Search

Feeding of managed populations of giant anteater ( Myrmecophaga tridactyla ) is challenging in injured patients that present with anorexia. This report describes an approach for esophagostomy tube placement in this species. Cadavers of two adult giant anteaters were used for technique development. The animal was positioned in dorsal recumbency, and a guide feeding tube was inserted orally into the esophagus. A ventral midline incision in the midcervical region was made to access the esophagus and to protect submandibular salivary glands. The cervical musculature was dissected and retracted laterally to the right, the vagosympathetic nerve trunk was identified and preserved, and the esophagus was incised over the guide tube. The guide tube was removed to facilitate placement of the definitive tube, which was premeasured from its insertion point in the midcervical area to the level of the seventh-ninth intercostal space. The tube was secured to the cervical skin on the left side with a finger-trap suture.

Background: Nutritional support has become an essential part of modern veterinary medicine. Among different techniques, esophagostomy tubes have been used extensively in dogs and cats. However, general anesthesia is typically required due to the critical step of passing an instrument orally to allow identification of the esophagus in the midcervical region. Therefore, clinicians commonly face a conundrum of poor general anesthesia candidacy for those who need an esophagostomy tube placed. Additionally, esophagostomy tubes are not a viable option for patients that have difficulty opening their mouth. Ideally, a technique that circumvents the step of passing an instrument orally would be developed., Key Findings: We report the successful development of a novel technique for esophagostomy tube placement using ultrasound guidance and serial percutaneous dilatation of the stoma in canine cadavers. Ultrasound guidance allowed for identification and avoidance of several vital structures in the cervical region., Significance: This is the first report of an esophagostomy tube placement technique that circumvents the step of passing any instrument orally to identify the esophagus in the midcervical region. Future studies are warranted to determine if this technique can be performed in live dogs., (© Veterinary Emergency and Critical Care Society 2022.)

Background: Esophagostomy tubes (E-tubes) are widely utilized for extended nutritional support in dogs and cats. Problems associated with their use include the unwieldy excess (10-20 cm) of external tubing, constant need for neck wraps and necessity for skin sutures, suture tract infection, and tube loss if sutures fail., Objectives: To evaluate 2 different, low profile (LP) "button" products intended for use in people as enteral (jejunostomy [J] and gastrojejunostomy [G-J]) feeding tubes for suitability as LP E-tubes in dogs and cats., Animals: A young giant breed dog that required extended (>6 months) nutritional and fluid support during recovery from severe neurological illness with protracted adipsia, anorexia, and dysphagia., Methods: Prospective evaluation of 2 commercially available LP feeding devices after placement of a standard E-tube. An LP J-tube and an LP G-J tube were assessed in consecutive 4-week trials, for tube retention, patient comfort, stoma health, and functionality., Results: Both products performed extremely and equally well as LP E-tubes in this clinical patient, enhancing patient freedom and comfort by eliminating external tubing, skin sutures, and bandaging. The dual port G-J tube allows medication delivery (eg, sucralfate) to the entire esophagus, but for safety alone (ie, to avoid aspiration), the single port J-tube appears the best device for client-owned patients., Conclusions and Clinical Importance: The LP enteral feeding tubes from the human medical field can be successfully used as LP E-tubes in dogs and cats, offering superior patient comfort, with no obvious detriment to the patient and main drawback of higher cost., (© 2021 The Author. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Objectives: To retrospectively assess the rate of oesophagostomy tube-related complications in azotaemic dogs, the influence of the oesophagostomy tube (o-tube) duration and the therapeutic approach (medical versus haemodialysis) on the complication rate., Materials and Methods: Medical records were retrospectively reviewed in order to identify azotaemic dogswhich underwent o-tube placement. o-Tube duration (short-term versus long-term), time of o-tube change, therapeutic approach (medical versus haemodialysis), prevalence of minor (malposition, suture related, inflammation, muco-purulent discharge, abscess) and major (haemorrhage, malposition, obstruction, dislodgement, vomiting of the tube, food coming from the stoma) o-tube-related complications were extracted. Univariate and multivariate logistic regression analysis were performed to identify the risk factors for o-tube-related complications., Results: Tube-related complications were reported in 74 of 139 dogs (53%). Minor complications were reported in 66 of 74 (89%) and major complications in eight of 74 (11%). In azotaemic dogs, o-tube indwelling time (odds ratio (OR) 1.03; 95% confidence interval (CI) 1.01 to 1.05), and the use of haemodialysis (OR 40.12; 95% CI 9.18 to 175.20) were risk factors for o-tube-related complications., Clinical Significance: The majority of o-tube-related complications were minor, and easily manageable, with no need of hospitalisation, tube-removal or euthanasia. In azotaemic dogs, the use of haemodialysis was strongly associated with a higher risk of o-tube-related complications, possibly as a consequence of the presence of the neck bandage., (© 2020 British Small Animal Veterinary Association.)

