Enteral Nutrition by Endoscopic Means; I. Techniques, Indications, Types of Enteral Feed
Enterale Sondenernährung - Techniken, Indikationen und SondendiätenO. Schröder1
, N. Hoepffner1
, J. Stein1
1Medizinische Klinik I, ZAFES, J. W. Goethe-Universität Frankfurt, Frankfurt/Main, Germany
The authors are grateful to Professor Jennifer Dressman for reviewing the manuscript. This work was supported by the Else Kröner-Fresenius-Stiftung, Bad Homburg.
Die künstliche enterale Ernährung spielt eine wichtige Rolle in der Therapie kritisch kranker Patienten auf Intensivstationen, bei Patienten mit (willentlich) unzureichender Nahrungszufuhr, chronischer neurologisch oder mechanisch bedingter Dysphagie sowie intestinaler Dysfunktion. Teil I dieser Übersicht befasst sich mit den in der enteralen Ernähung eingesetzten Sonden und Applikationstechniken und beschreibt darüber hinaus detailliert die endoskopisch-gestützten Sondierungsverfahren, wie perkutane endoskopische Gastrostomie, direkte endoskopische Jejunostomie oder den „One-step-Button”. In einem weiteren Abschnitt werden ausführlich die zur Ernährung verwendeten Nährstofflösungen unter Fokussierung auf nährstoffdefinierte Spezialdiäten im Rahmen bestimmter Erkrankungen dargestellt. Schließlich werden innovative Nährstoffsubstrate wie Arginin, w3-Fettsäuren, Glutamin und Nukleotide besprochen, denen aufgrund ihrer immunmodulierenden Wirkung eine besondere Bedeutung in der Ernährung kritisch Kranker zugesprochen wird. Im zweiten Teil dieser Übersicht werden Komplikationen und Langzeitergebnisse der verschiedenen in der enteralen Ernährung verwendeten Sondentechniken ausführlich erörtert.
Abstract
Enteral nutritional support plays a major role in the management of patients who are critically ill in intensive care units (ICU), those with poor volitional intake, persons with chronic neurological or mechanical dysphagia, and individuals with gut dysfunction. Part I of this review will briefly discuss the principles governing nasoenteral feeding and will describe in detail the endoscopic-assisted methods for placing enteral feeding tubes. These include percutaneous endoscopic gastrostomy, jejunal extension through a percutaneous endoscopic gastrostomy or direct endoscopic jejunostomy, and the “one-step button”. In addition, the types of enteral food with focus on disease-specific enteral diets will be discussed. Finally, the latest innovations in enteral feeding including immune-enhancing nutrients such as arginine, omega-3 fatty acids, glutamine, and nucleotides advocated for critically ill patients will be discussed. Questions regarding possible complications and long-term results of the various methods of enteral feeding will be discussed separately in part II.
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