Gastrointestinal endoscopy clinics of North America
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Gastrointest. Endosc. Clin. N. Am. · Oct 2007
ReviewDecreasing aspiration risk with enteral feeding.
Aspiration is a clinical concern in patients receiving enteral tube feeding. Aspiration can result in pneumonia leading to increases in the use of antibiotics, length of hospital stay, and the risk of mortality. Pneumonia caused by aspiration of gastric contents is of particular concern in patients who require mechanical ventilation and feeding by nasogastric tube. This article summarizes factors that might influence the development of aspiration pneumonia and minimize risk, such as the position of the patient's body, method of feeding, and size of the feeding tube.
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Gastrointest. Endosc. Clin. N. Am. · Oct 2007
ReviewDecisions to be made when initiating enteral nutrition.
Enteral nutrition support is preferred to parenteral or no nutritional support, but many patients who could benefit receive inadequate enteral feeding. Many decisions must be made before initiating enteral nutrition support; including if and when enteral nutrition should be started, which formula should be used, and how enteral nutrition support should be monitored. The gastroenterologist should be able to understand and evaluate these decisions in all patients potentially requiring nutritional support.
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Feeding into the small bowel is often recommended to improve nutrient delivery for critically ill patients, and thus improve outcome and reduce complications associated with enteral feeding. Risks and benefits of gastric feeding, use of motility agents, postpyloric feeding, and obtaining small bowel access are discussed here. ⋯ Current evidence does not support routine use of postpyloric feeding in the critically ill. A standardized approach to optimizing benefits and minimizing risks with enteral nutrition delivery will help clinicians identify patients who would benefit from small bowel feeding.
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The spectrum of gastrointestinal (GI) foreign bodies includes food bolus impaction in the esophagus, nonfood objects that are swallowed, and various objects that may be inserted into the rectum. The risk depends upon the type of object and its location. ⋯ All objects impacted in the esophagus require urgent or emergent treatment. Rectal foreign bodies are usually removable transanally, although general anesthesia and operative intervention sometimes are required.
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Nonvariceal upper gastrointestinal bleeding (NVUGIB) is an important condition facing gastroenterologists. The focus of this article is the management of NVUGIB, with a particular emphasis on the endoscopic modalities and techniques that are most effective for various bleeding etiologies. Attention also is given to medical management, risk assessment, and issues pertaining to the timing of endoscopy and need for scheduled second-look endoscopy.