An enteral feeding tube provides nutrition and fluids directly into the gastrointestinal (GI) tract. This process, called enteral nutrition, is used when the digestive system is functional but the patient cannot safely eat or drink enough by mouth. The final destination of the tube depends on the required duration of feeding and the patient’s specific digestive capabilities. Access ranges from temporary, non-surgical routes through the nose or mouth to permanent, surgically created openings in the abdomen.
Tubes Inserted Through the Nose or Mouth
Temporary feeding tubes are inserted non-surgically through the upper GI tract for short-term nutritional support, typically lasting less than four to six weeks. The most common is the Nasogastric (NG) tube, which travels through the nostril, down the pharynx and esophagus, and ends in the stomach. This placement is straightforward and can often be done at the bedside without specialized imaging.
A variation is the Orogastric (OG) tube, which enters through the mouth and is often preferred for infants or intubated patients to avoid nasal irritation. For feeding past the stomach, a Nasojejunal (NJ) or Nasoduodenal (ND) tube is used, guided through the nose and into the small intestine (the jejunum or duodenum). Inserting these longer tubes beyond the stomach often requires endoscopic or fluoroscopic guidance to ensure the tip passes the pylorus, the muscular valve separating the stomach and the small intestine.
Prolonged use of these temporary tubes can lead to complications such as sinusitis, tissue breakdown in the nasal passages, or discomfort. They offer a quick, non-invasive solution but are generally considered a bridge to oral feeding or a more permanent abdominal tube. The final destination, whether the stomach or the small intestine, is a clinical decision based on the patient’s ability to tolerate gastric feeding.
Tubes Placed Directly Through the Abdomen
For long-term nutritional needs, tubes are placed directly into the digestive tract through the abdominal wall. This requires a minimally invasive surgical procedure to create a stoma, which is a small, healed opening in the skin. The most common type is the Gastrostomy tube (G-tube), often placed using Percutaneous Endoscopic Gastrostomy (PEG).
The PEG procedure uses an endoscope to visualize the inside of the stomach and guide the tube’s placement through the skin and muscle. The tube is held in place by an internal bolster, such as a water-filled balloon, and an external bumper or disc that rests against the skin. G-tubes are designed to remain in place for many months or years, offering a more comfortable and discrete solution than nasal tubes.
Abdominal tubes come in two main styles: the standard long tube, which hangs outside the body, and the low-profile device, often called a “button.” The button lies flat against the skin and requires a separate extension set for feeding or administering medication. If the stomach cannot be used, a Jejunostomy tube (J-tube) or a Gastrojejunal tube (GJ-tube) is placed. A J-tube goes directly into the jejunum, while a GJ-tube has two ports: one ending in the stomach for decompression and one in the jejunum for feeding.
Why the Destination Matters
The final destination of the feeding tube is driven by the patient’s digestive physiology and risk factors. The stomach is the preferred site for feeding, known as gastric feeding, because it acts as a natural reservoir. This allows for larger volume bolus feedings and the normal digestive process to begin. If gastric feeding is not possible, a post-pyloric destination is necessary, meaning the tube ends in the duodenum or jejunum.
The primary reasons for bypassing the stomach are a high risk of aspiration and impaired gastric motility. Aspiration occurs when stomach contents, including formula, back up and are inhaled into the lungs, potentially causing aspiration pneumonia. Patients with a poor gag reflex, neurological deficits, or those on mechanical ventilation are at increased risk. Post-pyloric feeding delivers the formula directly into the small intestine, past the pyloric sphincter, which significantly reduces gastric reflux and aspiration risk.
Delayed gastric emptying, or gastroparesis, is another major indication for post-pyloric placement. When the stomach cannot empty efficiently, gastric feeding can lead to uncomfortable retention of food, high gastric residual volumes, and vomiting. Placing the tube tip in the jejunum allows for continuous, slow delivery of nutrition, which is better tolerated by a compromised digestive system.