Surgery
ÎFeeding jejunostomy or venting gastrostomy tubes in upper GI motility disorders reduces hospitalization rate by a factor of 5 during the year after placement.
ÎGastric electric stimulation is approved for patients with refractory symptoms from diabetic or idiopathic gastroparesis but does not accelerate gastric emptying.
ÎNear-total gastrectomy may reduce nausea, vomiting, and postprandial pain in severe postsurgical gastric stasis but is rarely performed, even in tertiary centers.
Table 7. Enteral Access for Nutrition Supplementation Type of Access
Usefulness Nasogastric tube
• Gastric decompression in acute management
Disadvantages
• Not meant for long-term use • Large tube size often causes discomfort
• Is a poor choice for feeding due to delayed gastric emptying
• Significant gastro-esophageal reflux can occur
Nasoduodenal/ nasojejunal tube
Gastrostomy tubes
• Used to give trial feeding to determine if jejunal feedings are tolerated
• May be used for venting of secretions to decrease vomiting and fullness
Percutaneous endoscopic gastrojejunostomy (PEG-J) or Jejunal extension tube through PEG ( Jet- PEG)
Jejunostomy (surgical, endoscopic, radiographic)
Dual gastrostomy and jejunostomy
• Allows to patient to vent gastric secretions to decrease/prevent persistent emesis
• May be acceptable if there are no other options
• Not for long-term use • Vomiting may expel the tube into the stomach
• Poor choice for feeding due to delayed gastric emptying
• May prevent proper electrode placement for gastric electrical stimulation
• Migration of the J-tube extension into stomach
• Provides jejunal feedings • New PEG-Js have distal feeding ports to reduce duodenogastric reflux
• Stable access for reliable jejunal nutrient delivery
• Avoids gastric penetration, which would interfere with proper electrode placement for gastric electrical stimulation
• Two sites – one for venting and one for enteral nutrition
• Increased risk of leakage, infection • Cosmetic issues
• Pyloric obsruction from J-tube • May prevent proper electrode placement for gastric electrical stimulation
• Cannot vent stomach
