Gastrostomy: percutaneous tube (endoscopic)

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Sections available in full article Introduction, Uses, Alternative techniques, Time required, Decision taking, Requirements, Personnel, Materials required, Preparation, Procedure, Aftercare, Immediate Aftercare, Long term Aftercare, Sequelae, Complications, Sources, Publications, Vetstream contributor(s),
Contributors Dr Marge Chandler DVM MS MACVSc DACVN DACVIM DECVIM-CA MRCVS
Mr Andrew Gardiner BVM&S, Cert SAS, MSc, MRCVS
Dr Joe Harari MS DVM DACVS

Introduction

  • To introduce an indwelling catheter into the stomach via the abdominal wall.

Uses

  • Portal of entry for enteral nutrition.
  • Replacement and maintenance of alimentation pre- and post-surgery.
  • Bypass esophagus in esophageal disease.
  • Bypass oral cavity in oral/pharyngeal disease.
  • Bypass esophagus in neurological disorders affecting swallowing.
  • Nutritional supplementation in anorexia.

Advantages

  • Easy provision of caloric and water requirements.
  • May use canned pet foods processed in a blender as well as liquid diets.
  • Easier, safer, less expensive and more physiological than parenteral methods.
  • No irritation of esophagus or pharynx and no gastroesophageal reflux around tube.

Disadvantages

  • General anesthesia required.
  • Endoscopy skills needed.
  • Not suitable method of feeding if gastric or intestinal disease present.

Requirements

Materials required

Minimum equipment

  • Endoscope with 2 or 4-pronged grasping forcep or basket snare snare  Endoscopy: basket forceps  .

Minimum consumables

  • 18G sheathed catheter.
  • 18G Medicut catheter.
  • Mushroom-tipped catheter.
  • 18G needle.
  • No. 1 or 2 silk or braided polyester suture.
  • Scalpel.

Ideal consumables

  • Gauze pad.
  • Povidine-iodine ointment.
  • Bandage.
  • Band aid.
  • Chlorhexidine ointment.
  • Vetrap.

Preparation

  • 10 min.

Sequelae

Complications

  • Peristomal infections (rare).
  • Tube migrations (rare).
  • Delayed gastric emptying - may be treated with metoclopramide  Metoclopramide  .

Sources

Publications

  • Recent references from PubMed.
  • Salinardi B J, Harkin K R, Bulmer B J & Roush J K (2006) Comparison of complications of percutaneous endoscopic versus surgically placed gastrostomy tubes in 42 dogs and 52 cats. J Am Anim Hosp Assoc 42 (1), 51-56 PubMed.
  • Buffington C A (1998) Unclogging gastrostomy tubes. JAVMA 213 (3), 338 PubMed.
  • Glaus T M et al (1998) Complications with non-endoscopic percutaneous gastrostomy in 31 cats and 10 dogs - a retrospective study. JSAP 39 (95), 218-222 PubMed.
  • Seaman R et al (1998) Owner experiences with home use of a gastrostomy tube in their dog or cat. JAVMA 212 (910), 1576-1578.

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