With the growing availability and improving capabilities of small animal intensive care facilities, there is an increasing demand for more advanced nutritional support of veterinary patients. Feeding tubes such as J-tubes, G-tubes, and esophagostomy tubes have been commonly used in small animals.1–14 In instances when both prepancreatic (ie, gastric) and postpancreatic (ie, jejunal) feeding is desired, having a single-access option would be ideal. In addition, when performing enteral feeding with a G-tube or J-tube, being able to measure gastric residual volume may help prevent complications such as regurgitation and aspiration pneumonia resulting from poor postoperative gastric motility.
Several commercial options exist for placing a J-tube through a G-tube to create a single-access feeding device (ie, a gastrojejunostomy tube), but they are expensive,a and commercial gastrojejunostomy tube sets designed for human patients are larger than would generally be appropriate for veterinary patients. Solutions such as placement of a J-tube and a G-tube through the same body wall and gastric incisions have been suggested.b However, it is unknown whether this would predispose to stomal leakage if the J-tube were to be removed before the G-tube.
To our knowledge, no studies exist that assess the patency of G-tubes and J-tubes combined into gastrojejunostomy tube constructs. Therefore, the objective of the study reported here was to evaluate combinations of various sizes of commercially available J-tubes and G-tubes to determine the feasibility of manufacturing a gastrojejunostomy tube adaptable to small-breed dogs that would allow feeding through both tubes as well as aspiration of gastric contents. Our hypotheses were that all constructs would allow both feeding and aspiration through the G-tube, that a smaller syringe size would allow for a faster flow rate with both manual aspiration and fluid administration, and that both tube diameter and consistency of the enteral feeding solution would affect flow rate.
The authors thank Dr. Kyle G. Mathews for assistance with manuscript preparation.
MILA International Inc, Erlanger, Ky.
Mathews KG, College of Veterinary Medicine, North Carolina State University, Raleigh, NC: Personal communication, 2014.
Argyle feeding tube (5F × 36 in and 10F × 42 in), Covidien LLC, Mansfield, Mass.
Kangaroo (8F × 42 in), Covidien LLC, Mansfield, Mass.
Bard urethral catheter, Bard Ltd, CR Bard Inc, Covington, Ga.
Stomahesive, ConvaTec Inc, Skillman, NJ.
SurgiVet, Smiths Medical ASD Inc, Saint Paul, Minn.
Vivonex, Nestlé HealthCare Nutrition Inc, Florham Park, NJ.
Hill's Prescription Diet a/d, Canine/Feline Critical Care, Hill's Pet Nutrition Inc, Topeka, Kan.
Covidien LLC, Mansfield, Mass.
SAS, version 9.3, SAS Institute Inc, Cary, NC.
1. Swann HM, Sweet DC, Michel K. Complications associated with use of jejunostomy tubes in dogs and cats: 40 cases (1989–1994). J Am Vet Med Assoc 1997;210:1764–1767.
2. Marks SL. The principles and practical application of enteral nutrition. Vet Clin North Am Small Anim Pract 1998;28:677–708.
3. Daye RM, Huber ML, Henderson RA. Interlocking box jejunostomy: a new technique for enteral feeding. J Am Anim Hosp Assoc 1999;35:129–134.
4. Jennings M, Center SA, Barr SC, et al. Successful treatment of feline pancreatitis using an endoscopically placed gastrojejunostomy tube. J Am Anim Hosp Assoc 2001;37:145–152.
5. Qin HL, Su ZD, Gao Q, et al. Early intrajejunal nutrition: bacterial translocation and gut barrier function of severe acute pancreatitis in dogs. Hepatobiliary Pancreat Dis Int 2002;1:150–154.
6. Heuter K. Placement of jejunal feeding tubes for post-gastric feeding. Clin Tech Small Anim Pract 2004;19:32–42.
7. Hewitt SA, Brisson BA, Sinclair MD, et al. Evaluation of laparoscopic-assisted placement of jejunostomy feeding tubes in dogs. J Am Vet Med Assoc 2004;225:65–71.
8. Chandler JC, Kudnig ST, Monnet E. Use of laparoscopic-assisted jejunostomy for fecal diversion in the management of a rectocutaneous fistula in a dog. J Am Vet Med Assoc 2005;226:746–751.
9. Jergens AE, Morrison JA, Miles KG, et al. Percutaneous endoscopic gastrojejunostomy tube placement in healthy dogs and cats. J Vet Intern Med 2007;21:18–24.
10. Pápa K, Psáder R, Sterczer A, et al. Endoscopically guided nasojejunal tube placement in dogs for short-term post-duodenal feeding. J Vet Emerg Crit Care (San Antonio) 2009;19:554–563.
11. Campbell SA, Daley CA. Endoscopically assisted nasojejunal feeding tube placement: technique and results in five dogs. J Am Anim Hosp Assoc 2011;47:e50–e55.
12. Mansfield CS, James FE, Steiner JM, et al. A pilot study to assess tolerability of early enteral nutrition via esophagostomy tube feeding in dogs with severe acute pancreatitis. J Vet Intern Med 2011;25:419–425.
13. Mansfield C. Acute pancreatitis in dogs: advances in understanding, diagnostics, and treatment. Top Companion Anim Med 2012;27:123–132.
14. Cummings F, Daley CA. Esophagojejunostomy feeding tube placement in 5 dogs with pancreatitis and anorexia. Vet Med Int 2014;2014:197294.
15. Holahan M, Abood S, Hauptman J, et al. Intermittent and continuous enteral nutrition in critically ill dogs: a prospective randomized trial. J Vet Intern Med 2010;24:520–526.