Endoscopic techniques for enteral nutrition: standards and innovations

Enteral nutrition has been increasingly used in clinical practice during the past decades. Today, nasogastric, nasoenteric, and transcutaneous gastric or enteral feeding tubes are well established as a routine endoscopic intervention. After clinical introduction of percutaneous endoscopic gastrostomy (PEG) in 1980, the sutureless 'pull' PEG has become a widespread endoscopic technique for transcutaneous gastric long-term nutrition. Multiple new techniques have been introduced since then, and today even long-term jejunal nutrition can be achieved with modified techniques. The introducer PEG (first reported in 1984) has not become an established procedure, but new techniques with an endoscopic gastropexy might be a more effective approach. To increase the quality of life of the patients, skin-level devices were designed and successfully introduced in 1984. A new development has been the one-step feeding tubes which provide the patients with a permanent tube. The standard techniques for long-term enteral feeding, new developments of feeding tubes, and future concepts are discussed in this review.