1.0 FOREWORD

Patients with undernutrition to a degree that may impair immunity, wound healing, muscle strength, and psychological drive are common in UK hospital populations.¹ These individuals cope poorly with modern medical and surgical interventions and, on average, stay in hospital for approximately five days longer than the normally nourished, incurring approximately 50% greater costs.^2,3 Hospitals should therefore aim to provide at least adequate nutrition to all patients. In the majority, this can be achieved by the catering services if they offer good food and care is taken to avoid missed meals and to provide physical help with eating, as necessary. However, even if these ideals are met, many hospital patients do not or cannot eat adequately. Some of these will benefit from oral supplements but others will need active nutritional support. This can usually be provided by enteral tube feeding (ETF).

This document contains guidelines covering the indications, benefits, administration, and problems of ETF in adult hospital practice. The guidelines were commissioned by the British Society of Gastroenterology (BSG) as part of an initiative in several areas of clinical practice. They are not rigid protocols and should be used alongside clinical judgement, taking local service provision into account.

2.0 FORMULATION OF GUIDELINES

These guidelines were compiled from the relevant literature by the authors in discussion with dietitians and specialist nutrition nurses. They were subsequently reviewed by the BSG small bowel/nutrition committee and dietetic, nursing, pharmacy, and medical representatives of the British Association of Parenteral and Enteral Nutrition (BAPEN). The strength of evidence used is as recommended by the North of England evidence based guidelines development project.⁴

• Ia—Evidence obtained from meta-analysis of randomised controlled trials.

• Ib—Evidence obtained from at least one randomised trial.

• IIa—Evidence obtained from at least one well designed controlled study without randomisation.

• IIb—Evidence obtained from at least one other …