A feeding tube, or enteral feeding device, is a medical instrument used to deliver nutrition and medication directly into the stomach or small intestine when a patient cannot safely or sufficiently take food by mouth. This device allows for necessary nutritional support when swallowing is impaired, or the upper gastrointestinal tract is compromised. The history of this life-saving technology is not tied to a single inventor, but rather represents a gradual evolution of materials, medical understanding, and insertion techniques over centuries. The development of the modern feeding tube involved many different global contributions, transforming a crude practice into a standardized medical procedure.
Early Concepts of Nutritional Support
The initial attempts at non-oral nourishment date back to ancient times. Records from ancient Egypt and Greece, going back as far as 3500 years ago, describe the use of nutrient enemas, often called rectal feeding. These methods involved infusing liquid mixtures into the rectum, operating on the incorrect belief that the large intestine could absorb complex nutrients. The solutions used included mixtures of wine, milk, eggs, barley gruel, and even brandy.
The early apparatus for this type of feeding was primitive, sometimes involving the use of animal bladders connected to reeds or hollow tubes for delivery. In the 12th century, a significant shift in medical thought occurred when Spanish-born Arab physician Ibn Zuhr proposed that the stomach was the sole place for nutrient absorption. This understanding led to a search for methods to bypass the throat. By the 16th century, devices like a silver, funnel-shaped cylinder were used to force-feed patients through the mouth, a technique that remained in use for hundreds of years.
Further attempts to reach the stomach involved creating early forms of flexible tubes. In the 17th century, the Belgian chemist Jan Baptist van Helmont fashioned a hollow leather tube that could be swallowed, allowing blended food to be injected via a syringe. The English surgeon John Hunter described a nasogastric tube in the 18th century, which was constructed from eelskin attached to a whalebone. These early designs highlighted the persistent challenge of inserting a device deep into the body using rigid or organic materials, often resulting in dangerous or short-lived attempts at nutritional support.
Formalizing the Procedure in the 19th Century
The feeding tube transitioned from experimental devices to a formalized medical procedure in the 19th century. This transformation was driven by a shift from temporary esophageal insertion to more permanent surgical access, known as a gastrostomy. The earliest gastrostomy procedures, suggested by Egeberg in 1837 and performed by Sédillot in 1845, were often unsuccessful due to high rates of infection.
The procedure became more viable with the introduction of soft rubber tubes in the late 19th century, which improved patient tolerance and reduced trauma. The first successful gastrostomy procedure in the United States with long-term survival was performed by Dr. Lycurgus Lafayette Staton in 1870. These successful cases proved that long-term non-oral feeding was possible.
Later in the century, the focus expanded to other parts of the gastrointestinal tract. French surgeon Surmay described the technique of jejunostomy in 1878, a procedure for accessing the small intestine for feeding. Additionally, German surgeon Oskar Witzel developed one of the most commonly used techniques for jejunostomy insertion in 1891. In 1894, German surgeon Martin Stamm published a description of a gastrostomy that, with minor adaptations, is still used today.
The nasogastric tube was further refined in the early 20th century. American physician Abraham Louis Levin introduced the “Levin tube” in 1921, a single-lumen tube foundational in popularizing short-term nasogastric feeding. The work of these surgeons and physicians established the core routes of enteral access—nasal, gastric, and intestinal—setting the stage for modern technology.
Technological Advances in Modern Tubing
The materials used in feeding tubes improved in the mid-20th century, enhancing patient comfort and safety. The early, stiff rubber and plastic tubes were replaced in the 1940s with more flexible polymers, such as polyethylene. Today, feeding tubes are typically manufactured from highly flexible, biocompatible materials like silicone and polyurethane.
Polyurethane offers high strength, allowing for tubes with thinner walls and a larger internal diameter, which improves flow without increasing the external size. This advancement helped reduce blockages, leaks, and improved the ease of insertion. The introduction of antibiotics in the 1940s also reduced the infection risk associated with surgical placement, making the procedures safer.
A major procedural innovation was the development of the percutaneous endoscopic gastrostomy (PEG) in the 1980s by surgeons Michael W. L. Gauderer and Jeffrey L. Ponsky. The PEG procedure allowed for the placement of a feeding tube directly into the stomach using an endoscope, eliminating the need for major open surgery. Specialized routes, such as the percutaneous endoscopic jejunostomy (PEJ), allow for feeding directly into the small intestine when stomach function is impaired. Modern refinements also include feeding pumps for controlled delivery and standardized connectors, like the ENFit system, designed to prevent dangerous misconnections.