Background: Esophageal feeding tubes are commonly used to provide enteral nutrition to cats, but their use is associated with adverse effects., Objectives: To evaluate the complications associated with e-tube placement in cats and to identify factors predisposing to these complications., Animals: Cats that had an esophageal feeding tube placed (n = 248)., Methods: This was a retrospective case review in which clinical records were interrogated across 2 referral centers to identify records of cats that had esophageal tubes placed. Clinical data were collected for signalment, clinical indication, method of placement, time of removal, and any complications. Logistic regression was then employed to assess the odds of an increase in complications, including infection and death., Results: For those cats that survived to discharge, tubes were in place for a median of 11 days, ranging from 1 to 93 days. Complications occurred in 35.8% of the cats, with the most common being tube dislodgement (14.5%), followed by stoma site infections (12.1%). Cats receiving glucocorticoids or oncolytic agents (OR = 3.91; 95% CI, 1.14-13.44) and with discharge at the stoma site (OR = 159.8; CI, 18.9-1351) were at an increased odds of developing a stoma site infection, whereas those with a lower weight (OR = 1.33; 95% CI, 1.02-1.75) or (pancreatic [OR = 4.33; 95% CI, 1.02-18.47], neoplastic [OR = 15.44; 95% CI, 3.67-65.07], respiratory [OR = 19.66; 95% CI, 2.81-137.48], urogenital [OR = 5.78; 95% CI, 1.15-28.99], and infectious diseases [OR = 11.57; 95% CI, 2.27-58.94]) had an increased odds of death. The duration of time in place and the cat being discharged with the tube in place were not associated with an increased risk of infection or death., Conclusions and Clinical Importance: Owners should be made aware of the potential risks involved and their predisposing factors., (© 2019 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

A gelding was diagnosed with dysphagia and left guttural pouch mycosis. Treatments included topical antifungal drugs, systemic voriconazole, and balloon occlusion of the internal carotid artery. Ongoing dysphagia of neurological origin necessitated extra-oral feeding through an esophagostomy tube. Complementary case management included acupuncture. Clinical remission occurred over 10 weeks.

Enteral nutrition improves survival rates and hospitalization times. Some diseases affecting the oral cavity can hinder spontaneous nutrition; in these cases the use of an esophagostomic tube can resolve nutritional problems. The innovative method described in this study is easier and more rapid than those currently known because the end of the tube does not need to be extracted from the oral cavity and then be reinserted with a number of maneuvers into the esophagus. The procedure does not require specific instruments, endotracheal intubation, and nor does it require the head to be moved or lifted. In addition, it can be carried out without the support of an assistant even with big or giant dogs. The new method involves the introduction of hemostatic forceps into the oral cavity, which pass through the esophagus wall and skin, then the distal extremity of the tube is firmly held between the extremity of the forceps and oriented caudally. The forceps, holding the tube, need to be retracted in the esophagus and then pushed ventrally and aborally in order to pass the esophagus stoma, without needing to extract the tube from the oral cavity and thus the risk of tube kinking., (Copyright © 2017 Elsevier Inc. All rights reserved.)

