tubes are contraindicated for dogs or cats with esophageal disease. Megaesophagus, esophagitis, esophageal stricture, and reflux are contradictions for the placement of an esophagostomy tube. However, an esophagostomy tube has been used to keep a megaesophagus decompressed to reduce the risk of aspiration pneumonia in one dog (Kanemoto et al. 2017). Esophagostomy tubes have also been advanced to the jejunum to support dogs with pancreatitis or anorexia (Cummings and Daley 2014).
The main advantage of an esophagostomy tube is that a diet modified into a gruel can be used to support the patient. The nutrition is delivered three or four times a day. Diet is blenderized with enough water and delivered slowly and warm to the patient. Also, dogs and cats can eat orally even if the tube is in place. The tube is then used for complement if the caloric intake is not sufficient.
4.2.2 Materials and Equipment
Esophagostomy tubes are usually 16–20 Fr in diameter. A red rubber tube, a polyvinyl chloride tube, a polyurethane tube, or a silicone tube can be used for an esophagostomy tube (Figure 4.3). The holes at the extremity of the tube need to enlarged to prevent clogging of the tube with the gruel (Crowe and Devey 1997b; Devitt and Seim 1997).
The dog or the cat needs to be placed under general anesthesia and intubated for the placement of an esophagostomy tube. The patient is positioned in right lateral recumbency and the left side of the neck is clipped and surgically prepared and draped.
4.2.3 Surgical Techniques
The length of the tube is measured from the proximal part of the esophagus to the level of the 8th or 9th rib. The appropriate length is marked on the tube.
A long curved forceps is introduced through the oral cavity in the proximal esophagus (Figure 4.4a). The tip of the forceps is palpated percutaneously in the proximal part of the neck.
A small skin incision is made over the tip of the forceps (Figure 4.4b). It is important to tent the soft tissue of the neck while the instrument is tipped up in the neck. This minimizes the risk of stabbing the jugular vein or the carotid artery. The tip of the forceps is then exposed after incising the wall of the esophagus. The incision should be long enough to advance the tip of the forceps through the wall of the esophagus. A large incision will result in leakage of saliva around the tube in the subcutaneous area, inducing cellulitis.
The tip of the esophagostomy tube is then grabbed and pulled in the oral cavity (Figure 4.4b and c). The tube is then reinserted in the esophagus (Figure 4.4d). It is important not to wrap the esophagostomy tube around the endotracheal tube. The tube is advanced until it passes the point of insertion in the esophagus. Then it can be pushed in the esophagus to the desired length.
As an alternative technique a special trocar can be used to place the esophagostomy tube. The tube is first introduced in the esophagus through the mouth (Figure 4.5a). Then the distal end of a special curved trocar is advanced in the proximal esophagus. The skin and the wall of the esophagus are incised over the tip of the trocar (Figure 4.5b). The esophagostomy tube is attached to the distal end of the trocar (Figure 4.5c). The trocar is then pulled through incision in the neck, dragging the esophagostomy tube with it (Figure 4.5d–g).
The tube is secured in placed with 2‐0 nylon suture as a Chinese finger trap (Song et al. 2008).
It is paramount that the placement of the tube is confirmed prior to feeding of the patient. A lateral radiograph is used to confirm the placement of the tip of the esophagostomy tube in the distal esophagus (Figure 4.5g). If the tube is in the stomach, it needs to be pulled back in the esophagus.
The tube can be removed eight days after placement if it is not needed. The finger‐trap suture is just cut and the tube is pulled out. The stoma is left to heal by second intention. The dog or cat can eat immediately.
4.2.4 Tips
It is important to have an endotracheal tube to prevent placement of the tube in the airway. A long curved forceps greatly facilitates the placement of the esophagostomy tube, especially in large obese dogs. The tube should be easy to advance in the esophagus. If the tube is forced in the esophagus, there is a significant risk of perforating the esophagus at the base of the heart.
4.2.5 Utilization
Esophagostomy tube can be used right away to feed the patient. After calculation of the daily caloric requirement, the amount of food is divided in four feedings. Any diet transformed in a gruel can be used with an esophagostomy tube. The gruel is delivered slowly over 5–10 minutes to prevent vomiting. The tube is then flushed with saline to prevent obstruction.
4.2.6 Complications
Esophagostomy tubes can be dislodged or kinked if the patient is vomiting. Laceration of the jugular vein and/or the carotid artery can happen with sharp dissection. Inflammation at the stoma is frequent. It may result in mild exudate. Obstruction of the tube can occur. It is important to flush the tube with saline regularly.
4.3 Gastrostomy Tube
4.3.1 Indications
Gastrostomy tubes are used in anorexic patients. They are used to bypass the oral cavity and the esophagus because of disease process, trauma, or obstruction (Armstrong et al. 1990a; Armstrong and Hardie 1990b; Bright et al. 1991; Marks 1998).
Gastrostomy tube can be kept for long‐term support of dogs and cats. It is not unusual to have tube in place for four months. Low‐profile gastrostomy tubes are then very appropriate for long‐term support. Low‐profile gastrostomy tubes are less bulky and have more likely less chance to be pulled accidentally by the dog or the cat (Yoshimoto et al. 2006).
4.3.2 Materials and Equipment
Large‐bore
