Flexible endoscopy and enteral nutrition.

The use of intensive nutritional support to meet the metabolic nutrient requirements of critically ill patients has become standard medical treatment. It has been shown that enteral feeding provides significantly better metabolic support than long-term intravenous hyper-alimentation and therefore, endoscopic placement of enteral access has become common-place. As an extension of flexible endoscopy, the transoral or percutaneous placement of enteral access devices is appropriate for patients with gastrointestinal disease, post-trauma support, and oncologic processes. The main access route continues to be achieved through the use of nasoenteric feeding tubes that may be facilitated by endoscopic placement. Percutaneous endoscopic gastrostomy and jejunostomy have become reliable methods of achieving enteral access as videoendoscopy usage has increased. The placement of jejunal feeding tubes reduces the opportunity for reflux of gastric content and, in the long-term, has proven a reliable method for enteral support.