PDF herunterladen
Z Gastroenterol 2004; 42(12): 1385-1392
DOI: 10.1055/s-2004-813806
Übersicht

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

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.
Weitere Informationen

Publikationsverlauf

manuscript received: 28.8.2004

manuscript accepted: 20.10.2004

Publikationsdatum:
09. Dezember 2004 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

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.

Schlüsselwörter

Perkutane endoskopische Gastrostomie - enterale Sondennernährung - Introducermethode - Pulltechnik - lokale Infektionen - Langzeiternährung - Button - Gastrostomie - jejunale Ernährung - nasoenterale Sonden

Key words

Percutaneous endoscopic gastrostomy - enteral tube feeding - introducer technique - pull method - local infections - long-term nutrition - skin-level gastrostomy - one-step button - jejunal nutrition - nasoenteral tube

References

  • 1 Angus F, Burakoff R. The percutaneous endoscopic gastrostomy tube. Medical and ethical issues in placement.  Am J Gastroenterol. 2003;  98 272-277
    PubMedGoogle Scholar
  • 2 Ponsky J L. Transilluminating percutaneous endoscopic gastrostomy.  Endoscopy. 1998;  30 656
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 3 Ryan J M, Hahn P F, Mueller P R. Performing radiologic gastrostomy or gastrojejunostomy in patients with malignant ascites.  AJR Am J Roentgenol. 1998;  171 1003-1006
    PubMedGoogle Scholar
  • 4 Levy H. Nasogastric and nasoenteric feeding tubes.  Gastrointest Endosc Clin N Am. 1998;  8 529-549
    PubMedGoogle Scholar
  • 5 Zaloga G P. Bedside method for placing small bowel feeding tubes incritically ill patients. A prospective study.  Chest. 1991;  100 1643-1646
    PubMedGoogle Scholar
  • 6 Ott D J, Mattox H E, Gelfand D W. et al . Enteral feeding tubes: placement by using fluoroscopy and endoscopy.  AJR Am J Roentgenol. 1991;  157 769-771
    PubMedGoogle Scholar
  • 7 Gomes G F, Pisani J C, Macedo E D. et al . The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia.  Curr Opin Clin Nutr Metab Care. 2003;  6 327-333
    CrossrefPubMedGoogle Scholar
  • 8 Hull M A, Rawlings J, Murray F E. et al . Audit of outcome of long-term enteral nutrition by percutaneous endoscopic gastrostomy.  Lancet. 1993;  341 869-872
    CrossrefPubMedGoogle Scholar
  • 9 Gauderer M W, Ponsky J L, Izant R J Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique.  J Pediatr Surg. 1980;  15 872-875
    CrossrefPubMedGoogle Scholar
  • 10 Hoepffner N, Schroder O, Stein J. Enteral nutrition by endoscopic means; II. Complications and management.  Z Gastroenterol. 2004;  42 1393-1398
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 11 Hogan R B, DeMarco D C, Hamilton J K. et al . Percutaneous endoscopic gastrostomy - to push or pull. A prospective randomized trial.  Gastrointest Endosc. 1986;  32 253-258
    Google Scholar
  • 12 Bleck J S, Reiss B, Gebel M. et al . Percutaneous sonographic gastrostomy: method, indications, and problems.  Am J Gastroenterol. 1998;  93 941-945
    CrossrefPubMedGoogle Scholar
  • 13 Russell T R, Brotman M, Norris F. Percutaneous gastrostomy. A new simplified and cost-effective technique.  Am J Surg. 1984;  148 132-137
    CrossrefPubMedGoogle Scholar
  • 14 Dewald C L, Hiette P O, Sewall L E. et al . Percutaneous gastrostomy and gastrojejunostomy with gastropexy: experience in 701 procedures.  Radiology. 1999;  211 651-656
    CrossrefPubMedGoogle Scholar
