Esophagostomy Tubes: Don't Underutilize Them!

Critical care veterinarians observe a wide variety of patients who easily become malnourished and display negative nitrogen balance due to inappetance, complete anorexia, vomiting, or inability to normally prehend food, as in patients with head and facial trauma (Tables 1 and 2). Negative nitrogen balance is associated with delayed wound healing and increased incidences of gastroinstestinal mucosal atrophy, bacterial translocation, sepsis, and mortality. Early interventional nutrition is necessary for maintenance of normal function and for proper healing to occur. While total parenteral nutrition (TNP) is an option, enteral nutrition is preferred whenever possible. Enterocytes undergo atrophy within several days in the absence of direct trophic stimuli Within the intestinal lumen.
"If the gut works, use it" has gained widespread Popularity in early interventional nutrition in the critically ill veterinary patient. Force-Feeding is often stressful for both patient and caretaker alike. Instead, tube feeding is often well tolerated and an easier route for enteral nutrition. The following methods of tube feeding have been described: nasoesophageal, nasogastic, nasojejunostomy, esophagostomy, pharyngostomy, gastrostomy, and jejunostomy.
Esophagostomy tubes were first described for use in human patients with maxillofacial and cervical neoplasta. Later, Dr. Crowe described their use for veterinary patients (1989). Since that time, several methods for esophagostomy tube placement have been proposed. The modified percutaneous method is one of the easiest to perform, and requires minimal equipement.