Endoscopically guided nasojejunal tube placement in dogs for short‐term postduodenal feeding

Objective – To evaluate a method for endoscopically guided nasojejunal tube placement allowing short‐term postduodenal feeding and chyme withdrawal in dogs. Design – Pilot study. Setting – University teaching hospital. Animals – Three healthy Beagle dogs with jejunal nipple valve fistulas. Interventions – After the dogs were anesthetized, an 8 Fr, 250‐cm polyvinyl chloride catheter was advanced through a gastroscope into the jejunum. Correct jejunal placement was established using endoscopic visualization and confirmed by fluoroscopy and radiography. The proximal end of the tube was pulled out through 1 nostril and sutured to the skin of the forehead. Thereafter, jejunal feeding was administered for 4 days. Follow‐up examinations included daily confirmation of the tube's position using radiography, physical examination, and blood analyses. Withdrawal of jejunal chyme was performed after jejunal and oral feeding. Measurements and Main Results – Fluoroscopic examination confirmed that endoscopic visualization alone allowed correct jejunal placement. During a 4‐day postduodenal feeding period, repeated radiographic examination revealed stable positioning of the tubes within the jejunum with minor cranial displacement. The tubes were functional throughout the study without causing identifiable problems. Repeated physical examinations and blood analysis showed no abnormalities. We were able to administer the daily caloric requirements as a liquid diet. Jejunal chyme was successfully withdrawn via the tube. Conclusions – Endoscopically guided nasojejunal tube placement was shown to be a minimally invasive, well‐tolerated method for short‐term jejunal feeding in healthy dogs. This technique is a viable option for dogs requiring jejunal feeding but not laparotomy. The feasibility of chyme sampling is another unique application of the procedure.     

Clinical experience utilizing a novel fluoroscopic technique for wire‐guided nasojejunal tube placement in the dog: 26 cases (2006–2010)

Objective – To describe the clinical use of a novel, minimally invasive fluoroscopic technique for the wire‐guided placement of nasojejunal tubes (NJT) in dogs. Design – Retrospective study (September 22, 2006–October 2, 2010). Setting – University veterinary teaching hospital. Animals – Twenty‐six consecutive dogs with intolerance of, or contraindications to gastric feeding that underwent attempted fluoroscopic NJT placement. No dogs were excluded from analysis. Interventions – All dogs underwent attempted fluoroscopic NJT placement using a novel fluoroscopic wire‐guided technique. Measurements and Main Results – Patient data were collected in concert with information about the NJT placement procedure as well as the maintenance and utilization of the tube. The primary diagnosis in dogs undergoing NJT placement was pancreatitis in 60%. The ability to achieve transpyloric passage of the tube was 92.3% (24/26) and the ability to achieve jejunal access was 78.2%. In the second half of the study period, the ability to achieve jejunal access was significantly higher than in the first half of the study period suggesting that technical proficiency improves over time. Mean duration of the procedure was 35.3±20 minutes. Significant oral migration was a complication of NJT placement in some dogs. The median duration of feeding was 3.3 days (range 0.3–10.5). Conclusions – Fluoroscopic wire‐guided NJT placement is a viable method for sustained postpyloric feeding in dogs. Success in acquiring jejunal access improves with experience. The NJT may be utilized as a strategy to provide enteral nutritional support to the population of dogs with contraindications to, or intolerance of gastric feeding.     

Evaluation of laparoscopic-assisted placement of jejunostomy feeding tubes in dogs

OBJECTIVE: To evaluate feasibility of performing laparoscopic-assisted placement of a jejunostomy feeding tube (J-tube) and compare complications associated with placement, short-term feedings, and medium-term healing with surgically placed tubes in dogs. DESIGN: Prospective study. ANIMALS: 15 healthy mixed-breed dogs. PROCEDURES: Dogs were randomly allocated to undergo open surgical or laparoscopic-assisted J-tube placement. Required nutrients were administered by a combination of enteric and oral feeding while monitoring for complications. Radiographic contrast studies documented tube direction and location, altered motility, or evidence of stricture. RESULTS: Jejunostomy tubes were successfully placed in the correct location and direction in all dogs. In the laparoscopic group, the ileum was initially selected in 2 dogs, 2 dogs developed moderate hemorrhage at a portal site, and 2 J-tubes kinked during placement but were successfully readjusted postoperatively. All dogs tolerated postoperative feedings. All dogs developed minor ostomy site inflammation, and 1 dog developed bile-induced dermatitis at the ostomy site. Despite mild, transient neutrophilia, no significant difference was noted in WBC counts between groups. No dog had altered gastric motility or evidence of stricture, although the jejunopexy site remained identifiable in several dogs at 30 days. CONCLUSIONS AND CLINICAL RELEVANCE: Requirements for successful J-tube placement were met by use of a laparoscopic-assisted technique, and postoperative complications were mild and comparable to those seen with surgical placement. Laparoscopic-assisted J-tube placement compares favorably to surgical placement in healthy dogs and should be considered as an option for dogs requiring enterostomy feeding but not requiring a celiotomy for other reasons.     

