ASGE Endo Hangout: Primer on Enteral Feeding | March 2022 OLWEBMAR0322-Primer on Enteral Feeding

Video Transcription

Video Summary

ASGE’s Endo Hangouts webinar for GI fellows focused on enteral feeding tube placement, tube types, care, and complications. Dr. Kevin Ruff reviewed indications such as dysphagia, weight loss, aspiration risk, and diseases including head/neck or esophageal malignancy, neurologic disorders (stroke, ALS), and gastroparesis. Pre-procedure preparation includes history/physical (prior surgeries, mesh, altered anatomy), considering cross-sectional imaging to identify intervening organs, and labs (CBC, electrolytes including magnesium/phosphorus for refeeding risk, and coagulation studies). Patients should be appropriately NPO, with added caution for delayed gastric emptying. Prophylactic antibiotics targeting skin flora (e.g., cephalosporin; vancomycin if allergic) should be given around incision time.<br /><br />He outlined tube locations (gastric, jejunal, gastrojejunal) and placement approaches (endoscopic, radiologic, surgical), plus techniques: pull (Gauderer-Ponsky), push (Sachs-Vine), and introducer (transabdominal with dilation, often with gastric anchors). Tube features discussed included standard vs low-profile “button” devices, balloon vs non-balloon internal retention, French sizes (often preferring 20 Fr to reduce clogging while allowing closure), tract length options, and ENFit connectors designed to prevent misconnections to IV lines.<br /><br />Care topics included starting feeds as early as 4 hours post-placement (practice-dependent), bolus/gravity feeds for gastric tubes, and pump feeds for jejunal delivery. Site care favors soap/water, avoiding peroxide, minimizing dressings, and limiting soaking early. Complications reviewed included infection, bleeding, misplacement, buried bumper, dislodgement (urgent replacement), leakage, hypergranulation (topical steroids or silver nitrate), refeeding syndrome monitoring, and tube occlusion management (flushes, 10 mL syringe agitation, enzyme/bicarbonate solutions; avoid soda/meat tenderizer). Q&A addressed anticoagulation considerations, cancer seeding risk (favor introducer technique), and troubleshooting bleeding and early dislodgement.

Keywords

enteral feeding tube placement

PEG tube

gastrostomy tube care

jejunal feeding tube

gastrojejunal tube

Gauderer-Ponsky pull technique

Sachs-Vine push technique

introducer gastrostomy technique

ENFit connectors

refeeding syndrome monitoring

buried bumper syndrome

tube occlusion management