ABSTRACT
The importance of nutrition in assisting recovery from disease has become more widely recognized and there has been a move away from parenteral nutrition to enteral feeding whenever possible. In general terms, enteral tube feeding is indicated whenever there is a functioning gastrointestinal tract but adequate nutrition cannot be maintained through oral feeding alone. Neurological dysphagia is the most common indication at most centres, chiefly as a result of cerebrovascular accidents. Dysphagia from oesophageal cancer can usually be overcome to an extent, but tumours of the oropharynx are much less amenable to palliation. Serious systemic illness results in an increased metabolic demand. For nasoduodenal or nasojejunal feeding, the choice is between ‘blind’ intubation at the bedside or assisted placement using fluoroscopy or endoscopy. A high proportion of percutaneous endoscopic gastrostomy placed for neurological dysphagia are in patients unable to give informed consent. The patient is prepared with pharyngeal anaesthesia, and intravenous benzodiazepine sedation is given as required.
