[Percutaneous endoscopic gastrostomy. A new technic for enteral feeding]

Technical aspects of enteral nutrition

Advances in technical aspects of enteral feeding such as the manufacture of tubes from polyurethane or silicone have helped promote the science of enteral nutrition. Nasoenteral tubes have few complications, apart from a high unwanted extubation rate and some reluctance from patients because of cosmetic unacceptability. Needle jejunostomy has low morbidity but can only be placed at laparotomy. Percutaneous gastrotomy (in all its different guises) has been established as a low risk procedure and is the access route of choice for longterm enteral feeding, in particular for cancer, geriatric, and neurological patients.

Percutaneous endoscopic duodenostomy (PED). Case report

Surgeons are increasingly using endoscopy to place transabdominal feeding tubes for enteral nutrition or gastric decompression. A possible extension for the application of this new technique is the direct placement of the feeding tube into the duodenal bulb. Two patients are presented in whom percutaneous endoscopic duodenostomy was successfully performed, although percutaneous endoscopic gastrostomy was not possible. It shows that this new method is technically possible. In both patients the positive influence of this technique on the patient's quality of life could be shown using the Spitzer Quality of Life Index and the Karnofsky Performance Status. Enteral nutrition was maintained for more than 6 weeks.