RESUMO
Innovation in endoscope design and application of lessons and techniques from minimally invasive surgery is allowing endoscopists to explore new frontiers in enteral access and meet the demands of an increasingly savvy and aging 'baby boomer' population that has high health care expectations. Another small but very labor intensive group of patients that is contributing both to increased awareness and to the demand for specialized nutrition support services, is made up of patients with intestinal failure. With steadily accruing experience in the care of these patients on long term home parenteral and enteral nutrition, as well as the improved outcomes for intestinal transplantation, these services are poised for exponential growth in coming years. The endoscopist whose practice involves enteral access should be capable of providing the whole gamut of enteral access services allowing individualization of approach to ensure the best possible outcomes for a given patient and indication. Experience with management of the many common complications of enteral access is a pre-requisite for successful long-term outcomes. While it would be desirable that such enteral access be provided within a broader multi-disciplinary model of specialized nutrition support, in the current climate of a tightening health care economy that may be counsel for perfection.