The importance of providing early enteral feeding in critically ill patients at risk for deterioration of nutritional status has necessitated the development of a number of techniques for establishing gut access. Using endoscopy to place nasoenteric feeding tubes can be a surprisingly complex and technically difficult procedure for even the experienced operator. Knowing the 4 main methods for placing nasoenteric tubes, paying attention to the details and the potential modifications of each technique, and matching the individual characteristics of each procedure to the particular patient needs are all involved in the decision-making process by which the endoscopist helps initiate effective nutritional management.