  • 15 Dormann A J, Glosemeyer R, Leistner U. et al . Modified percutaneous endoscopic gastrostomy (PEG) with gastropexy - early experience with a new introducer technique.  Z Gastroenterol. 2000;  38 933-938
    Google Scholar
  • 16 Dormann A J, Huchzermeyer H. Endoscopic techniques for enteral nutrition: standards and innovations.  Dig Dis. 2002;  20 145-153
    CrossrefPubMedGoogle Scholar
  • 17 DeLegge M H, Duckworth P F Jr, McHenry L Jr. et al . Percutaneous endoscopic gastrojejunostomy: a dual center safety and efficacy trial.  JPEN J Parenter Enteral Nutr. 1995;  19 239-243
    PubMedGoogle Scholar
  • 18 DeLegge M H, Patrick P, Gibbs R. Percutaneous endoscopic gastrojejunostomy with a tapered tip, nonweighted jejunal feeding tube: improved placement success.  Am J Gastroenterol. 1996;  91 1130-1134
    Google Scholar
  • 19 Norton B, Homer-Ward M, Donnelly M T. et al . A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke.  BMJ. 1996;  312 13-16
    PubMedGoogle Scholar
  • 20 Parasher V K, Abramowicz C J, Bell C. et al . Successful placement of percutaneous gastrojejunostomy using steerable glidewire - a modified controlled push technique.  Gastrointest Endosc. 1995;  41 52-55
    Google Scholar
  • 21 Faigel D O, Kadish S L, Ginsberg G G. The difficult-to-place feeding tube: successful endoscopic placement using a mucosal clip.  JPEN J Parenter Enteral Nutr. 1996;  20 306-308
    PubMedGoogle Scholar
  • 22 Ginsberg G G, Lipman T O, Fleischer D E. Endoscopic clip-assisted placement of enteral feeding tubes.  Gastrointest Endosc. 1994;  40 220-222
    CrossrefPubMedGoogle Scholar
  • 23 Mellert J, Naruhn M B, Grund K E. et al . Direct endoscopic percutaneous jejunostomy (EPJ). Clinical results.  Surg Endosc. 1994;  8 867-869
    Google Scholar
  • 24 Shike M, Latkany L, Gerdes H. et al . Direct percutaneous endoscopic jejunostomies for enteral feeding.  Gastrointest Endosc. 1996;  44 536-540
    CrossrefPubMedGoogle Scholar
  • 25 Rumalla A, Baron T H. Results of direct percutaneous endoscopic jejunostomy, an alternative method for providing jejunal feeding.  Mayo Clin Proc. 2000;  75 807-810
    CrossrefPubMedGoogle Scholar
  • 26 Gauderer M W. Percutaneous endoscopic gastrostomy and the evolution of contemporary long-term enteral access.  Clin Nutr. 2002;  21 103-110
    PubMedGoogle Scholar
  • 27 Willwerth B M. Percutaneous endoscopic gastrostomy or skin-level gastrostomy tube replacement.  Pediatr Emerg Care. 2001;  17 55-58
    CrossrefPubMedGoogle Scholar
  • 28 Kozarek R A, Payne M, Barkin J. et al . Prospective multicenter evaluation of an initially placed button gastrostomy.  Gastrointest Endosc. 1995;  41 105-108
    CrossrefPubMedGoogle Scholar
  • 29 Gottschlich M M, Schronts E P, Hutchins A M. Defined formula diets. In: Rombeau RH, Rolandelli RH (eds). Enteral nutrition and tube feeding. Philadelphia; WB Saunders 1997: 207-239
    Google Scholar
  • 30 Matarese L E. Enteral feeding solutions.  Gastrointest Endosc Clin N Am. 1998;  8 593-609
    PubMedGoogle Scholar
  • 31 Comper C, Seto R W, Lew J I. et al .Dietary fiber and its clinical applications to enteral nutrition. In: Rombeau RH, Rolandelli RH (eds). Enteral nutrition and tube feeding. Philadelphia; WB Saunders 1997: 81-95
    Google Scholar
  • 32 Wachtershauser A, Stein J. Rationale for the luminal provision of butyrate in intestinal diseases.  Eur J Nutr. 2000;  39 164-171
    CrossrefPubMedGoogle Scholar
