Compare and contrast the advantages and disadvantages of enteral feeding via a nasogastric tube, a PEG and a percutaneous feeding jejunostomy.
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, moreexpensive 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.
Elsewhere, there is a brief summary of the routes of enteral nutrition, and it contains this table, which is essentially a tabulated form of the stream-of-consciousness answer offered by the college.
M Keymling Technical aspects of enteral nutrition Gut 1994; supplement 1: S77-S80
Hayden White1*, Kellie Sosnowski1, Khoa Tran1, Annelli Reeves2 and Mark Jones A randomised controlled comparison of early post-pyloric versus early gastric feeding to meet nutritional targets in ventilated intensive care patients. Critical Care 2009, 13:R187 doi:10.1186/cc8181
Eatock FC, Chong P, Menezes N, Murray L, McKay CJ, Carter CR, Imrie CW. A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. Am J Gastroenterol. 2005 Feb;100(2):432-9.
O. Odocha, R. C. Lowery, Jr, H. M. Mezghebe, S. M. Siram, and O. G. WarnerTracheopleuropulmonary injuries following enteral tube insertion J Natl Med Assoc. 1989 March; 81(3): 275–281. PMCID: PMC2571629 .