Tube feeding comes in many forms, but it most often implies enteral nutrition, or delivering food through a tube directly into the gastrointestinal tract. Occasionally a person with cancer cannot appropriately nourish their body through eating and drinking, and their doctor may recommend nutritional support in the form of tube feeding. A Google search of the term “tube feeding” brings up a list of reports on Terri Schiavo and other controversial end of life issues, but tube feedings are often used by people who have a full life ahead. The decision to receive tube feeding can be emotion-laden, but addressing related concerns can help allay fears and help patients decide whether enteral nutrition is right for them.
Tube feeding is used for a number of reasons, including hydration for people who can’t ingest their daily fluid requirement; prevention of weight loss for patients at risk for malnutrition during cancer treatment; and nourishment of patients who have had surgery or radiation to the mouth, neck, or esophagus and are unable to eat normally. The most common techniques for providing enteral nutrition include nasogastric tubes (NG); gastrostomy tubes (G-tube); percutaneous endoscopic gastrostomy (PEG) tubes; percutaneous jejunostomy tubes (J-tube); and gastro-jejunostomy tubes (GJ). These sound complicated but can be understood in a simple way: the first word describes where the tube goes in, the last word is where the tube ends, and the addition of stoma/stomy is used when there will be an opening to the outside environment.
Nasogastric tubes: NG tubes are passed through the nostrils and into the stomach. They are used as a temporary way of giving a person food, medicine, or fluid, and are typically used for less than 30 days. NG tubes can be placed at bedside without the need for surgery, and they don’t leave a scar. Because part of the tube holds open the passage from the esophagus to the stomach, NG tubes may allow food to pass from the stomach back up to the esophagus. This regurgitated food can then enter a person’s airway, leading to a dangerous problem called aspiration pneumonia. Because of this and other risks, if it appears a patient will require nutritional support for a period longer than 30 days, other methods of enteral feeding are considered.
G-tubes and PEG tubes: These refer to tubes passed through the skin of the abdominal wall that end in the stomach (gastro). Stomy refers to the opening in the abdominal wall, and percutaneous refers to placement through the skin. G-tubes are placed during surgery or with radiographic guidance, and the PEG, which is a type of g-tube, is placed through the abdominal wall with an endoscopic guidance (camera inserted through the mouth into the stomach) under moderate sedation. G-tubes are used for long term nutrition (more than 30 days) and they can be removed when the patient no longer requires nutritional support.
The external portion of a g-tube is typically just below the ribcage on the left, and it can be easily hidden with loose clothing. If the g-tube is placed laparoscopically, there will only two additional small incisions near the belly-button. No additional scars are created with PEG placement. A typical g-tube complication is skin irritation from leakage of gastric juices, and the stoma often requires daily care.
Other: J-tubes can come from the nose (NJ), from the abdominal wall, and from the stomach via a g-tube (GJ tube). Jejunal tubes come in different forms and they are used to deliver feeds to the small bowel when there is difficulty delivering food to the stomach.
Making the choice to receive tube feedings can be difficult for a number of reasons. A person may fear surgery, loss of independence, and deformity related to an external tube. Some patients view a feeding tube as an outward sign of an illness they would rather not accept. On the other hand, enteral feedings are increasingly common, and current techniques allow placement with minimal discomfort or scarring. Often a feeding tube can be placed with moderate sedation rather than general anesthesia, and most feeding tubes are small and can be easily hidden with loose clothing. If you are considering enteral feeding, you may find it helpful to speak with others who have had a feeding tube and, most importantly, address your concerns with your doctor.
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