Enteral feeding tubes

Malnutrition is a condition in which the body no longer functions properly because it is not receiving sufficient essential nutrients (carbohydrates, fats and proteins). In some situations, it becomes necessary to provide enteral nutrition: you then receive liquid food directly into the stomach or the first part of the small intestine (the jejunum), via a thin, flexible tube.

The choice of tube depends on your disease and the anticipated duration of enteral nutrition.

• In most cases, a tube inserted through the nose—called a nasogastric or nasojejunal tube—is sufficient to improve your nutritional status.

When enteral nutrition is required over the long term, the tube is inserted directly into the stomach (gastrostomy) or the small intestine (jejunostomy) endoscopically at the Digestive Endoscopy Clinic.

The gastrostomy is performed during a gastroscopy. To arrange for the tube to be placed, you will be seen by the clinical nutrition nurse or the gastroenterologist to prepare for your procedure. To prepare for your procedure: 

• Inform your doctor about your medical history and all the medicines you take, particularly those that affect blood clotting: aspirin, Plavix, Sintrom, Xarelto, Eliquis, Pradaxa, Lixiana, Innohep, Fraxiparine (the list is not exhaustive).
• Inform your doctor of any known allergies.
• Fast for at least 6 hours before the examination: do not eat, drink or smoke.
• Depending on your situation, the examination will be performed under light sedation or general anaesthesia. 

The procedure is performed by two gastroenterologists and generally takes between 15 and 30 minutes:

1. The first doctor inserts an endoscope (a thin, flexible camera) through the mouth into the stomach.
2. The second doctor identifies the best site on the abdominal wall from the outside, using the light from the endoscope.
3. A small incision of a few millimetres is made in the skin after local anaesthesia.
4. The tube is then passed from the inside outwards and secured in place, passing directly through the abdominal wall into the stomach (a technique commonly known as “pull gastrostomy”).

After the procedure, you will remain in hospital for at least 2 days to ensure that enteral nutrition through the gastrostomy is well tolerated.

The most frequent complications are pain around the tube opening, which is generally temporary. More rarely, bleeding or perforation may occur; these are detected promptly by means of an abdominal CT scan.

Before you are discharged, the dietitian and theclinical nutrition nurse will explain the type and quantity of enteral nutrition suited to your situation, as well as how to use the tube at home. If necessary, home nursing care will be arranged before your discharge.

Once the tube is in place, regular follow-up is essential to ensure your care proceeds smoothly:

• Regular consultations with the gastroenterologist and the clinical nutrition nurse
• Dietary assessments to adapt your nutritional intake to changes in your condition
• Blood tests to monitor your nutritional parameters

For young patients: the transition to adulthood

If you have been followed in paediatrics until now, the transition to an adult service is prepared gradually from the age of 16:

• Your paediatrician will contact the adult team and provide them with all the information concerning your health and treatment
• A first joint consultation — in the presence of your paediatrician and your new doctor responsible for your care — will be arranged, so that you do not feel alone during this stage
• If necessary,, follow-up in both services (paediatric and adult) can be maintained for a maximum of 6 months in order to facilitate this transition in complete peace of mind.

You can make an appointment for a consultation (by email at ConsGastroMed [dot] erasme [at] hubruxelles [dot] be or by telephone on +32 (0)2 555.35.04, or contact the H.U.B Gastroenterology Department directly at SecMed [dot] GastroMed [dot] erasme [at] hubruxelles [dot] be (SecMed[dot]GastroMed[dot]erasme[at]hubruxelles[dot]be)

You can also contact our clinical nutrition nurses, Asuncion Ballarin ( asuncion [dot] ballarin [at] hubruxelles [dot] be (asuncion[dot]ballarin[at]hubruxelles[dot]be)), Valerie Burion (val%C3%A9rie [dot] burion [at] hubruxelles [dot] be (valérie[dot]burion[at]hubruxelles[dot]be)), and, for the Jules Bordet Institute, Ingrid Amorison (ingrid [dot] amorison [at] hubruxelles [dot] be).