title: Endoscopic solutions to challenging enteral feeding problems.
abstract: OBJECTIVE
  Enteral nutrition support is often required in patients who are unable to meet their own nutritional requirements. Endoscopists play a key role in the placement of enteral feeding catheters. This review focuses on the recently published solutions to common problems encountered during endoscopic placement of enteral feeding devices.
  
  
  RESULTS
  Case reports and case series describe solutions for overcoming common problems encountered during the placement of enteral feeding devices. Transnasal techniques can simplify nasojejunal tube placement, whereas deep enteroscopy techniques provide more reliable jejunostomy placement. Endoscopic ultrasound can help when transillumination is not possible or in the setting of postsurgical anatomy like Roux-en-Y. Laparoscopic-assisted procedures are useful when endoscopic techniques have failed in adults or in select high-risk pediatric patients. The American Society for Gastrointestinal Endoscopy and the American Gastroenterology Association both published comprehensive guidelines that outline the indications, contraindications, technical aspects of feeding catheter placement, and complications.
  
  
  CONCLUSIONS
  Advances in endoscopic techniques, including deep enteroscopy, endoscopic ultrasound, ultra-slim transnasal endoscopes and laparoscopic-assisted procedures, have enabled endoscopists to successfully place enteral feeding tubes in patients who previously required open procedures.
authors.affiliation: VA Puget Sound Healthcare System and Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98108, USA. shirley.paski@va.gov
authors.forename: Shirley C
authors.initials: SC
authors.lastname: Paski
authors.forename: Jason A
authors.initials: JA
authors.lastname: Dominitz
mesh_terms: D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition; D005774:Gastrostomy; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010535:Laparoscopy; D018579:Patient Selection; D018084:Ultrasonography, Interventional