Enteral and parenteral nutrition support

Enteral nutrition (nasogastric, gastrostomy or jejunostomy) is preferred whenever the gut works: it maintains mucosal integrity and carries fewer infectious complications. It is standard during chemoradiation for head and neck and oesophageal cancer, where prophylactic versus reactive gastrostomy remains debated. Parenteral nutrition is indicated for intestinal failure (obstruction, short bowel, severe mucositis, high-output fistula) when enteral feeding is impossible for more than about a week; randomised trials of routine parenteral nutrition during chemotherapy showed more infections and no survival gain, which is why guidelines restrict it. Home parenteral nutrition in advanced malignant bowel obstruction can extend life by months in patients with a good performance status but is contentious near the end of life. ESPEN advises against artificial nutrition in the last weeks of life.