Which of the following feeding routes are for long-term use?

November 21, 2025 •

4 min read

Over 3 million people in the UK alone are malnourished or at risk of malnutrition, with many requiring artificial nutritional support. Deciding which of the following feeding routes are for long-term use is a crucial medical decision, hinging on a patient's specific health condition, the duration of anticipated need, and the functioning of their gastrointestinal tract.

Quick Summary

Several feeding routes are suitable for extended periods, primarily categorized as enteral (via the gut) and parenteral (intravenous) methods. Long-term enteral options, like gastrostomy and jejunostomy tubes, involve permanent openings into the stomach or intestine. Parenteral options, such as tunneled central venous catheters and implanted ports, deliver nutrients directly into the bloodstream for individuals with non-functional digestive systems.

Key Points

Long-term feeding involves enteral and parenteral routes: The main options for long-term feeding are enteral (feeding through the gut via gastrostomy or jejunostomy) and parenteral (intravenous feeding via a central venous catheter).
Gastrostomy is a common enteral route: G-tubes, including PEG tubes, are a common long-term feeding route for patients with a functional stomach who cannot swallow.
Jejunostomy is for post-gastric feeding: J-tubes are placed directly into the small intestine, bypassing the stomach, and are used for patients with gastric motility issues, severe reflux, or stomach surgery.
Parenteral nutrition is for non-functional guts: When the GI tract is non-functional, TPN is delivered intravenously through long-term access like tunneled central venous catheters or implantable ports.
Route selection depends on patient factors: The choice of long-term feeding route is determined by the patient's underlying condition, prognosis, gut function, and risk factors like aspiration.
Short-term routes are distinct: Routes such as nasogastric (NG) or nasojejunal (NJ) tubes are for short-term use (less than 4-6 weeks), not for long-term nutrition.

Understanding Long-Term Feeding Routes: Enteral vs. Parenteral

For patients unable to meet their nutritional needs orally for an extended period, medical professionals must determine the most suitable long-term feeding route. The primary distinction is between enteral nutrition (feeding via a functional gastrointestinal tract) and parenteral nutrition (intravenous feeding when the gut is not viable). Short-term routes, such as nasogastric (NG) and nasojejunal (NJ) tubes, are suitable for less than four to six weeks, while long-term routes are designed for prolonged use. The choice is based on patient anatomy, tolerance, and prognosis.

Gastrostomy Tubes (G-Tubes)

Gastrostomy tubes are a staple for long-term enteral nutrition, especially when the patient has a functional stomach. A tube is placed directly into the stomach through a small incision in the abdomen.

Percutaneous Endoscopic Gastrostomy (PEG): A PEG tube is one of the most common G-tubes and is placed endoscopically. A doctor uses an endoscope (a thin, flexible tube with a camera) to guide the tube through the mouth, down the esophagus, and into the stomach. The procedure is less invasive than surgical methods and can often be performed with sedation.
Radiologically Inserted Gastrostomy (RIG): When endoscopic placement isn't possible, an interventional radiologist can insert a tube using imaging guidance.
Surgical Gastrostomy: In some cases, a G-tube is placed during open or laparoscopic surgery, particularly if other procedures are being performed concurrently or if the patient's anatomy is complex.
Buttons: After the initial tube site has healed, a more discreet, low-profile “button” can often replace the original tube. This lies flat against the skin and is connected to an extension tube for feeding.

Jejunostomy Tubes (J-Tubes)

Jejunostomy tubes are an alternative for long-term feeding when the stomach cannot be used, for example, due to severe acid reflux, gastroparesis (delayed stomach emptying), or a history of gastric resection. The tube is placed directly into the jejunum, the middle section of the small intestine.

Direct Percutaneous Endoscopic Jejunostomy (D-PEJ): A direct PEJ involves an endoscopically guided puncture into the small bowel.
Gastrojejunostomy (G-J) Tube: This dual-port tube extends from the stomach into the jejunum. The gastric port can be used for decompression (venting gas or fluid) while the jejunal port delivers nutrition.
Surgical Jejunostomy: A surgeon can place a jejunostomy tube via laparoscopy or open surgery.

