World Journal of Surgery

, Volume 16, Issue 6, pp 1042–1047 | Cite as

Endoscopic intervention for enteral access

  • Thomas A. Stellato
World Progress In Surgery

Abstract

Contrary to total parenteral nutrition with its relatively recent introduction into modern clinical medicine, enteral nutrition has a long and colorful history. Prior to development of fiberoptic endoscopy, physicians attempting to feed patients who could not or would not eat were limited to the blind placement of intestinal tubes or radiologically assisted placement of these devices. Previous to these modern attempts, the use of nutrient enemas was attempted for which there was evidence of occasional success. With the introduction of fiberoptic flexible endoscopy, guidance of tubes into the upper intestinal tract under direct vision became feasible. The manner in which tubes were positioned, advanced, or manipulated are myriad and attest to the ingenuity of clinicians. A revolution in endoscopic intervention occurred with the introduction of the percutaneous endoscopic gastrostomy in 1980. This provided secure access to the stomach without a laparotomy. This technique was also modified to allow decompression of the stomach with feeding distally into the small intestine and also direct puncture and placement of tubes into the small intestine. The most recent advance in enteral nutrition is taking place at the present time with the introduction of laparoscopic techniques in the creation of gastrostomies and jejunostomies.

Keywords

Enteral Nutrition Total Parenteral Nutrition Endoscopic Intervention Percutaneous Endoscopic Gastrostomy Cela 

Résumé

En contraste avec l'alimentation parentérale qui a été introduite relativement tard dans la panoplie de la médecine moderne, l'alimentation entérale a une histoire plus longue et pittoresque. Avant l'essor de l'endoscopie par fibres optiques, les médecins ou radiologistes étaient obligés de placer á l'aveugle des tubes intestinaux chez les patients qui ne voulaient ou qui ne pouvaient pas s'alimenter. avant cela encore, les essais de nutrition entérale passait par des lavements dits “nutitifs”, Malgré tout, il y a quelques succès rapportés dans la littérature. avec la découverte de l'endoscopie à fibres optiques, la mise en place de ces conduits dans le tube digestif supérieur sous contrôle de la vue est devenu réalisable. La manière avec laquelle les tuyaux sont placés avancés ou manipulés sont multiples et attestent de l'ingénuités des opérateurs. Une nouvelle révolution a vu le jour en 1980 avec l'introduction de la gastrostomie endoscopique percutanée. Cette technique permet de réaliser un gastrostomie sans laparotomie. Elle permet alors un accès à l'estomac pour l'alimentation comme un moyen de décomprimer celui-ci. Par la même technique, on peut également réaliser une jejunostomie d'alimentation. Tout dernièrement, on a commencé à réaliser des gastrostomies et des jéjunostomies par coelioscopie.

Resumen

En contraste con la nutrición parenteral total, de relativemente reciente introducción a la medicina clínica, la nutrición enteral posee una historia larga y de gran colorido. Con anterioridad al desarrollo de la endoscopia con fibra óptica, los médicos, en su esfuerzo por alimentar pacientes que no podían o no querían comer, se encontraban límitados a la colocación ciega o asistida por radiología de tubos intestinales. Con anterioridad a estos modernos procedimientos, se intentó el uso de enemas de nutrición, con éxito ocasional. La introducción de la endoscopia flexible de fibra óptica hizo posible guiar, bajo visión directa, la colocación de estos tubos en el tracto gastrointestinal superior. Son muy numerosas las maneras de colocar los tubos, de avanzarlos y de manipularlos, todos el resultado del ingenio médico. Una verdadera revolución en el campo de la endoscopia intervencionista se produjo con la introducción de la gastrotomía endoscópica percutánea en 1980, método que hizo posible asegurar el acceso al estómago sin laparotomía. Esta técnica fue luego modificada para permitir la descompresión del estómago concomitante con alimentación yeyunal, así como la punción directa y la colocación de tubos en el intestino delgado. El avance más reciente en la nutrición enteral está representado por la introducción de técnicas laparoscópicas para crear gastrostomías y yeyunostomías.

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Copyright information

© the Société Internationale de Chirurgie 1992

Authors and Affiliations

  • Thomas A. Stellato
    • 1
  1. 1.Department of SurgeryCase Western Reserve UniversityClevelandU.S.A.

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