TableĀ 1:

Characteristics of the four types of enteral feeding tube*

Feeding tube
NasoenteralOesophagostomyGastrostomyJejunostomy
Typical size5 to 8 French8 to 19 French16 to 28 French5 to 8 French
PlacementRelatively easy to place, generally using intranasal local anaesthesiaRelatively easy to place under general anaesthesia with minimal equipmentPlaced under general anaesthesia using surgery, blind or percutaneous endoscopy techniquesNasojejunal tube can generally be placed without general anaesthesia or sedation. Gastrojejunostomy and enterostomy tubes require general anaesthesia. Enterostomy tubes can be placed using surgery or laparoscopy
Length of time usedThree to seven daysWeeks to monthsAt least 12 monthsDuration of hospitalisation (up to 4 weeks in one study [Novo and others 2001]
IndicationsAnticipated short-term anorexia or anaesthetic riskAnticipated longer-term anorexia (more than seven days' duration); mandibular, maxillary, nasal or pharyngeal diseaseAnticipated longer-term anorexia (more than seven days' duration); mandibular, maxillary, nasal, pharyngeal or oesophageal diseaseWhen gastric feeding is contraindicated (eg, cases of pancreatitis, severe functional or physiological disease of the stomach, delayed gastric emptying, proximal obstruction or intractable vomiting)
ContraindicationsNasal, oral, pharyngeal or oesophageal disease or trauma; reduced consciousness; protracted vomiting or regurgitation; coagulopathyOesophageal disease; coagulopathy; anaesthetic risk; reduced consciousness; protracted vomiting or regurgitationWhen gastric feeding is contraindicated (eg, cases of pancreatitis, severe functional or physiological disease of the stomach, delayed gastric emptying, proximal obstruction or intractable vomiting); coagulopathy; anaesthetic risk; reduced consciousnessCoagulopathy; anaesthetic risk (generally except nasojejunal feeding tube)
AdvantagesAnaesthesia or special equipment are not needed; relatively non-invasive; relatively inexpensiveLight/short anaesthesia needed; relatively easy to place without the need for special equipment; relatively inexpensive; generally well tolerated with only a light neck bandage needed; little danger of serious life-threatening complications if the tube is inadvertently removed before stoma formation; can be maintained by the owner at homeLarger diameter tube allows more dietary options; gastric residual volume can be checked; oesophagus is bypassed if megaoesophagus or oesophagitis is presentAvoids stomach, duodenum and pancreas
DisadvantagesGenerally for in-hospital use only; usually short-term use only; may be uncomfortable as an Elizabethan collar is required; the tube may be removed inadvertently by the patient due to vomiting or sneezing; only liquid feedings are possible due to the tube's small diameter; daily energy requirements are hard to achieve without continuous-rate infusionGeneral anaesthesia required; there is potential for infection at entry site; the gastric residual volume cannot be checked in cases of suspected ileusGeneral anaesthesia and specialised equipment are required in some cases; there is a risk of septic peritonitis if the tube is inadvertently removed before stoma formation (before 12 to 14 days); a longer/deeper anaesthetic is needed, which may increase risk and costGastrojejunostomy and enterostomy tubes require general anaesthesia; in-hospital use only and therefore relatively short-term use; specialised liquid diet required due to the tube's small diameter and location; there is a risk of septic peritonitis if the tube is inadvertently removed before stoma formation (before 12 to 14 days)
Possible complicationsIncorrect placement of the tube resulting in aspiration pneumonia; nasal irritation; obstruction of tube with food or due to kinking; the tube can be removed by vomiting or sneezingInfection at the entry site; obstruction of tube with food or medication, or kinking; the tube can be removed by vomitingSeptic peritonitis due to tube removal before stoma formation; gastric bleeding during placement; improper tube placement; vomiting; infection or leakage at the entry site; aspiration pneumoniaSeptic peritonitis due to tube removal before stoma formation; retrograde tube migration; vomiting/diarrhoea; cellulitis at the entry site; tube obstruction; leakage of gastrointestinal contents
  • * Saker and Remillard (2010), Larsen (2012)