Parenteral Feeding Routes

Parenteral feeding, or Total Parenteral Nutrition (TPN), is used when a patient's gastrointestinal tract is non-functional. This method delivers a nutrient-rich fluid intravenously through a large central vein, bypassing the digestive system entirely.

Tunneled Central Venous Catheters (CVCs): For permanent or extended use, a tunneled catheter is inserted into a large vein (like the subclavian vein) and then tunneled under the skin before exiting the body. This tunneling reduces the risk of infection compared to non-tunneled lines.
Implantable Ports: An implanted port is a device with a reservoir that is surgically placed under the skin, often in the upper chest. The port is accessed with a special needle, providing a discreet, long-term intravenous access point. This is associated with a lower rate of septic complications than percutaneous CVCs.
Peripherally Inserted Central Catheters (PICCs): For medium-term use (weeks to months), a PICC line is inserted through a peripheral vein in the arm and advanced to a central vein. PICC lines offer a balance between convenience and central access.

Comparison Table: Long-Term Feeding Routes


Feature	Enteral (G-tube/J-tube)	Parenteral (Central Line/Port)
Mechanism	Delivers nutrients directly to the stomach or small intestine, relying on a functioning gut.	Delivers nutrients directly into the bloodstream, bypassing the digestive tract.
Placement	Requires an abdominal stoma (surgical opening) into the stomach or jejunum.	Involves a central venous catheter or port placed into a large vein near the heart.
Risks	Includes stoma site infection, tube dislodgement, reflux, or peritonitis.	Risks include blood infections (sepsis), catheter blockage, blood clots, or metabolic imbalances.
Cost	Generally more cost-effective than parenteral nutrition.	More expensive due to special nutrient solutions and sterile handling requirements.
Quality of Life	Often more physiological and allows for home-based management; low-profile buttons offer better mobility.	Requires careful monitoring but can be done at home, often via cyclic nocturnal infusions.
Indications	Requires a functional gut but inability to consume sufficient oral nutrients due to swallowing disorders, head/neck cancer, or obstruction.	Used for non-functional digestive systems due to conditions like intestinal failure, short bowel syndrome, or severe pancreatitis.

Conclusion

The most appropriate feeding route for long-term use depends on a patient's overall medical condition, including the functionality of their gastrointestinal tract. For those with a working digestive system, enteral feeding options like gastrostomy (G-tubes, including PEG tubes) and jejunostomy (J-tubes) are the preferred choice, being more physiological and cost-effective. When the gut is compromised, parenteral nutrition delivered through central venous catheters or implantable ports becomes a life-saving alternative. Medical teams make this decision based on a comprehensive assessment to maximize patient comfort and nutritional outcomes.

Frequently Asked Questions

Short-term routes, such as nasogastric (NG) and nasojejunal (NJ) tubes, are used for nutritional support lasting less than four to six weeks. Long-term feeding routes, like gastrostomy and jejunostomy tubes, are surgically placed into the abdomen for use beyond this timeframe when long-term nutritional support is anticipated.

A gastrostomy tube is the preferred long-term option for patients who cannot swallow safely but have a functional stomach. It is suitable for conditions like stroke, head and neck cancer, or other neurological disorders affecting swallowing.

A jejunostomy is used when feeding into the stomach is contraindicated. Reasons include poor gastric emptying (gastroparesis), severe gastroesophageal reflux, gastric surgery, or a high risk of aspirating stomach contents into the lungs.

Parenteral nutrition is the delivery of nutrients directly into the bloodstream via an intravenous route, bypassing the gastrointestinal tract. For long-term use, it is typically administered through a central venous catheter (CVC) or an implantable port placed in a large vein.

Not exactly. A PEG (Percutaneous Endoscopic Gastrostomy) tube is a specific type of G-tube that is placed endoscopically. While all PEG tubes are G-tubes, not all G-tubes are PEG tubes, as they can also be placed surgically or radiologically.

Long-term tubes are designed for prolonged use, lasting months or even years, but they are not necessarily permanent. The device may be replaced if it wears out, breaks, or is no longer needed if the patient's condition improves.

Enteral nutrition (using G-tubes or J-tubes) is almost always preferred over parenteral nutrition when the gastrointestinal tract is functional. It is more physiological, has a lower risk of infection, and is typically less costly than parenteral feeding.