  • 33 Kallet R H. Evidence-based management of acute lung injury and acute respiratory distress syndrome.  Respir Care. 2004;  49 793-809
    PubMedGoogle Scholar
  • 34 Schols A M, Slangen J, Volovics L. et al . Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1998;  157 1791-1797
    CrossrefPubMedGoogle Scholar
  • 35 Schols A M. Nutrition in chronic obstructive pulmonary disease.  Curr Opin Pulm Med. 2000;  6 110-115
    CrossrefPubMedGoogle Scholar
  • 36 Schols A M. Nutrition and respiratory disease.  Clin Nutr. 2001;  20 (suppl. 1) 173-179
    PubMedGoogle Scholar
  • 37 Caglar K, Fedje L, Dimmitt R. et al . Therapeutic effects of oral nutritional supplementation during hemodialysis.  Kidney Int. 2002;  62 1054-1059
    CrossrefPubMedGoogle Scholar
  • 38 Cockram D B, Hensley M K, Rodriguez M. et al . Safety and tolerance of medical nutritional products as sole sources of nutrition in people on hemodialysis.  J Ren Nutr. 1998;  8 25-33
    PubMedGoogle Scholar
  • 39 Kopple J D. Dietary protein and energy requirements in ESRD patients.  Am J Kidney Dis. 1998;  32 S97-104
    PubMedGoogle Scholar
  • 40 Kopple J D. Therapeutic approaches to malnutrition in chronic dialysis patients: the different modalities of nutritional support.  Am J Kidney Dis. 1999;  33 180-185
    PubMedGoogle Scholar
  • 41 Calvey H, Davis M, Williams R. Controlled trial of nutritional supplementation, with and without branched chain amino acid enrichment, in treatment of acute alcoholic hepatitis.  J Hepatol. 1985;  1 141-151
    CrossrefPubMedGoogle Scholar
  • 42 Hasse J M, Blue L S, Liepa G U. et al . Early enteral nutrition support in patients undergoing liver transplantation.  JPEN J Parenter Enteral Nutr. 1995;  19 437-443
    CrossrefPubMedGoogle Scholar
  • 43 Horst D, Grace N D, Conn H O. et al . Comparison of dietary protein with an oral, branched chain-enriched amino acid supplement in chronic portal-systemic encephalopathy: a randomized controlled trial.  Hepatology. 1984;  4 279-287
    CrossrefPubMedGoogle Scholar
  • 44 Kanematsu T, Koyanagi N, Matsumata T. et al . Lack of preventive effect of branched-chain amino acid solution on postoperative hepatic encephalopathy in patients with cirrhosis: a randomized, prospective trial.  Surgery. 1988;  104 482-488
    PubMedGoogle Scholar
  • 45 Lochs H, Plauth M. Liver cirrhosis: rationale and modalities for nutritional support - the European Society of Parenteral and Enteral Nutrition consensus and beyond.  Curr Opin Clin Nutr Metab Care. 1999;  2 345-349
    PubMedGoogle Scholar
  • 46 Coulston A M. Enteral nutrition in the patient with diabetes mellitus.  Curr Opin Clin Nutr Metab Care. 2000;  3 11-15
    CrossrefPubMedGoogle Scholar
  • 47 Peters A L, Davidson M B, Isaac R M. Lack of glucose elevation after simulated tube feeding with a low-carbohydrate, high-fat enteral formula in patients with type I diabetes.  Am J Med. 1989;  87 178-182
    PubMedGoogle Scholar
  • 48 Peters A L, Davidson M B. Effects of various enteral feeding products on postprandial blood glucose response in patients with type I diabetes.  JPEN J Parenter Enteral Nutr. 1992;  16 69-74
    PubMedGoogle Scholar
  • 49 Peters A L, Davidson M B. Addition of hydrolyzed guar to enteral feeding products in type I diabetic patients.  Diabetes Care. 1996;  19 899-900
    PubMedGoogle Scholar
  • 50 Printz H, Recke B, Fehmann H C. et al . No apparent benefit of liquid formula diet in NIDDM.  Exp Clin Endocrinol Diabetes. 1997;  105 134-139
