Tubes for Enteric Access

Tubes are an integral part of gastroenterology practice and have been used in clinical care as well as in research for more than a century. A multitude of tubes are available to allow access to the gastrointestinal tract. They vary by composition, inner and outer diameter, presence or absence of weighted tip, tip size and shape, and location and number of access and egress ports. There are tubes intended to remove content or decompress the gastrointestinal tract as well as to introduce content, usually nutrients or medications, into the gastrointestinal tract. They may be classified by their intended use and site of insertion. For example, nasogastric (or nasoenteric) tubes are placed through the nose into the stomach or small bowel. In some situations, orogastric or oroenteric tubes may be placed through the mouth and passed into the stomach or small bowel. Natural orifice tubes are generally easy to place but frequently become clogged or dislodged. If the tube is to be used over the long term, surgical placement is considered (gastrostomy, jejunostomy, or gastrojejunostomy). These tubes are placed through the skin (percutaneously) into the gastrointestinal tract. Cecostomy tubes (access tubes placed percutaneously into the cecum) are now commonly used in antegrade continence programs to the treat constipation and incontinence related to neurologic issues. Tubes are also classified according to the technique of placement (surgical, laparoscopic, radiologic, or endoscopic). As with all medical procedures, complications may occur, and the decision to place a tube of any type requires care in patient selection and review of indications and desired outcomes. Selection of the appropriate tube and technique of placement as well as the actual performance of the procedure and maintenance of access thereafter are important aspects of quality care.