# Enteral and parenteral nutrition support

Source: https://onco.cc/technologies/enteral-parenteral-nutrition/  
OnCo record `enteral-parenteral-nutrition` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Nutrition support means tube feeding into the gut, or nutrition into a vein when the gut cannot be used. It is life-saving in the right patient, harmful or futile in the wrong one.

## Summary

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.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-08
- Principle: Deliver macronutrients, micronutrients and fluid by the least invasive route that works, matched to the patient's prognosis, with monitoring for refeeding syndrome and line infection.
- Strengths: Prevents treatment interruption in head and neck and oesophageal cancer; Home parenteral nutrition can restore months of life in selected patients
- Limitations: Parenteral nutrition adds infection and metabolic risk with no survival benefit in most oncology settings; Overuse near end of life; Cost and nursing burden

## Notes

- NICE NG85 says for people who have had a pancreatoduodenectomy and have a functioning gut, offer early enteral nutrition (oral or tube feeding) rather than parenteral nutrition; Pancreatic Cancer UK says a tube through the nose or a small hole in the tummy may be used until the stomach works normally, and feeding into a vein is reserved for a pancreatic leak.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Parenteral_nutrition
- ESPEN guideline on clinical nutrition in cancer 2017: https://doi.org/10.1016/j.clnu.2016.07.015
- NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations: https://www.nice.org.uk/guidance/ng85/chapter/Recommendations
- Pancreatic Cancer UK: after your operation: https://www.pancreaticcancer.org.uk/information-and-support/treatments-for-pancreatic-cancer/surgery-for-pancreatic-cancer/after-your-surgery/

## Connected records

- cancers: [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [Ovarian cancer](https://onco.cc/cancers/ovarian/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- fronts: [Diet, Exercise & Lifestyle](https://onco.cc/fronts/nutrition-lifestyle/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Nutrition support and cachexia management](https://onco.cc/technologies/oncology-nutrition/), [Swallowing therapy around head and neck radiotherapy](https://onco.cc/technologies/rejuv-rehab-swallowing/)
- terms: [Feeding tube (gastrostomy, PEG, jejunostomy)](https://onco.cc/terms/feeding-tube/), [Malnutrition screening tools (MUST, NRS-2002, MST, PG-SGA)](https://onco.cc/terms/malnutrition-screening/), [Nutrition impact symptoms](https://onco.cc/terms/nutrition-impact-symptoms/), [Weight loss, fat digestion and enzymes with gallbladder cancer](https://onco.cc/terms/weight-loss-and-fat-digestion-biliary/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Pain relief and palliative care are unavailable to most](https://onco.cc/bottlenecks/b-palliative/)
- key papers: [ESPEN guidelines on nutrition in cancer patients](https://onco.cc/key-papers/paper-arends-clin-nutr/)
- roadmaps: [Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment](https://onco.cc/roadmaps/nutrition-lifestyle-roadmap/)

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