Commentary: Endoscopic Techniques in Management of Biliary Tract Injuries

Nutrition support teams depend on the skills of an endoscopist to deliver enteral tube feeding, especially when certain medical or surgical conditions require deep jejunal access. The need for short-term feeding (less than four weeks in duration) can be met by placement of a nasoenteric tube, but if longer periods of feeding are anticipated, a percutaneous device should be utilized. Mastering the many techniques described for achieving enteral access allows the endoscopist to adjust to the varying clinical scenarios and anatomic variations that may be encountered in general practice. Techniques which involve untethered endoscopy or placement of the tube over a guidewire are preferred over those which require dragging the tube itself down through in the gastrointestinal tract with the endoscope. Attention should be paid to securing the tube post placement. As the nutritional therapy is delivered, patients should be monitored for tolerance of their feeding regimen and the enteral access site should be examined regularly to avoid complications. Careful vigilance allows the identification of early problems, affords the opportunity for quick solutions, and avoids the more serious complications requiring endoscopic or even surgical intervention.