A comparison of enteral feeding tubes

This has come from Question 15 from the first paper of 2003, and Question 20 from the first paper of 2008. Elsewhere, there is a brief summary of the routes of enteral nutrition and it contains the table displayed below.

~Enteral Feeding Routes~
A Comparison of the Nasogastric Tube, Percutaneous Endogastic Tube and Feeding Jejunostomy
Tube type Advantages Disadvantages
Nasogastric
  • Easy to insert
  • The tubes are cheap
  • Gastric aspiration is possible
  • Gastric food delivery buffers gastric acids and protects the gastric mucosa
  • The gastric acid has a bactericidal action which helps prevent gastroenteritis
  • Gastric secretions (gastric pepsin and lipase) facilitate absorption of feeds, which means one is not limited to any specialised feed mixtures
  • Uncomfortable in the awake patient
  • It is easily dislodged by a delirious patient
  • It may increase aspiration risk because the gastro-oesophageal sphincter is less competent when there is something constantly in it.
Nasojejunal tube
  • Decreased risk of aspiration.
  • Decreased stimulus to pancreatic secretion.
  • Uncomfortable in the awake patient
  • Difficult to place.
  • Not exactly cheap
  • One must wait for the tip to migrate into the jejunum
  • Impossuble to administer large boluses.
  • Gastric mucosa is unprotected from acid, and loses trophic stimulus
  • The feeds do not benefir from the bactericidal eactivity of stomach acid
  • Absorption may be impaired due to the loss of gastric pepsin and lipase; specialised mixtures may be required
PEG tube
  • Improved tolerance in the awake patient
  • None of the facial pressure are complications
  • No sinusitis or mucositis
  • No risk of oesophageal stricture
  • Better tolerance in the extremely long term (one can have a percutaneous tube for their entire life)
  • Nice, large bore tube - less likely to block
  • All the advantages of gastric feeding (eg. tolerance of bolus feeds, sterilising effects of stomach acid and usefulness of gastric digestive enzymes)
  • All the advantages of NG sumps - can aspirate and sample gastric contents
  • Less likely to result in aspiration, as it does not interfere with the gastrooesophageal sphincter.
  • Alows earlier feeding, as poor gastric emptying is not an issue
  • Needs to be surgically placed
  • Requires endoscopy to position
  • Risk of early dislodgement and loss of the imamture fistula tract
  • Tube can block unless it is wide-bore
  • Skin erosion and ulceration may take place.
Feeding jejunostomy
  • Improved tolerance in the awake patient
  • None of the facial pressure are complications
  • No sinusitis or mucositis
  • No risk of oesophageal stricture
  • Least likely to be dislodged
  • Alows earlier feeding, as poor gastric emptying is not an issue
  • Decreased stimulus to pancreatic secretion.
  • Needs to be surgically placed
  • Requires endoscopy, or more usually laparoscopy, to position
  • It is a small bore tube which is blocked more easily
  • One can neither aspirate it, nor bolus-feed through it

References

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. Warner Tracheopleuropulmonary injuries following enteral tube insertion J Natl Med Assoc. 1989 March; 81(3): 275–281. PMCID: PMC2571629 .

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