Continuous Pump/Tube Enteric Hyperalimentation—Use in Esophageal Disease

A safe simple and reliable method for ensuring adequate nutritional support for catabolic patients is described which has most of the advantages of “parenteral hyperalimentation” and few of the risks. The technique requires a functionally competent gastrointestinal tract, utilization of a special, small feeding tube the tip of which is easily positioned distal to the pylorus, and continuous controlled pump feeding of a balanced, lactose-free, liquid diet of near normal osmolarity which provides 1 calorie/cc. Use in over 250 adult patients has uniformly resulted in weight gain with good patient tolerance, minimal problems, and great simplicity. There has been no sepsis, glucosuria, aspiration, or diarrhea, and only minimal metabolic monitoring. Of special interest has been the use of this method of nutritional support during the treatment of esophageal lesions, before and after surgery and during irradiation which has resulted in early return to anabolism. Esophageal fistulas have closed, wound healing promoted, and progressive weight gain established during intensive cobalt therapy. If the GI tract is intact and functioning, it can and should be used as a site of alimentation. With this technique continuous pump infusion of liquid diets through a small caliber feeding tube into the distal duodenum or proximal jejunum is superior to previous methods of bolus tube feedings through a large tube into the stomach. In addition, expensive elemental diets requiring a period of patient adaptation to their hyperosmolality are not needed for routine enteric alimentation.