A 10-year-old neutered male Labrador Retriever dog was diagnosed with idiopathic megaesophagus. Despite receiving conventional treatments including elevated feeding, the dog showed repeated regurgitation and aspiration pneumonia, consequently developing weight loss and severe malnutrition. For the purpose of controlling regurgitation, an esophagostomy tube was placed for draining the esophageal fluid. Additionally, an esophagogastric tube was placed for nutritional support. After tube placement, the average frequency of regurgitation was reduced from 2.4 times a day to 0.1 times a day. The nutritional state of the dog improved gradually, and the body weight increased from 18.5 to 27.9 kg. The dog died on day 951, and necropsy revealed a gastric ulcer (2.5 cm in diameter), presumably esophagostomy tube-induced injury. This case report suggests that patients with idiopathic megaesophagus and persistent regurgitation might benefit from esophageal drainage through an esophagostomy tube.

Esophagostomy feeding tubes are useful, and in many cases essential, for the comprehensive management of cats with moderate to advanced chronic kidney disease (CKD). They should be considered a lifelong therapeutic appliance to facilitate the global management of cats with CKD thus providing improved therapeutic efficacy and quality-of-life. Esophagostomy tubes facilitate the maintenance of adequate hydration and increase owner compliance by facilitating the administration of medications. Finally, feeding tubes provide a means to deliver a stage-appropriate dietary prescription for cats with CKD and maintain an adequate nutritional plane in a patient that otherwise would be subject to chronic wasting., (Copyright © 2016 Elsevier Inc. All rights reserved.)

We determined if esophagostomy tube placement is feasible for nutritional support in raptors. The clinical data were reviewed from 18 raptors admitted between 2006 and 2012, and in which esophagostomy tubes were placed. Indications for tube placement, complications associated with its placement and management, duration of treatment, and changes in patient body weight were evaluated. The most common indication was nutritional and medical support in stressed hospitalized animals, and intensive care cases. Complications were regurgitation, unexpected removal, and misplacement of the tube. The esophagostomy tube was well tolerated in all but 2 cases. A tube was replaced once in 2 patients. Five birds died during the treatment course. Mortality was not associated with the placement of the tube. Average duration of tube placement was 6.1 +/- 3.7 days. Most birds did not gain any weight with use of the feeding tubes. Esophagostomy tubes are well tolerated in raptors, but further studies are needed to demonstrate their efficiency.

Background: The putative role of the gut in amplification of systemic inflammation in acute pancreatitis is gaining credence, and intraluminal nutrition has been shown to decrease inflammation in experimental models of pancreatitis. Prepyloric feeding often is used in people with acute pancreatitis, but has not been evaluated in dogs., Hypothesis: Early intervention with enteral nutrition (EN) delivered proximal to the pylorus will be well tolerated in dogs with acute pancreatitis and provide justification for further larger trials., Animals: Ten dogs with severe acute pancreatitis in an open-label, prospective pilot study., Methods: Dogs were treated with plasma transfusion and standard care, and then consecutively assigned to receive either EN via esophagostomy tube feeding or parenteral nutrition (PN). Outcome was used to determine optimal study size for future studies, and complications were compared between the 2 groups., Results: A significantly greater number of vomiting or regurgitating episodes occurred in dogs receiving PN. The dogs receiving EN did not demonstrate any noticeable postprandial pain. There were more catheter-related complications in the PN group. There was no difference in outcome between the 2 treatments, and 43 dogs for each treatment would be required in future studies to determine a difference in outcome., Conclusions and Clinical Relevance: Early EN delivered proximal to the pylorus is well tolerated in dogs with severe pancreatitis and resulted in fewer complications than PN. Prospective trials in a larger cohort are justified to fully establish the potential benefit of early EN, preferably compared with minimal enteral nutrition., (Copyright © 2011 by the American College of Veterinary Internal Medicine.)

A percutaneous technique to place oesophageal feeding tubes in cats is described. Nineteen traumatised cats underwent different surgical procedures for facial and/or oral trauma and subsequent oesophagostomy. The tube placement was easy to perform, requiring a 14G over-the-needle vascular catheter, a curved forceps and a 1.2mm feeding tube. During insertion, the tube was directed aborally (normograde direction) to its definitive position in a one-step procedure. The tube was removed when the patient started to eat voluntarily. A major limit of this technique was represented by the small diameter of the feeding tube, requiring the use of a liquid diet. However, considering the absence of complications, the rapidity of the procedure and its cost efficacy, it was considered as an effective alternative to more complicated and invasive techniques, in particular if a short period of starvation is predictable.

