Page 2229 - Cote clinical veterinary advisor dogs and cats 4th

1110 Feeding Tube Placement: Percutaneous Endoscopic Gastrostomy (PEG)

• The loop at the tip of the PEG tube is
then passed into the loop of the wire that
VetBooks.ir • The PEG tube is then passed into its own
is emerging from the animal’s mouth.
loop and pulled to tighten the connection
between the two loops.
• After this is done, the clinician can start to
pull on the wire emerging on the abdominal
side until the connected loops emerge from
the abdominal wall.
• By continuing to pull on the wire, the tapered D
tip of the PEG tube soon appears through B
the skin. Here again, bracing with digital
counterpressure at the abdominal wall is
essential. To also allow the PEG tube to
pass through the skin, the clinician often
must widen the skin incision using a scalpel
blade. Caution is warranted to avoid cutting
the wire.
• The PEG tube must be pulled all the way
until the disk lies against the gastric wall
(this can be checked by endoscopy). A C E
• After the PEG tube is fully pulled out with
the disk and well in contact with the gastric FEEDING TUBE PLACEMENT: PERCUTANEOUS ENDOSCOPIC GASTROSTOMY A, Anesthetized
wall, its extremity is cut and inserted through dog in right lateral recumbency, head to bottom. The light of the endoscope in the stomach is visible through
the two parts of the 90-degree flange. These the skin, indicating where the needle should be inserted and pointing toward. B, Endoscopic view of the tenting
two parts are then pushed all the way against of the gastric wall created by the needle. C, The tip of the needle has entered the stomach. D, The loop of the
the abdominal skin and assembled. The disk wire is passed through the needle. E, This loop is grabbed using an endoscopic biopsy or grasping forceps.
of the flange is then sutured to the skin.
This flange reorients the PEG tube, which
becomes parallel to the abdominal wall.
Additional sutures can be used to keep the
PEG tube in place against the flank.
• The adapter is then fitted to the extremity
of the PEG tube.
Postprocedure
• An Elizabethan collar may be necessary
to prevent removal of the tube by the
animal.
• Water can be administered as soon as 18
hours after placement, and food 24 hours
after placement of the tube.
• Removal of the PEG tube: no sooner than
2 weeks after the placement (as described)
to avoid possible leakage of food from the
stomach into the abdominal cavity.
Low-profile PEG tubes:
• For long-term use, the temporary PEG tube
can be replaced by a low-profile PEG tube,
also called gastrostomy button. To do that, A B C
wait at least 2 weeks (or preferably, 6 weeks)
before removing the temporary PEG tube to FEEDING TUBE PLACEMENT: PERCUTANEOUS ENDOSCOPIC GASTROSTOMY After the looped
extremity of the wire is pulled from the mouth, the loop of the wire attached to the PEG is passed into it (A).
allow the fibrous tunnel to become strong The PEG is passed into its own loop (B), and the two wires are pulled to secure the connection (C).
enough.
• After the temporary PEG tube is removed,
the low-profile PEG tube is introduced
directly through the fibrous tunnel. This
tube is kept in place by inflating the distal
balloon on the gastric side and by suturing
the proximal side to the skin.

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