Unless the GI tract is non-functional, its use for nutritional suppo is preferable as compared to TPN. In a patient who is comatose either NG feeding or feeding through a gastrostomy tube may lead to vomiting and aspiration. This can be avoided by using a nasoenteric tube with the tip placed in jejunum under fluoroscopic guidance or endoscopic control. Alternatively, a catheter may be placed directly into the proximal jejunum through a small upper abdominal incision. Enteral Nutrition Enteral feeding means delivery of nutrients into the GIT. The alimentary tract should be used whenever possible. This can be acheived with oral supplements (sip feeding) or with a variety of tube-feeding techniques delivering food into the stomach, duodenum or jejunum. Advantages of Enteral route over Parenteral route Maintains integrity of gastrointestinal tract. Reduces translocation of gut bacteria that may lead to infection. Reduces levels of pro inflammatory cytokines generated by the gut that contribute to hypermetabolism. Enteral Nutrition Indication Contraindication Protein-energy malnutrition with inadequate oral intake Dysphagia except for fluids Major trauma (Or surgery) when return to required dietary intake is prolonged Inflammatory bowel disease Distal, low-output (<200 ml/day) enterocutaneous fistula To enhance adaptation after massive enterectomy Small bowel obstruction or ileus Severe diarrhoea Proximal small intestinal fistula Severe pancreatitis Ref: Sabiston 27th edition Pgno: 112