Pushing the PEG

The Better Method in Tube Feeding

Enteral (“through the gut”) feeding is recognised as the preferred method of delivering nutrition, over intravenous methods, for those who are unable to maintain nutrition on their own. It is the most natural way of nutritional delivery, while it also maintains the defence systems of the gut for better immunity, and costs less compared to intravenous nutrition.

WAYS OF DELIVERY

For those who are unable to ingest or imbibe safely because of various reasons, including neurological conditions, tumours of the oral cavity or functional decline, tube feeding is the most common way of delivering enteral nutrition.

The most common tube employed is the nasogastric (NG) tube, which is a long plastic or silicone tube that is inserted through the nostrils and oesophagus, and ends in the stomach. While this is the simplest method, it has its own set of drawbacks. For example, it needs to be changed frequently (every two weeks), can be irritating to the nostrils and throat, and can potentially promote aspiration pneumonia. Aspiration pneumonia is a potentially serious condition where food contents backflow from the stomach into the lungs causing infection. The constant presence of an NG tube in the oesophagus keeps the sphincter open and potentially promotes the backflow of gastric contents.

There have also been rare cases where NG tubes were accidentally inserted into the airways. If undetected, this can potentially lead to fatal consequences.

GASTROSTOMY TUBES

Gastrostomy tubes are an increasingly common alternative to NG tubes, whereby a shorter tube is inserted through the abdominal wall directly into the stomach in a simple surgical procedure. A gastrostomy tube provides a shorter conduit for the delivery of enteral nutrition at faster speeds (as the tube is often wider) and it does not encourage aspiration pneumonia.