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
