DESCRIPTION OF ESOPHAGOSTOMY TUBE PLACEMENT IN TWO GIANT ANTEATER (MYRMECOPHAGA TRIDACTYLA) CADAVERS.

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.

Description of a novel ultrasound-guided percutaneous dilatational esophagostomy tube placement in dog cadavers.

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.

Inadvertent placement of an esophagostomy tube into the mediastinum of a cat.

An 8-year-old neutered male Siberian forest cat was presented for respiratory distress. Endoscopy, exploratory surgery of the neck, and sternotomy confirmed initial placement of the esophagostomy tube (e-tube) into the mediastinum. The patient recovered from surgery, developed laryngeal paralysis, and then arrested and died within 48 h after surgery. Key clinical message: To the authors' knowledge, there are no other case reports documenting inadvertent placement of an e-tube into the mediastinum of a cat. This case report highlights the complications that can be associated with incorrect placement of an e-tube.

Placement par inadvertance d'un tube d'oesophagostomie dans le médiastin d'un chat. Un chat des Forêts sibériennes mâle castré âgé de 8 ans a été présenté pour détresse respiratoire. L'endoscopie, la chirurgie exploratoire du cou et la sternotomie ont confirmé le placement initial du tube d'oesophagostomie (e-tube) dans le médiastin. Le patient s'est remis de la chirurgie, a développé une paralysie laryngée, puis a fait un arrêt cardiaque et est décédé dans les 48 heures suivant la chirurgie.Message clinique clé:À la connaissance des auteurs, il n'y a pas d'autres rapports de cas documentant le placement par inadvertance d'un e-tube dans le médiastin d'un chat. Ce rapport de cas met en évidence les complications qui peuvent être associées au placement incorrect d'un e-tube.(Traduit par Dr Serge Messier).

Repurposing medical devices as "button" esophagostomy tubes for extended nutritional support.

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.

Oesophagostomy tube complications in azotaemic dogs: 139 cases (2015 to 2019).

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.

Esophageal feeding tube placement and the associated complications in 248 cats.

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.

Reversible dysphagia secondary to guttural pouch mycosis in a gelding treated medically with voriconazole and surgically with carotid occlusion and esophagostomy.

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.

Dysphagie réversible secondaire à une mycose de la poche gutturale chez un hongre traité médicalement avec du voriconazole et chirurgicalement par l'occlusion de la carotide et l'œsophagostomie. Un hongre a été diagnostiqué avec de la dysphagie et une mycose de la poche gutturale gauche. Les traitements ont inclus des médicaments antifongiques topiques, du voriconazole systémique et l'occlusion par ballon de l'artère carotide interne. Une dysphagie non résorbée d'origine neurologique a nécessité une alimentation extra-orale par un tube d'œsophagostomie. Une gestion du cas complémentaire a inclus l'acupuncture. Une rémission clinique s'est produite pendant 10 semaines.(Traduit par Isabelle Vallières).

A New and Easy Procedure to Place an Esophagostomy Tube into Dogs and Cats.

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.

Long-term management of a dog with idiopathic megaesophagus and recurrent aspiration pneumonia by use of an indwelling esophagostomy tube for suction of esophageal content and esophagogastric tube feeding.

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.

Utilization of Feeding Tubes in the Management of Feline Chronic Kidney Disease.

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.

Use of an esophagostomy tube as a method of nutritional management in raptors: a case series.

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.

A pilot study to assess tolerability of early enteral nutrition via esophagostomy tube feeding in dogs with severe acute pancreatitis.

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.

Normograde, minimally invasive technique for oesophagostomy in cats.

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.

Placement of canine and feline esophagostomy feeding tubes.

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.

Esophagostomy tube placement in the anorectic rabbit.

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.

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.

A comparison of owner management and complications in 67 cats with esophagostomy and percutaneous endoscopic gastrostomy feeding 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.