College Answer

Nasogastric tube: simple, commonly used, cheap, can assess and retrieve residual gastric contents (depends on tube size), advantages of gastric feeding (tolerant of bolus and continuous feeds, buffers gastric acids, bactericidal action of acid, gastric pepsin and lipase facilitate absorption of most feeds) BUT aesthetic appearance, potential trauma of insertion, potential misplacement during insertion (especially critically ill), requires radiological confirmation of placement, easily dislodged, sinusitis, increase aspiration risk (less competence gastro-oesophageal sphincter), potential for gastric distension, tolerance of feeding susceptible to gastroparesis (emesis, regurgitation).

PEG:  avoids nose/mouth issues, better tolerated than nasogastric, less likely to be displaced than nasaogastric, can assess and retrieve gastric contents (if large bore and in stomach), advantages of gastric  feeding  (see  above),  avoids  interfering  with  gastro-oesophageal  sphincter  BUT  more complex to insert, less commonly performed, more expensive tube, requires endoscopy (with associated complications), percutaneous wound, often larger bore tube with potential for trauma and displacement, potential for gastric distension, tolerance of feeding susceptible to gastroparesis (emesis, regurgitation).

Percutaneous feeding jejunostomy:  avoids nose/mouth issues, better tolerated than nasogastric, less  likely  to  be  displaced  than  others,  avoids  interfering  with  gastro-oesophageal sphincter, bypasses stomach and allows earlier feeding (avoids gastric distension and problems of gastroparesis), theoretically better for pancreatitis (less pancreatic exocrine secretion) BUT more complex  to  insert,  less  commonly performed, more  expensive tube,  requires  endoscopy &/or surgery (with associated complications), percutaneous wound, small bore tube with potential for displacement and blockage (eg. with enteral drugs), less tolerant of bolus or high volume infusions.

Discussion

This question is identical to Question 20 from the first paper of 2008.