Endoscopically assisted nasojejunal feeding tube placement: technique and results in five dogs

Interest in noninvasive feeding tube placement in companion animals led to the adaption of a human technique utilizing endoscopy to place nasojejunal feeding tubes. Data from medical records in which nasojejunal feeding tubes were attempted were reviewed. Feeding tubes were attempted and successfully placed in five dogs within a median of 35 min. Feeding tubes remained in place for approximately 7 days. Complications included facial irritation (5/5), sneezing (5/5), fractured facial sutures (4/5), vomiting (3/5), diarrhea (3/5), crimping of feeding tube (3/5), regurgitation (1/5), epistaxis (1/5), clogging of the feeding tube (2/5), and oral migration with premature removal of the feeding tube (1/5). The deployment technique used in this study was found to be cumbersome. Despite minor complications, endoscopy can be used to rapidly and accurately place nasoenteric feeding devices.     

Successful treatment of feline pancreatitis using an endoscopically placed gastrojejunostomy tube

A cat with pancreatitis, diagnosed using abdominal ultrasonography, fine-needle aspirate cytopathology, and increased concentration of serum trypsin-like immunoreactive substance, was treated successfully using jejunal alimentation provided through a percutaneous gastrojejunostomy tube. This method of jejunal feeding is less technically difficult, less stressful for the patient, and has fewer complications than surgically placed jejunostomy tubes. Nutritional support with jejunal feeding is superior to total parenteral nutrition, as it maintains gut integrity, decreases septic complications, and may reduce exogenous insulin requirements. The methods of tube insertion and maintenance, and the physiological advantages over other feeding methods are described.     

Placement of a low-profile duodenostomy and jejunostomy device in five dogs

Five male crossbred dogs successfully underwent surgical placement of button enterostomy tubes to evaluate the placement technique, maintenance and complications of these tubes. Surgical placement was quick, technically straightforward and similar to techniques used for other feeding tubes. None of the dogs experienced life-threatening complications during the 10 month follow-up period. One device required replacement as it was removed by the dog before a permanent fistula had formed. Open tubes due to loose safety plugs and focal cellulitis surrounding the exit sites of these tubes were noted in all dogs. The button tube may be a feasible option for long-term nutritional support in patients with pancreatic, hepatobiliary or gastrointestinal conditions.     

Esophageal and gastric feeding tubes in ICU patients

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.     

Capnographic documentation of nasoesophageal and nasogastric feeding tube placement in dogs