Esophagostomy feeding tubes may be used to provide nutrition to animals with insufficient calorie intake. This column describes tube placement and use in the feline patient.

Anorexia is a common sign of illness in laboratory rabbits. When not treated promptly, the condition can lead to hepatic lipidosis and death. The author describes a technique for cervical esophagostomy as an alternative to pharyngostomy tube feeding, oral gavage, and nasogastric procedures.

Providing nutrition to critically ill patients is important to the healing process. This article will focus on selection and placement of nasoesophageal, nasogastic, esophagostomy, and gastrostomy tubes. Advantages and disadvantages of these tubes will be discussed, as well detailed instructions on the placement of the aforementioned tubes.

Esophagostomy feeding tubes were placed in 46 cats. Percutaneous endoscopic gastrostomy (PEG) feeding tubes were placed in 21 cats. Owner management and complications and facility of use were evaluated retrospectively by review of medical records and owner survey. Both tube types were equally effective for maintenance of body weight, ease of owner management, and complication rates. All of 12 owners surveyed were comfortable with PEG tube management. Ninety-six percent of 24 owners surveyed were comfortable with esophagostomy tube management. The esophagostomy tube can be placed less invasively, without specialized equipment, making it an excellent alternative to the PEG tube.

We report use of esophagomyotomy and esophagopexy to create a diverticulum for relief of chronic type I esophageal stricture in 2 horses. After esophagomyotomy, the mucosa was dissected free from the muscularis for approximately 180 degrees around the myotomy. Then, the tunica muscularis of esophagus was sutured to the sternocephalicus muscle ventrally and the periesophageal tissues dorsally to create a diverticulum without disruption of the esophageal mucosa. Clinical signs of esophageal stricture were relieved, and the horses were fed normal diets without further esophageal obstruction., (Copyright 2001 by The American College of Veterinary Surgeons)

A new percutaneous insertion technique for esophageal feeding tubes in cats is presented. The technique has been successfully applied in 12 feline patients. The placement technique is relatively simple, takes approximately five minutes to perform, and requires a scalpel blade, a curved hemostat, and an applicator for the insertion of the feeding tube. In contrast to other esophageal tube placement techniques, the tube is inserted into the definitive aboral position in a one-step procedure. Because of its shoehorn shape, the applicator allows the tube to be inserted into the esophagus safely and precisely. Placement of the tube in the midcervical area does not interfere with the function of the pharynx and avoids having the animal irritated by the presence of the tube. The chosen diameter of the tube is large enough to permit feeding of diluted, blended, commercial canned food. For the patients of this study, feeding was started after recovery from anesthesia, and tubes were removed without complications once the animals had started to eat voluntarily.

Nutrition is an integral part of the management of the critically ill patient. Nutritional support can be provided by either parenteral or enteral routes. Whenever possible, enteral nutrition is the method of choice, as it reduces complication rates and improves outcome. Potential choices for enteral feeding include nasoesophageal, esophagostomy, gastrostomy, jejunostomy, and transpyloric feeding tubes. The modes of parenteral and enteral nutrition are reviewed individually, including indications and selection of appropriate routes of feeding, methods of tube placement, and benefits and risks associated with each feeding approach.

The enteral route is the preferred method of nutritional support in patients with functional gastrointestinal tracts. Many techniques for obtaining enteral access are available, and the decision regarding which one to use depends on several issues, including the functional integrity of each part of the gastrointestinal tract, the duration of anticipated nutritional support, and the risk of aspiration and gastroesophageal reflux. Nasoesophageal tubes are useful for short-term supplementation; however, patients needing nutritional support for longer than 2 weeks may be better served with a more permanent tube. Blenderized pet food diets are recommended for nutritional support because these diets do not need to be supplemented with protein or micronutrients. Commercial human enteral formulas provide a useful alternative for patients with specific nutrient requirements or for feeding via nasoesophageal or jejunostomy tubes.

