TY - JOUR
T1 - Endoscopic management of enteral tubes in adult patients - Part 1: Definitions and indicationsEuropean Society of Gastrointestinal Endoscopy (ESGE) Guideline
AU - Arvanitakis, Marianna
AU - Gkolfakis, Paraskevas
AU - Despott, Edward J.
AU - Ballarin, Asuncion
AU - Beyna, Torsten
AU - Boeykens, Kurt
AU - Elbe, Peter
AU - Gisbertz, Ingrid
AU - Hoyois, Alice
AU - Mosteanu, Ofelia
AU - Sanders, David S.
AU - Schmidt, Peter T.
AU - Schneider, Stéphane M.
AU - van Hooft, Jeanin E.
N1 - Funding Information: France (2016 to 2018); he has been or is a consultant for Laboratoires Grand Fontaine (2013), Nestlé Health Sciences (2020), and Baxter (2019). J.E. van Hooft has received lecture fees from Medtronic (2014 to 2015, 2019) and Cook Medical (2019), and consultancy fees from Boston Scientific (2014 to 2017); her department has received research grants from Cook Medical (2014 to 2019), and Abbott (2014 to 2017). M. Arvanitakis, A. Ballarin, K. Boeykens, P. Elbe, I. Gisbertz, P. Gkolfakis, A. Hoyois, O. Mosteanu, D. Sanders, and P. Thelin-Schmidt declare that they have no conflicts of interest. Publisher Copyright: © 2020 BMJ Publishing Group. All rights reserved.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Main recommendations ESGE recommends considering the following indications for enteral tube insertion: (i) clinical conditions that make oral intake impossible (neurological conditions, obstructive causes); (ii) acute and/or chronic diseases that result in a catabolic state where oral intake becomes insufficient; and (iii) chronic small-bowel obstruction requiring a decompression gastrostomy. Strong recommendation, low quality evidence. ESGE recommends the use of temporary feeding tubes placed through a natural orifice (either nostril) in patients expected to require enteral nutrition (EN) for less than 4 weeks. If it is anticipated that EN will be required for more than 4 weeks, percutaneous access should be considered, depending on the clinical setting. Strong recommendation, low quality evidence. ESGE recommends the gastric route as the primary option in patients in need of EN support. Only in patients with altered/unfavorable gastric anatomy (e. g. after previous surgery), impaired gastric emptying, intolerance to gastric feeding, or with a high risk of aspiration, should the jejunal route be chosen. Strong recommendation, moderate quality evidence. ESGE suggests that recent gastrointestinal (GI) bleeding due to peptic ulcer disease with risk of rebleeding should be considered to be a relative contraindication to percutaneous enteral access procedures, as should hemodynamic or respiratory instability. Weak recommendation, low quality evidence. ESGE suggests that the presence of ascites and ventriculoperitoneal shunts should be considered to be additional risk factors for infection and, therefore, further preventive precautions must be taken in these cases. Weak recommendation, low quality evidence. ESGE recommends that percutaneous tube placement (percutaneous endoscopic gastrostomy [PEG], percutaneous endoscopic gastrostomy with jejunal extension [PEG-J], or direct percutaneous endoscopic jejunostomy [D-PEJ]) should be considered to be a procedure with high hemorrhagic risk, and that in order to reduce this risk, specific guidelines for antiplatelet or anticoagulant use should be followed strictly. Strong recommendation, low quality evidence. ESGE recommends refraining from PEG placement in patients with advanced dementia. Strong recommendation, low quality evidence. ESGE recommends refraining from PEG placement in patients with a life expectancy shorter than 30 days. Strong recommendation, low quality evidence*.
AB - Main recommendations ESGE recommends considering the following indications for enteral tube insertion: (i) clinical conditions that make oral intake impossible (neurological conditions, obstructive causes); (ii) acute and/or chronic diseases that result in a catabolic state where oral intake becomes insufficient; and (iii) chronic small-bowel obstruction requiring a decompression gastrostomy. Strong recommendation, low quality evidence. ESGE recommends the use of temporary feeding tubes placed through a natural orifice (either nostril) in patients expected to require enteral nutrition (EN) for less than 4 weeks. If it is anticipated that EN will be required for more than 4 weeks, percutaneous access should be considered, depending on the clinical setting. Strong recommendation, low quality evidence. ESGE recommends the gastric route as the primary option in patients in need of EN support. Only in patients with altered/unfavorable gastric anatomy (e. g. after previous surgery), impaired gastric emptying, intolerance to gastric feeding, or with a high risk of aspiration, should the jejunal route be chosen. Strong recommendation, moderate quality evidence. ESGE suggests that recent gastrointestinal (GI) bleeding due to peptic ulcer disease with risk of rebleeding should be considered to be a relative contraindication to percutaneous enteral access procedures, as should hemodynamic or respiratory instability. Weak recommendation, low quality evidence. ESGE suggests that the presence of ascites and ventriculoperitoneal shunts should be considered to be additional risk factors for infection and, therefore, further preventive precautions must be taken in these cases. Weak recommendation, low quality evidence. ESGE recommends that percutaneous tube placement (percutaneous endoscopic gastrostomy [PEG], percutaneous endoscopic gastrostomy with jejunal extension [PEG-J], or direct percutaneous endoscopic jejunostomy [D-PEJ]) should be considered to be a procedure with high hemorrhagic risk, and that in order to reduce this risk, specific guidelines for antiplatelet or anticoagulant use should be followed strictly. Strong recommendation, low quality evidence. ESGE recommends refraining from PEG placement in patients with advanced dementia. Strong recommendation, low quality evidence. ESGE recommends refraining from PEG placement in patients with a life expectancy shorter than 30 days. Strong recommendation, low quality evidence*.
UR - http://www.scopus.com/inward/record.url?scp=85097404229&partnerID=8YFLogxK
U2 - https://doi.org/10.1055/a-1303-7449
DO - https://doi.org/10.1055/a-1303-7449
M3 - Article
C2 - 33260229
SN - 0013-726X
VL - 53
SP - 81
EP - 92
JO - Endoscopy
JF - Endoscopy
IS - 1
ER -