Objective: To evaluate the ability of capnography to document proper placement of nasoesophageal (NE) and nasogastric (NG) feeding tubes. This study was conducted in 3 phases. Phase I of this study was designed in order to test the efficacy of capnography to distinguish placement of a feeding tube in the alimentary tract versus the respiratory tract. Phase II was designed in order to document that carbon dioxide (CO₂) could be measured through a polyvinyl chloride (PVC) feeding tube. Phase III was performed in order to evaluate the technique of continuous monitoring during insertion of the feeding tube into the esophagus and stomach as would be performed during a clinical‐tube placement. Design: Prospective study. Setting: Research laboratory. Animals: 24 adult dogs. Interventions: In Phase I, sedated dogs were instrumented with an intratracheal catheter and an 8 French feeding tube placed nasally into the distal esophagus and later advanced into the stomach. In Phase II, dogs were anesthetized and an 8 French feeding tube was placed down the endotracheal tube, then into the esophagus and later advanced into the stomach. In Phase III, sedated dogs were instrumented with an 8 French feeding tube inserted intranasally and then advanced to the level of the nasopharynx, distal esophagus and, lastly, the stomach. Fluoroscopy was used in order to determine location of the feeding tube. Measurements and main results: Phase I measurements included respiratory rate and CO₂ from the trachea, esophagus, and stomach and pH of gastric fluid sample. Phase II measurements included respiratory rate and CO₂ from the endotracheal tube, feeding tube in the endotracheal tube, feeding tube in the distal esophagus, and feeding tube in the stomach. Phase III data collection included respiratory rate and CO₂ as the tube was passed through the nasal cavity, nasopharynx, esophagus and stomach. Phase I fluid samples were collected from 5 of the 9 dogs and had pH values from 1.68 to 4.20. In both phases, values for the respiratory rate and CO₂ from the esophagus and stomach were 0 ± 0, significantly lower (P < 0.001) than the values from the trachea. In Phase II, there was no significant difference between the respiratory rates (P = 0.886) and CO₂ (P = 0.705) readings obtained from the endotracheal tube compared to readings from the feeding tube in the endotracheal tube. In Phase III, there was a significant difference (P < 0.001) between the respiratory rates and CO₂ readings obtained from the nasal cavity and the nasopharynx when compared to those readings obtained from the esophagus and stomach. Measurement of CO₂ and respiratory rate resulted in a reading of 0 every time the feeding tube was in the esophagus or stomach. Conclusions: Capnography may be used in order to detect airway placement of NE and NG tubes.     

USE OF A GASTROSTOMY AND JEJUNOSTOMY TUBE FOR MANAGEMENT OF GASTRIC DISTENTION FOLLOWING PYLORIC OUTFLOW OBSTRUCTION IN A FERRET (MUSTELA PUTORIUS FURO)

An 8-month-old spayed female ferret (Mustela putorius furo) was presented for evaluation of persistent, severe gastric distention following gastrotomy to retrieve several foreign bodies. A structural cause of gastric outflow obstruction was not identified ultrasonographically or surgically. A 14 Fr gastrostomy and an 8 Fr jejunostomy tube were used to facilitate medical management of severe gastric stasis and to allow enteral nutrition. The ferret tolerated the feeding tubes well and recovered completely following intensive medical therapy. This report describes successful management of idiopathic gastric distention using gastric and jejunal feeding tubes in a ferret. Feeding tubes and supplemental nutrition plans should be considered for management of ferrets with compatible disease processes.     

Clinical Experience With Jejunostomy Feeding Tubes In 47 Small Animal Patients

The medical records of 39 dogs and 8 cats which had jejunostomy feeding tubes placed using modifications of a previously described surgical technique were retrospectively reviewed. Modifications included the addition of a suture to anchor the feeding tube to the jejunum, the use of a continuous circumferential suture to pexy the jejunum to the abdominal wall, and the placement of a skin suture that penetrated deep into the abdominal wall fascia. All tubes were placed during surgical treatment of a primary intraabdominal disease. Tubes were used for feeding from 1 to 41 days (average 9.7 days). Sixteen patients (34%) developed mild to moderate complications such as chewing at the tube, inadvertent tube removal, tube obstruction, and cellulitis around the ostomy site. Three patients (6%) developed severe complications associated with breakdown of the surgical site. The modified jejunostomy technique was effective for placement of jejunostomy tubes as a complementary procedure to exploratory celiotomy.     

A new technique for insertion of esophagostomy tubes in cats

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.     

Fungal colonization and failure of a long-term gastrostomy tube in a cat

Candida krusei was isolated from a gastrostomy tube that failed 175 d after placement in a 13-year-old cat. Fungal colonization of gastrostomy tubes is common in humans and a contributor to tube failure. Veterinarians should be aware of this phenomenon in patients that have long-term indwelling feeding tubes.     

