitor their progress, and adjust as required.

Enteral nutrition through nasointestinal feeding, gastrostomy, and jejunostomy each offer valuable options for supporting patients with diverse nutritional needs.