Which long-term enteral access is preferred in patients at increased risk for aspiration?

• A. PEG feeding
• B. PEJ feeding
• C. Gastric feeding via NG
• D. Central PN

Answer: (B)

When aspiration risk is a major concern, delivering nutrition beyond the stomach minimizes the chance of aspirating gastric contents. Feeding into the jejunum via a percutaneous endoscopic jejunostomy (PEJ) tube places the nutrient stream distal to the stomach and pylorus, so refluxed or regurgitated contents are less likely to be inhaled into the lungs. This post-pyloric approach helps protect the airway in patients with impaired swallow, gastroparesis, or high reflux risk, making it the preferred long-term enteral access in these situations.

Gastric feeding via a PEG tube, while convenient, keeps nutrients in the stomach and thus retains a higher risk of aspiration if there is reflux or delayed gastric emptying. An NG tube is typically for short-term use and is not ideal for long-term access. Central PN bypasses the gut entirely (parenteral nutrition) and is not an enteral access method.