Use of gastrostomy and combined gastrojejunostomy tubes for enteral feeding.

Recent economic changes in health care delivery have led to more frequent feeding by tube enterostomy. Over the last two decades percutaneous endoscopic gastrostomy (PEG) has been established as the standard method for long-term enteral access for nutrition, though operative gastrostomy remains indicated in a few conditions. Additionally, the combined gastrojejunostomy tube is indicated in selected patients in need of concomitant access to the jejunum and gastric decompression. This report reviews data regarding the safety and efficacy of the PEG tube and the indications for operative gastrostomy. Complications of feeding tubes and strategies to avoid or remedy them are also discussed. More recent techniques, including laparoscopic gastrostomy and jejunal access via the stomach, are reviewed as are some ethical concerns regarding the appropriateness of feeding enterostomies in certain patients.