Sec. VII: Digestive- Esophagus & Feeding Tubes Flashcards
1
Q
Aertsen JSAP 2016
What was found with surgical extraction of canine esophageal foreign bodies?
A
- Gastrotomy approach in 12 cases after endoscopic approaches failed
- FB extracted (majority- 66%- were bones) successfully in all cases
- 10 dogs recovered well w/o any postop complications
- 1 dog: refractory hypotension and died
- 1 dog: esophageal necrosis and died
- 50% were WHWT
2
Q
Binvel JSAP 2018
What was found in this study in regards to endoscopic retrieval of esophageal/ gastric FB?
A
- Total of 33 cases ( 2 cats & 31 dogs)
- Most common location: prox esophagus (36%) and stomach (33%)
- Endoscopic retrieval was successful in 82% of cases
- Esophageal perforation occurred in 18% of cases (3 treated medically and 3 treated surgically)
- Surgery performed in 18% of cases and no early complications were noted
- Survival rate was 100% overall
- No breed predisposition (other studies describe a high % in small breeds- terrier and poodles)
3
Q
Bongard JVECCS 2019
- Which risk factors were found in this study regarding esophageal foreign bodies?
A
- Small breed dogs were overrepresented (Yorkies, WHWT, Shih Tzu)
- Dogs w/ FB present for more than 24 hours were significantly more likely to have severe esophagitis and major complications
- FB type did not predict degree of esophagitis or complications, though fishhooks were more likely to require surgery and more likely located in cervical esophagus/thoracic inlet
- FB more commonly lodged in distal esophagus
- Feeding tubes (15 gastrostomy, 1 NE) were placed in 14% of dogs are more likely placed if FB had been present for more than 24 hours
- Overall success rate for removal via scope was 95% and complication rate 22%
- 78% survival rate with no complications
4
Q
Breheny JVIM 2019
Which complications/factors were in in 248 cats with esophageal feeding tubes?
A
- Complications occurred in 35.8% (compared to 71% in previous study) w/ most common: tube dislodgement (14.5%), followed by stoma site infections (12.1%)- E.coli and Enterococcus most common
- cats receiving steroids or oncolytic agents & with discharge at stoma site were at increased odds of developing infection
- lower weight or with (pancreatic, neoplastic, respiratory, urogenital and infections diseases) had an increased odds of death
- Duration of time in place and cat being discharged with tube in place were not assoc. with an increased risk of infection or death
- Tubes were in place for a median of 11 days (1-93 d)
- Mila tubes: higher odds of developing an infection than other E-tubes
5
Q
Brisson JAVMA 2018
A
- Terrier breeds most common (30.5% of 233 dogs)
- Duration of EFB entrapment, body wt, anorexia, lethargy, rectal temp, and esophageal perforation were assoc. with need for sx
- Older age, longer duration of EFB entrapment, and perforation were assoc. with poorer prognosis
- Endoscopy or advancement into stomach was a success in 83.6% EFBs
- 11.2% resulted in postprocedural esophageal stricture
- Mortality rate was 5.4%
- 88.2% of dogs with a median follow-up period of 27 months had excellent outcomes
6
Q
Burton JVIM 2017
A
- 81% osseous foreign body, 49.5% distal esophagus
- duration of c/s not assoc w/ risk of death*
- 91.8% endoscopy, 5.9% sx, repeat endoscopy 2.3%
- In hospital case fatality rate was 5% (23.1% Sx, 1.5% Endo)
- Risk of death was higher with surgery and 100% dogs died - repeat endoscopy bc sx was declined
- Increasing numbers of postprocedural complications, esophageal perforation, and post procedure esophageal hemorrhage increased in-hospital risk of death
- Esophageal strictures in 2.1% of survivors available for follow-up
7
Q
Carabetta JVECCS 2019
Novel fluoroscopic technique for wire-guided esophagojejunal tube placement
A
- Primary diagnosis was pancreatitis in 61%
- Ability to achieve postpyloric access with technique was 95%
- Mean duration of procedure in dogs where placement was successful was 63.8 minutes
- Esophagostomy site infection was a complication in 2 dogs
- Mean duration that tube remained in place was 3.8 d
- Vomiting was noted in 89% pre-placement and 24% postplacement
8
Q
Cinti JSAP 2019
Megaesophagus due to Aberrant R subclavian artery
A
- 2 different approaches because 1 also had a PDA
- 1 esophagoscopy
- Know the pics
9
Q
Grobman JVIM 2019
lower esophageal sphincter achalasia-like syndrome
A
- 19/130 dogs were id as having LES-AS
- Megaesophagus in 73.7% dogs with LES-AS
- baseline esophageal fluid-line and “bird beak” present in 68.4% and 63.2% of affected dogs, respectively
- Esophagus graded as acontractile in 8/19, hypomotile in 8/19 and hypermotile in 3/19
- distal esophageal diameter: height of T12 vertebral body ratio= greater than 4.7 = 94% sensitive and 100% specific for ME
10
Q
Hansen JVECCS 2019
Gastrostomy tube usage in dogs w/ septic peritonitis
A
- 75% survived to discharge
- 75% had GI source of sepsis
- Complications in 50%
- 16.6% had non GT related complications
- 33.3% had GT related complications; majority were minor; only 2/8 had major complications requiring removal
- Significant difference between survivors and nonsurvivors: between length of time after placement of GT to when they began eating and outcome; and GT dwell time and outcome (table easier to understand)
11
Q
Herring JVECCS 2016
Novel placement for NE and NG tubes
A
- The main variation from standard procedure involves a second tube measurement, with the distal tip of the tube positioned at the thoracic inlet and measured to the nostril. The tube is advanced to this level and tested for negative pressure using a 12 mL syringe attached to the end of the feeding tube. This improves confidence in esophageal positioning before complete advancement of the tube to its distal endpoint.
