Percutaneous Feeding Tube Placement
Hospitalized veterinary patients commonly require nutritional supplementation due to insufficient caloric intake from vomiting, increased metabolic requirements, severe systemic/gastrointestinal disease or surgery. Nutritional therapy is routinely provided through minimally-invasive nasoesophageal (NE) tubes, esophagostomy (E) tubes, or more invasive means including PEG tubes and surgically placed gastrostomy or jejunosotomy tubes. Parenteral feeding can replace these methods but is costly and is associated with an increased risk of catheter infection, hyperglycemia, and electrolyte disturbances. In addition, enteral feedings are preferred when possible because of improved gut mucosal integrity. Unfortunately, some patients cannot tolerate traditional enteral feedings due to severe pancreatitis, intractable vomiting, or decreased mental awareness, and the potential morbidity associated with surgically placed jejunostomy tubes is not insignificant in these debilitated animals. Recently, fluoroscopically-placed nasojejunal feeding tubes have been described in veterinary patients28,29 and fluoroscopically-placed esophagojejunostomy are currently being investigated (Figure 11).
Figure 11. Lateral radiograph of a dog with severe pancreatitis and 1 day following fluoroscopic-guided placement of feeding tube through an esophagostomy tube. A guidewire and angled catheter combination are directed under fluoroscopic guidance into the distal duodenum and proximal jejunum. The catheter is removed and the feeding tube is advanced over the guidewire and as far into the jejunum as possible. In this case, the feeding tube (white arrows) reached the ascending duodenum which was sufficient to provide enteral support for the following week.