Evaluation of surgically placed gastrojejunostomy feeding tubes in critically ill dogs

Abstract

Objective—To evaluate complications and outcomes associated with surgical placement of gastrojejunostomy feeding tubes in dogs with naturally occurring disease. Design—Prospective study. Animals—26 dogs. Procedures—Multiple preoperative, intraoperative, and postoperative variables were evaluated. Daily postoperative abdominal radiographic examinations were performed to determine the presence of the following mechanical tube complications: kinking, coiling, knotting, and migration. Tube stoma abnormalities (erythema, cellulitis, and discharge) were observed daily and recorded by use of a standardized visual analog grading scale. Additionally, presence of complications was compared with median survival times. Results—The most common indication for gastrojejunostomy tube placement was gastrointestinal disease (n = 11), with confirmed septic peritonitis in 8 of 11 dogs. Other indications for gastrojejunostomy tube placement included extrahepatic biliary surgery (n = 6) and pancreatic disease (9). Mean ± SD surgical time required for tube placement was 26 ± 14 minutes. Overall, mechanical tube complication rate was 46% (12/26), including coiling (7), migration (4), and kinking (2). Overall minor tube stoma complication rate was 77% (20/26) and included erythema (16), cellulitis (13), and discharge (17). Dislodgement or self-induced tube trauma resulted in accidental tube removal in 2 of 26 dogs, and inadvertent tube damage necessitated premature removal by the clinician in 1 of 26 dogs. Kaplan-Meier median survival time was 39 days with 13 of 26 dogs still alive. Conclusions and Clinical Relevance—Gastrojejunostomy tube placement affords flexibility in the postoperative nutritional regimen by allowing for postgastric feeding with simultaneous access to the stomach.

Retrospective study of complications associated with surgically‐placed gastrostomy tubes in 43 dogs with septic peritonitis

“…The importance of early nutritional support in critically ill patients is well‐established in both veterinary and human medicine (Chan , Chan & Freeman , Cavanaugh et al . , Holahan et al . , Tsuruta et al .…”

“…Multiple methods of delivering enteral nutrition have been described, including nasoenteric tubes, gastrostomy tubes, gastrojejunostomy tubes, and jejunostomy tubes (Cavanaugh et al . , Tsuruta et al . , Hoffberg & Koenigshof ).…”

“…Septic peritonitis is associated with prolonged anorexia postoperatively and gastrointestinal dysfunction such as vomiting, regurgitation and ileus (Liu et al 2012, Hoffberg & Koenigshof 2017. The importance of early nutritional support in critically ill patients is well-established in both veterinary and human medicine (Chan 2004, Chan & Freeman 2006, Cavanaugh et al 2008, Holahan et al 2010, Tsuruta et al 2016. Enteral nutrition is generally the preferred route because of its beneficial effects on the integrity of the gut mucosa (Liu et al 2012).…”

“…Thus, it is widely accepted that early nutritional support should be part of the management of septic peritonitis (Hoffberg & Koenigshof 2017). Multiple methods of delivering enteral nutrition have been described, including nasoenteric tubes, gastrostomy tubes, gastrojejunostomy tubes, and jejunostomy tubes (Cavanaugh et al 2008, Tsuruta et al 2016, Hoffberg & Koenigshof 2017.…”

Barium Peritonitis in Small Animals

“…Early enteral nutritional support after surgery helps diminish the risk of hypoproteinemia [11]. In septic peritonitis cases in dogs, early nutritional support is associated with a shorter hospitalization length [42].…”