12
Q
Hlusko JVECCS 2019
Novel technique for surgical placement of gastrostomy tubes
A
A thoracic trocar catheter (TTC) with an attached Pezzer tube is inserted through a gastrotomy incision and exited
through the left gastric body and body wall. A left-sided tube gastropexy is performed using an interlocking box (ILB) pattern.
13
Q
Mack JVECCS 2016
Percutaneous radiologic gastrojejunostomy tube placement
A
- Technique: Gastropexy was performed using GI suture
anchors. An over-the-wire catheter technique using fluoroscopic guidance was used to achieve jejunal access. An 18F/8F, 58 cm, dual-lumen gastrojejunal feeding tube was placed via serial over-the-wire dilation of thebody wall using an 18F peel-away introducer kit. - Percutaneous radiologic gastrojejunostomy (PRGJ) tube placement was successful in all dogs.
- Median time to pyloric passage with the guide wire was 23.5 minutes (range, 9–93 minutes).
- Median total procedure time was 53 minutes (range, 49–113 minutes).
- Significant tube migration was not observed at any point during the study.
- One dog developed linear foreign body obstruction secondary to the tube on day 5 that was relieved by release of the jejunal component.
- Other complications were minor and included mild-to-moderate peristomal inflammation in all dogs and removal of the feeding tube on day 3 by 1
dog.
14
Q
Nathanson JVIM 2019
-Esophagostomy tube complications
A
- 100 patients (44.4%) experienced a complication related to tube placement, with a similar complication rate among dogs (43.1%) and cats (45.5%).
- Twenty-two cats (17.8%) and 14 dogs (13.7%) developed signs of infection at the E-tube site, with 5 cats (22.7%) and 5 dogs (35.7%) requiring
surgical debridement. - Regurgitation of food through the E-tube stoma was
noted in 7 dogs and 1 cat. - Three patients were euthanized as a result of tube-related complications
- No statistically sig risk factors found
15
Q
Reeve JSAP 2017
hiatal hernia and other esophageal abnormalities in brachiocephalic dogs
A
- with use of fluoro: 16/36 (44%)had hiatal hernia
- all were Frenchies
- 31 (86%)had delayed esophageal transit time
- 27 (75%) had gastro-esophageal reflux
- 4 (11%) had redundant esophagus
16
Q
Risselada JAVMA 2018
Various gastrojejuostomy tube constructs
- review
A
- The 20F/8F, 24F/8F, 28F/8F, and 28F/10F (gastrostomy tube/jejunostomy tube) constructs allowed for injection and aspiration of all solutions.
- The 5F jejunostomy tubes allowed only water to be injected, whereas the 8F
jejunostomy tubes did not allow injection of the canned food–water mixtures. - The 20F/10F construct did not allow injection or aspiration through the gastrostomy tube, whereas the 18F/8F construct allowed injection but not aspiration through the gastrostomy tube.
- Faster flow rates through the
gastrostomy tube were associated with larger gastrostomy tube diameter, smaller jejunostomy tube diameter, and smaller syringe size. - Faster flow rates through the jejunostomy tube were assoc with smaller jejunostomy
tube diameter
17
Q
Robin JAVMA 2018
Esophageal leiomyoma treated with transcardial placement of a self-expanding, covered, nitinol esophageal stent
A
- Consider benign causes
- Know images/ CT images
18
Q
Smith JVECCS 2019
route and timing of nutrition for septic peritonitis cases
A
- Nutritional strategy was categorized into 1 of 4 groups: voluntary, feeding tube, parenteral (PN), and combined feeding tube and PN.
- Overall, 54/68 dogs survived (79%).
- Survival Prediction Index 2 scores were not significantly different between groups.
