Enteral Access: Percutaneous Endoscopic Gastrostomy, Gastrostomy-Jejunostomy, and Jejunostomy

Abstract

Endoscopic approaches for enteral feeding access are the preferred method of long-term nutrition support. Compared to parenteral nutrition, enteral feeding provides physiological and structural benefits to the gastrointestinal tract, which in turn have systemic benefits. Additionally, endoscopic modalities are less invasive than surgical approaches, thereby reducing complication rates and duration of hospital stay. Percutaneous endoscopic gastrostomy was first introduced in 1980 and served as a cornerstone for the development of percutaneous endoscopic gastro-jejunostomy and percutaneous endoscopic jejunostomy. These procedures are commonly performed today for patients with various chronic, traumatic, or malignant conditions and who are in need of nutritional support. Although endoscopic enteral access provides many benefits, understanding its indications and limitations is critical for performing these procedures safely and effectively. This chapter provides an overview of current knowledge and practices in the rapidly evolving field of endoscopic enteral access, with emphasis on patient selection, preoperative considerations, technical conduct, and avoidance of complications.