Current management of endoscopic feeding tube dysfunction

Abstract

Surgically placed gastrostomy and jejunostomy feeding tubes allow administration of enteral nutrition for patients who are unable to swallow safely. Several endoscopic techniques have been used for tube placement. Endoscopically placed feeding tubes provide access to the gastrointestinal tract, but only when patent. Use of the approaches presented permits optimal feeding tube care and prolongs tube patency. Table 1 summarizes the recommendations for preventing and restoring patency to feeding tubes.

Multidisciplinary Practical Guidelines for Gastrointestinal Access for Enteral Nutrition and Decompression From the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, With Endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE)

“…GI tubes have a tendency to clog, especially tubes of smaller diameter. This occurs between 20% and 45% of the time, depending on the definition of tube occlusion (149). This number could be increased 10-fold if gastric residuals are checked through the feeding tube (148).…”

Emergency department visits by demented patients with malfunctioning feeding tubes

“…Complications of feeding tubes are well described [1,4,5,7,[12][13][14] Minor complications including hematomas, peristomal infections, and mechanical tube malfunctions occur in 3% to 85% of cases [1,5]. Major complications including severe bleeding, systemic infection, and even death occur in 3% to 8% of cases [5,7].…”

“…It has been demonstrated, however, that the efficacy of feeding these patients by surgically or endoscopically placed tubes can be debated on both clinical [2] and ethical [6,8,11] grounds. Although the complications of feeding tubes are well documented [4,5,[12][13][14] tube malfunction requiring emergency department (ED) evaluation has not been studied with regard to its frequency and resource utilization. If this method of feeding is ineffective and associated with costly complications, alternative methods for feeding terminally demented patients should be considered.…”