加温饲养和定时饲喂对断奶仔猪肠黏膜形态和肠道发育的影响

试验旨在探索对仔猪床进行加温处理以及采用定时饲喂的方式的对早期断奶仔猪不同肠段黏膜形态和肠道发育的影响,从而为确定断奶仔猪适宜的饲养温度和科学的饲喂方式提供理论依据。试验采用2×2因子设计。选用21日龄杜长大断奶仔猪240头,随机分到4个处理组:1):28~30℃的仔猪床加温处理组;2)23~25℃的低温对照组(炉火暖气管道舍内加热);加温处理组和低温对照组中又根据不同的饲喂模式分为每天6次定时饲喂组和自由采食组。每个处理6个重复,每个重复10头猪。经过14 d的试验之后,在每圈仔猪中随机抽取1头,屠宰后取样检测小肠黏膜的绒毛高度、隐窝深度和肠壁厚度。结果表明:加温饲养组(28~30℃)的仔猪空肠中段的绒毛高度显著高于低温对照组(23~25℃)(P<0.05)。加温饲养组十二指肠的隐窝深度和空肠中段的肠壁厚度显著低于低温对照组(P<0.05)。定时饲喂饲养的仔猪空肠后段的绒毛高度显著高于自由采食饲养的仔猪(P<0.05)。定时饲喂组仔猪空肠中段的肠壁厚度和十二指肠隐窝深度显著低于自由采食组(P<0.05)。2因子的互作效应表明:加温定时饲喂组饲养的仔猪空肠后段的绒毛高度显著高于其他处理组。低温自由采食组饲养的仔猪空肠后段的绒毛高度极显著低于其他处理组(P<0.01)。加温定时饲喂组的仔猪空肠中段的肠壁厚度极显著低于其他处理组(P<0.01)。由结果可知,28~30℃的加温饲养组以及定时饲喂的饲喂模式有利于仔猪的肠道黏膜形态的改善,有益于肠道的发育和健康。     

Care and use of feeding tubes in dogs and cats

Feeding tubes are an accepted way of providing nutritional support for animals unable or unwilling to consume adequate calories on their own. This article provides information on the indications for the use of feeding tubes in small animals, the types of tubes available, and ways to initiate nutritional support once the tubes are in place. The pros and cons of the various tubes are discussed, as well as potential complications.     

Laparoscopic-assisted enterostomy tube placement and full-thickness biopsy of the jejunum with serosal patching in dogs

OBJECTIVE: To develop laparoscopic-assisted techniques for enterostomy feeding tube placement and full-thickness biopsy of the jejunum in dogs. ANIMALS: 15 healthy dogs. PROCEDURE Dogs were anesthetized, and positive pressure ventilation was provided. A trocar cannula for the laparoscope was inserted on the ventral midline caudal to the umbilicus. For enterostomy tube placement, a second trocar cannula was placed lateral to the right rectus abdominis muscle, and a Babcock forceps was used to grasp the duodenum and elevate it to the incision made for the cannula. The duodenum was sutured to the abdominal wall, and a feeding tube was inserted. For jejunal biopsy, a third trocar cannula was placed lateral to the left rectus abdominis muscle. A portion of jejunum was elevated to the incision for the second or third cannula, and a full-thickness biopsy specimen was obtained. A second specimen was obtained from another portion of jejunum, and retention sutures for the 2 biopsy sites were tied so that serosal surfaces of the biopsy sites were apposed to each other. Dogs were euthanatized 30 days after surgery. RESULTS: The enterostomy tube was properly positioned and functional in all 8 dogs that underwent laparoscopic-assisted enterostomy tube placement, and sufficient samples for histologic examination were obtained from all 7 dogs that underwent laparoscopic-assisted jejunal biopsy. None of the dogs had any identifiable problems after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in dogs, laparoscopic-assisted procedures for enterostomy tube placement and jejunal biopsy are an acceptable alternative to procedures performed during a laparotomy.     

Owner experiences and complications with home use of a replacement low profile gastrostomy device for long-term enteral feeding in dogs

The purpose of this study was to evaluate complications and owner impressions of a low profile gastrostomy device (LPGD) for enteral feeding in dogs. Medical records of dogs that had placement of a percutaneous endoscopic gastrostomy tube followed by a LPGD between 1995 and 2003 were reviewed. Fifteen dogs had 29 devices placed for a variety of disease states in which enteral nutritional support was indicated. The individual tubes were placed for a median duration of 212 d. Most complications occurred more than 15 d after placement and were of no health risk to the animals. The most common reason for LPGD replacement was leakage through the 1-way antireflux valve. Fourteen of 15 owners that were contacted were supportive of the device. Based on its durability, ease of placement, minor complications, and positive owner impressions, we conclude that the LPGD is a valuable device for long-term enteral nutritional support of dogs.     

