Tube feeding into the gut (enteral nutrition)

Enteral nutrition (EN) is a type of tube feeding for nutritional support. EN is where the nutritional fluid or feed is given into the gut, through a tube going into the stomach or small intestine.

EN works best if your digestive system is working normally, but you are not able to eat or drink enough. This could be because of a cancer in the head or neck area or after surgery for stomach cancer or gullet (oesophagus) cancer.

EN uses specially prepared liquid feeds. Your dietitian chooses the type and amount of feed you need. This depends on your nutritional needs and where the tube is placed. You may get all your nutrition in this way. Or you may get some by eating food as you normally would, and have the rest as a liquid through the tube. You will be encouraged to eat normally if you can.

Different types of tube can be used to give EN. The type of tube you have depends on:

• your nutritional needs
• how long you are likely to need EN for
• how well your digestive system is working.

These are the most common ways of giving EN:

For gastrostomy feeding, an opening is made through the tummy (abdominal) wall. This opening is called a fistula. A feeding tube is then passed through the opening into the stomach.

The tube is held in place with a small, water-filled balloon, or a plastic disc (a bumper) around the tube, just inside the stomach.

Your doctor may recommend you have gastrostomy feeding if your digestive system is still working but you may need nutritional support for more than a few weeks.

Gastrostomy feeding is done with a PEG tube or RIG tube.

A PEG feeding tube is a percutaneous endoscopic gastrostomy tube. Percutaneous means through the skin. Endoscopic refers to the endoscope that is used when the tube is put in. Gastrostomy means an opening into the stomach.

A RIG feeding tube is a radiologically inserted gastrostomy tube. It is very similar to a PEG tube, but it is put in using x-ray as a guide.

Before a PEG feeding tube is put in, a doctor or specialist nurse will explain the procedure to you. You will be asked to sign a form saying that you agree (consent) to having the PEG put in, and that you understand why it is being done.

You will not be able to eat or drink for several hours before the procedure. This is to make sure your stomach is empty. Your doctor may also give you antibiotics to reduce your risk of getting an infection.

You will be given a sedative to make you feel sleepy. The person putting the PEG in will pass a flexible tube with a light at the end (an endoscope) into your mouth. This goes down the gullet and into the stomach. They inflate the stomach with air, and position the endoscope so the light shines through the abdominal wall. This shows the position of the stomach. The person putting the PEG then cleans the skin of the abdominal wall and uses local anaesthetic to numb the area. They make a small cut (incision) through the skin and muscle and insert the feeding tube into the stomach.

When the tube is in place, the area around the tube (the tube site) is cleaned. The tube site needs to be cleaned daily with soap and water and dried thoroughly. You may need a dressing at first, but the area is then usually left uncovered. The tube needs to be flushed with a minimum of 30ml of water before and after each feed.

It takes about 3 weeks for the skin to heal around the tube. During this time, you should avoid getting the area too wet. It is fine to shower, as long as the tube site is protected. You should avoid having a bath until the skin is fully healed.

A RIG feeding tube is put in in a similar way to a PEG feeding tube, but x-ray scanning is used to guide it instead of an endoscope. An NG feeding tube is put in first. You will then have some local anaesthetic injected to numb an area on your tummy (abdomen). They will then make a small cut (incision) in your tummy.

Some air is pumped down the NG feeding tube and into your stomach. This helps position the RIG tube accurately. The gastrostomy tube is then inserted directly into the stomach using x-ray guidance.

Once the gastrostomy tube is in place, some dye is flushed into it and you have another x-ray. This is to make sure the tube is in the right place. After this, the NG feeding tube is removed. The RIG is held in place with stitches. These are usually removed 10 to 14 days later.

PEGs and RIGs allow people who cannot eat in the usual way to get enough nutrients through the liquid feed and fluids. These tubes are often more suitable if you need long-term feeding. They cannot be seen when a person is wearing clothes, whereas an NG feeding tube is more visible.

The most common complications with a PEG or RIG include the following:

Other problems that may sometimes happen. For example, an infection can develop in the tissues around the site. It is important to tell your doctor as soon as possible if:

• the skin around the tube becomes red or swollen
• you notice fluid coming from around the tube
• you develop a high temperature or feel unwell.

Rarely, more serious complications may develop. Contact your hospital straight away if you:

• have any swelling around your tummy area
• have any pain
• are bleeding
• start to feel very unwell.

If you are at home, you should have the name of a healthcare professional at the hospital or from the community team. Contact them if you develop any problem with your PEG or RIG.

If you are having long-term feeding, your PEG or RIG tube will need to be replaced. How often it is replaced depends on the type of tube you have. Your doctor, specialist nurse or dietitian can give you more information.