    PubMedGoogle Scholar
  • 51 Sanz-Paris A, Calvo L, Guallard A. et al . High-fat versus high-carbohydrate enteral formulae: effect on blood glucose, C-peptide, and ketones in patients with type 2 diabetes treated with insulin or sulfonylurea.  Nutrition. 1998;  14 840-845
    CrossrefPubMedGoogle Scholar
  • 52 Garcia-de-Lorenzo A, Zarazaga A, Garcia-Luna P P. et al . Clinical evidence for enteral nutritional support with glutamine: a systematic review.  Nutrition. 2003;  19 805-811
    CrossrefPubMedGoogle Scholar
  • 53 Griffiths R D, Jones C, Palmer T E. Six-month outcome of critically ill patients given glutamine-supplemented parenteral nutrition.  Nutrition. 1997;  13 295-302
    PubMedGoogle Scholar
  • 54 Jensen G L, Miller R H, Talabiska D G. et al . A double-blind, prospective, randomized study of glutamine-enriched compared with standard peptide-based feeding in critically ill patients.  Am J Clin Nutr. 1996;  64 615-621
    PubMedGoogle Scholar
  • 55 Jones C, Palmer T E, Griffiths R D. Randomized clinical outcome study of critically ill patients given glutamine-supplemented enteral nutrition.  Nutrition. 1999;  15 108-115
    CrossrefPubMedGoogle Scholar
  • 56 Werlin S, Glicklich M, Cohen R. Early feeding after percutaneous endoscopic gastrostomy is safe in children.  Gastrointest Endosc. 1994;  40 692-693
    PubMedGoogle Scholar
  • 57 Brown D N, Miedema B W, King P D. et al . Safety of early feeding after percutaneous endoscopic gastrostomy.  J Clin Gastroenterol. 1995;  21 330-331
    PubMedGoogle Scholar
  • 58 Choudhry U, Barde C J, Markert R. et al . Percutaneous endoscopic gastrostomy: a randomized prospective comparison of early and delayed feeding.  Gastrointest Endosc. 1996;  44 164-167
    CrossrefPubMedGoogle Scholar
  • 59 McCarter T L, Condon S C, Aguilar R C. et al . Randomized prospective trial of early versus delayed feeding after percutaneous endoscopic gastrostomy placement.  Am J Gastroenterol. 1998;  93 419-421
    CrossrefPubMedGoogle Scholar
  • 60 Stein J, Schulte-Bockholt A, Sabin M. et al . A randomized prospective trial of immediate vs. next-day feeding after percutaneous endoscopic gastrostomy in intensive care patients.  Intensive Care Med. 2002;  28 1656-1660
    CrossrefPubMedGoogle Scholar
  • 61 Keohane P P, Attrill H, Love M. et al . Relation between osmolality of diet and gastrointestinal side effects in enteral nutrition.  Br Med J (Clin Res Ed). 1984;  288 678-680
    PubMedGoogle Scholar
  • 62 Mentec H, Dupont H, Bocchetti M. et al . Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications.  Crit Care Med. 2001;  29 1955-1961
    CrossrefPubMedGoogle Scholar
  • 63 Rees R G, Keohane P P, Grimble G K. et al . Elemental diet administered nasogastrically without starter regimens to patients with inflammatory bowel disease.  JPEN J Parenter Enteral Nutr. 1986;  10 258-262
    PubMedGoogle Scholar
  • 64 Marik P E, Zaloga G P. Early enteral nutrition in actually ill patients: a systematic review.  Critical Care. 2003;  7 46-51
    PubMedGoogle Scholar
  • 65 Zaloga G P. Early enteral nutritional support improves outcome: hypothesis or fact?.  Crit Care Med. 1999;  27 259-261
    CrossrefPubMedGoogle Scholar

Prof. Dr. Dr. Jürgen Stein

Medizinische Klinik I, ZAFES, J. W. Goethe-Universität Frankfurt

Theodor-Stern-Kai 7

60590 Frankfurt/Main

Germany

Telefon: ++ 49/69/63 01-59 17

Fax: ++ 49/69/63 01-64 48

eMail: J.Stein@em.uni-frankfurt.de

      >