Enteral access procedures revisited in the era of minimally invasive surgery

The impact of adequate nutrition on wound healing, immunity and patient morbidity has been ap preciated since the early work of Stanley Dudrik in the late 60s and early 70s. Although total parenteral nutrition improved the outcome in nutritionally debilitated patients, it often led to overwhelming infections in these immunologically sensitive patients. In the 90s, the importance of gut as an endocrine and immune organ has been well established, as weU as the superiority of enteral feeding over parenteral nutrition, in most cases. Here we discuss the available techniques for accessing the gastrointestinal tract as well as the guidelines for selection of patients.