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View of the left optic nerve 6 months after an optic 26 PART I BASIC CONSIDERATIONS TABLE 1-4 Options for Enteral Feeding Access Access option Nasogastric tube Nasoduodenalnasojejunal Percutaneous endoscopic gastrostomy (PEG) Surgical gastrostomy Fluoroscopic gastrostomy PEG-jejunal tube Direct percutaneous endoscopic jejunostomy (DPEJ) Surgical jejunostomy Fluoroscopic jejunostomy Comments Short-term use only; aspiration risks; nasopharyngeal trauma; frequent dislodgment Short-term use; lower aspiration risks in jejunum; placement challenges (radiographic assistance often necessary) Endoscopy skills required; may be used for gastric decompression or bolus feeds; aspiration risks; can last 1224 months; slightly higher complication rates with placement and site leaks Requires general anesthesia and small laparotomy; may allow placement of extended duodenaljejunal feeding ports; laparoscopic placement possible Blind placement using needle and T-prongs to anchor to stomach; can thread smaller catheter through gastrostomy into duodenumjejunum under fluoroscopy Jejunal placement with regular endoscope is operator dependent; jejunal tube often dislodges retrograde; two-stage procedure with PEG placement, followed by fluoroscopic conversion with jejunal feeding tube through PEG Direct endoscopic placement with enteroscope; placement challenges; greater injury risks Commonly applied during laparotomy; general anesthesia; laparoscopic placement usually requires assistant to thread catheter; laparoscopy offers direct visualization of catheter placement Difficult approach with injury risks; not commonly done Nasoenteric tubes.
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