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Your feeding tube options

Gastrostomy tubes


E tubes vs. G tubes: Did you know?
Gastrostomy (G) tubes can be placed surgically or with endoscopic guidance (percutaneous endoscopic gastrostomy [PEG]). While blind placement techniques exist, we do not recommend blind placement of G tubes. We recommend 18- to 30-Fr mushroom-tip (Pezzer) tubes, though some clinicians use commercial veterinary PEG tube kits, which can vary in the tubes' ease of placement and security. General anesthesia is required for placing G tubes. Tubes should be left in place for a minimum of 10 to 14 days to allow adequate adhesion to form between the gastric serosa and body wall and should be left longer if there is concern about wound healing.

For large dogs, a gastropexy may be performed to reduce the tension placed on the tube. For animals that require extended nutritional support, a low-profile gastrostomy device may be placed to reduce the amount of external tubing present and, thus, the risk of inadvertent removal.

Potential contraindications for the placement of a G tube include underlying gastric disease, ascites, hypoalbuminemia, or risk for poor adhesion formation (e.g. animals receiving immunosuppressive medication). To prevent pressure necrosis of the skin, care should be taken not to place too much tension on the skin with the external flange of the G tubes.

Jejunostomy tubes

Indications for jejunostomy (J) tubes include the need to bypass the stomach, pancreas, or proximal duodenum (e.g. severe pancreatitis). J tubes are typically 3.5- to 8-Fr feeding tubes (red rubber, silicone, or polyurethane) that require surgical placement in most cases. New techniques have been described for the endoscopic and fluoroscopic guidance of nasojejunal5,6 and gastrojejunostomy7 tubes; however, placing these tubes is more technically difficult, and further studies are warranted to investigate their clinical relevance. J tubes require a liquid enteral diet and are usually reserved for hospitalized patients since continuous-rate infusion should be used for feedings because of the lack of a reservoir function of the small intestine (vs. the stomach).

REFERENCES

1. Holahan ML, Abood SK, McLoughlin MA, et al. Enteral nutrition. In: Dibartola SP, ed. Fluid, electrolyte, and acid-base disorders in small animal practice. 4th ed. St. Louis, Mo: Elsevier, 2012;623-646.

2. Larsen JA. Enteral nutrition and tube feeding. In: Fascetti AJ, Delaney SJ, eds. Applied veterinary clinical nutrition. West Sussex, United Kingdom: Wiley-Blackwell, 2012;329-352.

3. Marks SL. Nasoesophageal, esophagostomy, gastrostomy, and jejunal tube placement techniques. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 7th ed. St. Louis, Mo: Saunders, 2010;333-340.

4. Ireland LM, Hohenhaus AE, Broussard JD, et al. A comparison of owner management and complications in 67 cats with esophagostomy and percutaneous endoscopic gastrostomy feeding tubes. J Am Anim Hosp Assoc 2003;39:241-246.

5. Beal MW, Brown AJ. Clinical experience utilizing a novel fluoroscopic technique for wire-guided nasojejunal tube placement in the dog: 26 cases (2006–2010). J Vet Emerg Crit Care 2011;21:151-157.

6. Pápa K, Psáder R, Sterczer Á, et al. Endoscopically guided nasojejunal tube placement in dogs for short-term postduodenal feeding. J Vet Emerg Crit Care 2009;19:554-563.

7. Jergens AE, Morrison JA, Miles KG, et al. Percutaneous endoscopic gastrojejunostomy tube placement in healthy dogs and cats. J Vet Intern Med 2007;21:18-24.


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Source: VETERINARY MEDICINE,
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