The use of esophagostomy tubes in 60 feline patients was evaluated retrospectively. Indications for tube placement, complications associated with placement and management, duration of treatment, and change in patient body weight were evaluated. Hepatic disease was the most common indication for tube placement. A minor complication associated with the surgical technique for tube placement was observed in three cases. Inflammation or infection of the tube site, swelling of the head, or vomition of the tube were observed complications during management in 19 cases. Vomiting occurred and was a complicating factor in nine cases. The average duration of tube placement was 23 days, and most patients maintained or gained weight while being fed through their esophagostomy tubes.

Esophagostomy tubes were placed surgically in 13 dogs and 16 cats. The placement technique used was rapid and only required curved forceps, a scalpel blade, and suture material. Flexible tubes (5- to 30-French) were used for feeding liquids or blenderized diets for up to 557 days. Additionally, esophageal and gastric decompression were accomplished using these tubes. Following tube removal, all ostomy wounds healed by second intention without evidence of esophageal stricture or esophagocutaneous fistula. Complications included kinking, placement in an inappropriate location, obstruction, inflammation or infection of the ostomy site, and reflux of feedings.

A new technique for percutaneous placement of tube esophagostomy for enteral feeding in cats is described. The technique is characterized by its symplicity and rapid placement of the feeding tube. Its use is demonstrated in 8 cats in which nutritional support with enteral feeding was indicated. Placement of the tube was performed without complications. The feeding tube was tolerated well. Complications after placement were restricted to occasional vomiting after feeding (n = 2) and minor inflammation of the esophagostomy incission. Tubes could be removed after 7 to 16 (median 14) days. Two cats died as a result of the primary disease. This technique is a useful aid in the application of enteral feeding because of its simplicity and minimal complications.

An alternative technique for placement of tube esophagostomy in small animals is described. Tube esophagostomy was placed in 13 dogs and nine cats. The mean duration of tube placement was 23 days (range, one to 48 days). No significant complications related to the tube were noted. In each case, tube esophagostomy was tolerated and time to healing of the esophagostomy site following tube removal was less than two weeks. Tube esophagostomy is suitable for use in a nutritionally compromised small animal with a functional esophagus and gastrointestinal tract.

Tracheoesophageal fistulae endanger newborn children by aspiration pneumonia. An animal model of this dangerous malformation was thought to be impossible until now. By tracheoesophageal anastomosis, occlusion of the oesophagogastral junction, proximal cervical oesophagostomy and continent gastrostomy in 25 minipiglets a reliable model of tracheoesophageal fistula has been developed. After establishing the model in a pilot study the mortality following the establishment of this procedure was 5.6% and the minipiglets survived in excellent condition for 2-10 week periods under complete alimentary restriction and gastrostomy feeding. Therefore the method seems to be suitable for long-term investigations on major oesophagotracheal surgery.

Pharyngeal or esophageal trauma was diagnosed in 9 horses after nasogastric intubation. Evidence of trauma (edema or ulceration) was detected in the pharynx of 3 horses and in the esophagus of 6 horses. Complications associated with nasogastric intubation were first observed in 5 horses while they were intubated and in 4 horses after extubation. Clinical signs of pharyngeal or esophageal trauma were similar, and included salivation, bruxism, coughing, and nasal discharge. Treatment, including extubation, enteral feeding through a small nasogastric tube, or esophagostomy distal to the affected site, was attempted in 6 horses. Three of 6 treated horses survived, but 4 of 5 horses with perforated esophagus were euthanatized.

An esophageal stricture was diagnosed in a 9-month-old quarterhorse by esophagoscopy and positive pressure contrast esophagography. Medical management and two attempts at surgical intervention were unsuccessful. The initial surgical technique used was a linear esophagotomy, mucosal resection and anastomosis, and closure of the muscular tunic, which resulted in a more severe stricture. The second surgical procedure was interruption of the stricture cicatrix by a single linear esophagotomy and primary closure of only the esophageal muscular tunic. This technique resulted in an increased lumen diameter, but failed to adequately resolve the stricture. Successful resolution of the stricture with return to a normal diet was achieved by a two stage repair using formation of an esophagostomy to stabilize the esophagus, followed by fenestration of the mucosal-submucosal cicatrix. Six months postoperatively, the horse was asymptomatic on a normal diet.