Equine cervical esophagostomy: complications associated with duration and location of feeding tubes

Cervical esophagostomy for tube feeding was evaluated in 11 ponies. Minor complications responded to supportive therapy in 8 ponies. Two died of complications, and 1 pony had a permanent fistula because of persistent infection. There was a positive correlation between the duration of tube feeding and the event of closure of the esophageal stoma after the tube was removed. There was no difference in the frequency of complications related to duration of tube feeding. When the distal end of the feeding tube was located in the thoracic portion of the esophagus, instead of in the stomach, tubes were more readily dislodged. Reinsertion of some tubes was difficult or impossible to do and resulted in false passage of the tube into the mediastinal space, dissecting infections into the thorax, or both. Reflux of food around the tube occurred in ponies with the distal end of the feeding tube located in the stomach, but this was not associated with other complications.     

Comparison of cardiopulmonary responses during sedation with epidural and local anesthesia for laparoscopic-assisted jejunostomy feeding tube placement with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical jejunostomy feeding tube placement in healthy dogs

OBJECTIVE: To evaluate the use of laparoscopic-assisted jejunostomy feeding tube (J-tube) placement in healthy dogs under sedation with epidural and local anesthesia and compare cardiopulmonary responses during this epidural anesthetic protocol with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical J-tube placement. ANIMALS: 15 healthy mixed-breed dogs. PROCEDURES: Dogs were randomly assigned to receive open surgical J-tube placement under general anesthesia (n = 5 dogs; group 1), laparoscopic-assisted J-tube placement under general anesthesia (5; group 2), or laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia (5; group 3). Cardiopulmonary responses were measured at baseline (time 0), every 5 minutes during the procedure (times 5 to 30 minutes), and after the procedure (after desufflation [groups 2 and 3] or at the start of abdominal closure [group 1]). Stroke volume, cardiac index, and O(2) delivery were calculated. RESULTS: All group 3 dogs tolerated laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia. Comparison of cardiovascular parameters revealed a significantly higher cardiac index, mean arterial pressure, and O(2) delivery in group 3 dogs, compared with group 1 and 2 dogs. Minimal differences in hemodynamic parameters were found between groups undergoing laparoscopic-assisted and open surgical J-tube placement under general anesthesia (ie, groups 1 and 2); these differences were not considered to be clinically important in healthy research dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Sedation with epidural and local anesthesia provided satisfactory conditions for laparoscopic-assisted J-tube placement in healthy dogs; this anesthetic protocol caused less cardiopulmonary depression than general anesthesia and may represent a better choice for J-tube placement in critically ill patients.     

Improved nasogastric intubation technique for administration of nutritional support in dogs.

Established procedures for nasogastric intubation are difficult to perform in dogs because of anatomic variation of nasal passages and turbinate structures. Twenty-five clinically normal dogs were used to improve and refine the technique of nasogastric tube placement, and 13 clinical patients at our teaching hospital were evaluated for malnutrition and were considered candidates for nutritional support by nasogastric tube feeding. An improved method for the placement of nasogastric tubes in dogs was used. By pushing the external nares dorsally while advancing the tube in a caudoventral, medial direction, the tube passed through the ventral meatus and into the oropharynx and esophagus easily. The procedure does not require chemical restraint, and the complication of epistaxis was not observed in any dog. Materials required to perform this technique are inexpensive, and the method can be used for the administration of nutritional support, fluids, drugs, or contrast material.     

Complications with non-endoscopic percutaneous gastrostomy in 31 cats and 10 does: a retrospective study

Percutaneous gastrostomy tubes were placed non-endoscopically in 31 cats and 10 dogs using either a rigid insertion tube (n=13) or an Eld gastrostomy tube applicator (n=28). Tubes were placed successfully in 38 of the 41 animals and the consequent feeding was of therapeutic benefit to 31 of the animals. Six of 41 died or were euthanased for reasons unrelated to gastrostomy. In four cases (10 per cent), gastrostomy failed with respect to correct tube placement or tube feeding. Overall complications occurred in 18 of 41 animals. Severe procedural complications occurred in two cats; a cardiorespiratory arrest during pharyngeal manipulation and erroneous tube placement through the distal oesophagus. Moderate late complications included peristomal food leakage (n=2), peristomal abscess (n=2) and pyloric outflow obstruction by a migrated tube (n=1). Complications associated with the feeding procedure, nausea and vomiting (n=3), led to aspiration pneumonia in one case.