Complications of enteral access.

The perceived health benefits of enteral feeding have placed increasing demands on endoscopists to acquire the expertise needed to establish enteral access, to monitor patients undergoing enteral feeding, and to manage the complications arising from the initial access procedure. In the setting of acute critical care, the provision of enteral feeding is seen as therapy that reduces systemic bacterial challenge to the host, attenuates the stress response, downregulates both innate and acquired immune responses, and improves outcomes for the patient. In long-term chronic care, achieving enteral access may serve to decrease the risk of aspiration by diverting the feeding stream to more distal segments of the GI tract, to reduce the morbidity that accompanies protein-calorie malnutrition, to provide an effective bridge for patients expected to regain neurologic function, and to facilitate efficient supportive management and utilization of health care resources. Complications are inherent to the moderately invasive endoscopic procedures for achieving enteral access. Older age and the existence of comorbid conditions increase this risk. Proper patient selection and appropriate modification of endoscopic technique to suit the peculiarities to the individual case may decrease risk during initial tube placement. Proper monitoring, early recognition of impending complications, and quick, often simple, endoscopic solutions can reduce the frequency and the severity of enteral access–associated complications.