Administration of enteral nutrition in adults

Enteral nutrition can be given through nasal or percutaneous tubes into the stomach or small intestine (usually the jejunum). Percutaneous tubes are recommended if prolonged enteral nutrition is anticipated or if the gastrointestinal tract cannot be accessed via the nasal route (eg after oesophagostomy). Additionally, placement of a gastrostomy may be considered for patients who have oesophageal obstruction or a swallowing disorder. Gastrostomy may also be considered as replacement for a long-term nasogastric tube or as a decompressive tube for palliation (carcinomatosis, gastric obstruction, gastroparesis). Gastrostomies do not decrease silent aspiration risk.

Contraindications to gastrostomy insertion include serious coagulation disorders, haemodynamic instability, sepsis, marked ascites, peritonitis, abdominal wall infection at the placement site, marked peritoneal carcinomatosis, history of total gastrectomy, and prognosis of less than 4 weeks.