- Dogs receiving PN only were less likely to survive than
those receiving any enteral nutrition - Compared to dogs not receiving PN, dogs receiving any PN were significantly less likely to survive and were in hospital significantly longer
- Metabolic complications (63%) associated with PN were frequent but not associated with increased length of hospitalization or survival to discharge.
- 5%- PN- complications: tube dislodgement
19
Q
Sterman JAVMA 2019
Perforations secondary to esophageal FB in dogs
A
- Bones [44%] and fishhooks [30%] were the most common
types of EFBs. - Fifteen (12%) dogs had an esophageal perforation (10
with a fishhook EFB and 5 with a bone EFB). - No association was identified
between dog body weight and esophageal perforation. - Esophageal perforation
was more likely in dogs with a fishhook EFB [27%] versus other EFBs [6%] - Median interval
from fishhook or bone ingestion to initial evaluation was significantly longer for dogs with (12 and 96 hours, respectively) versus without (1 and 24 hours, respectively) perforation. - 87% dogs with esophageal
perforation survived to hospital discharge, including all 10 dogs with perforation secondary to fishhook ingestion. - 8 survivors with esophageal perforation required no surgical intervention.
20
Q
Sutton JAVMA 2016
Esophageal surgery
A
- Most common indication for surgical intervention was an esophageal FB in dogs (50/63 [79%]) and esophageal stricture in cats (3/9).
- Complications: 54% (34/63) of dogs and 3 of 9 cats.
- The most common immediate postoperative complications were respiratory in nature (9 dogs, 1 cat).
- Partial esophagectomy and resection with anastomosis
were significantly associated with the development of immediate postoperative complications in dogs. - Most common delayed postop complications were persistent regurgitation (7 dogs) and esophageal stricture formation (3 dogs, 1 cat).
- For dogs, a mass lesion and increasing lesion size were significantly associated with the development of delayed
postop complications. - 6 dogs (10%) and 1 cat died or were euthanized prior to discharge, and pneumomediastinum and leukopenia were
negative prognostic factors for dogs being discharged from the hospital. - 90% of patients discharged from hospital
21
Q
Tan JVIM 2018
indwelling esophageal dilatation feeding tube
A
- for benign strictures in dogs and cats
- The B-Tube management was relatively well tolerated and effective in maintaining dilatation of a BES while in place.
- Median of 2 anesthetic episodes and monitored for a median of 472 days.
- Mean modified dysphagia score before treatment
was 3.1 /4.0 and final follow-up MDS were significantly improved at 0.36 /4.0. - 11 of 12 animals (91.7%) had improved MDS at the end of the follow-up period, with 8/12 (66.7%) having an MDS of 0/4, 2/12 (16.7%) an MDS of 1/4, and 1/12 (8.3%) an MDS of 2/4.
- One dog died.
22
Q
Teh JVECCS 2018
Medical management in 5 dogs with esophageal perforation secondary to esophageal FB
A
- C/S at presentation included tachycardia, tachypnea, and increased respiratory effort.
- Thoracic rad was performed in all cases, and in each case, pleural and mediastinal effusion was present, suggesting
esophageal perforation prior to endoscope-guided removal. - A full thickness esophageal defect was visualized after FB removal in 4/5 cases.
- Treatment included IV crystalloid fluid therapy, IV abx,
analgesia, and proton pump inhibitors in all cases. - Two dogs had a percutaneous endoscopically placed gastrostomy feeding tube placed and 1 dog received prednisolone sodium succinate IV because of marked pharyngeal inflammation.
- Complications after EFB removal: pneumothorax (n = 2) and pneumomediastinum
(n = 4). - 4/5 dogs survived to discharge and did not have complications 2–4 wk following discharge.
- One dog was euthanized as result of aspiration pneumonia following EFB removal.
23
Q
Tsuruta JVECCS 2016
Evaluation of jejunostomy tube feeding
A
- Most dogs (81%) survived.
- The median intrajejunal feeding period was 2.1 days
- Only 3 (5%) dogs received their estimated RER by
intrajejunal feeding. - Of dogs that were fed intrajejunally (58 out of 64), most (55 out of 58) received intrajejunal feeding within 24 hours after surgery.
- Energy provision via the jejunal feeding tube did not differ between dogs
with and without complications OR between nonsurvivors and survivors - 35 dogs ate voluntarily concurrently with intrajejunal feeding.
- Of dogs that ate voluntarily concurrently with intrajejunal feeding for 50% of the postoperative period, most (74%) survived to discharge.
- Complications in 22% of dogs, and none were life-threatening; GI signs were most common.
- There was no difference in preop [plasma ALB] between dogs with and without complications and between nonsurvivors and survivors
- Fecal score was not significantly different between
the 2 liquid diets studied
