Feeding Tube Placement
Upper gastrointestinal endoscopy is used to examine the esophagus, stomach and the beginning portion of the small intestine, the duodenum. It is often performed after radiographs (X-rays) and abdominal ultrasound to further evaluate patients with changes in appetite, weight loss, vomiting, diarrhea, intestinal bleeding, or unexplained anemia. Endoscopy can be used to diagnose foreign bodies, inflammation, inflammatory bowel disease, ulcers, tumors, and strictures of the upper gastrointestinal tract
Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement
Percutaneous Endoscopic Gastrostomy (PEG) tubes are feeding tubes placed into the stomach. They are most commonly used to provide nutritional support for patients that are not eating enough to maintain their health and recovery. Commercial canned food and sometimes soaked kibble can be delivered through PEG tubes. PEG tubes are often considered for patients with diseases of the head and mouth, megaesophagus, esophageal stricture, chronic kidney disease and liver disease.
Besides their obvious use for supplemental feeding, PEG tubes have a number of additional uses and advantages, including:
Supplemental fluids can be administered at home without the repeated needle pokes associated with subcutaneous fluid administration.
Medications may be administered without a dog or cat realizing it is being medicated.
The tube may also be used to relieve gaseous distention (bloating or colic) at home.
Patients tolerate PEG tubes better than most other types of feeding tubes. Low-profile tubes, designed for long-term use, often require no bandaging or suture.
PEG tubes may be left in place for months to years with limited care or maintenance.
The patients is generally fasted for 12 hours prior to the procedure, because food in the stomach increases the risk of aspiration of stomach contents into the lungs. Before anesthesia, an area on the left side of the abdomen is selected and shaved for tube placement. After being anesthetized, the patient is placed on its side and anesthetic monitoring equipment is attached. The patient’s heart rate and rhythm, respiratory rate, blood pressure, carbon dioxide level and oxygen saturation level are closely monitored while under anesthesia to prevent and minimize anesthesia-associated complications.
The tip of the endoscope is advanced through the mouth into the esophagus and down into the stomach. The inner lining of the stomach is carefully examined for abnormalities. If no abnormalities are found, the stomach is filled with air until the stomach wall touches the abdominal wall. The shaved site is sterilely prepared and then the tube is placed across the stomach and body walls, leaving only the bulbous tip (internal flange) inside the stomach. The endoscope is used ensure the PEG tube is properly seated on the interior surface of the stomach. An external retention disk is applied to the external portion of the tube to prevent tube migration. At the end of the procedure, air is evacuated from the stomach, the endoscope is withdrawn, and the animal is recovered from anesthesia.
In most cases, the patient is fitted with a protective stocking to protect the tube from trauma or chewing in the immediate healing period. This ‘sweater’ will cover the majority of the trunk. The free end of the tube is attached to the stockinette with tape. The tube placement site, or stoma, is cleansed daily for 7 to 10 days. Use of the tube can begin 12 to 24 hours after tube placement.
PEG Tube Removal
When no longer required for patient support, a PEG tube may be easily removed, often without sedation or anesthesia. The stoma site can be anticipated to close within 24 hours of feeding tube removal. PEG tubes should not be removed for 10 to 14 days after placement because gastric contents may leak into the abdominal cavity – a potentially life-threatening complication.
Risks and Limitations
Complications include irritation or infection at the stoma site, patient intolerance, vomiting following feeding and tube clogging. Serious but rare complications include necrosis of the stoma site or tube dislodgement. Major risks are minimized through careful patient selection and tube placement.
Limitations or contraindications to PEG tube placement include intolerance of general anesthesia, presence of a non-functional or diseased gastrointestinal tract, abnormal clotting function, free fluid accumulation in the abdomen, and splenomegaly.