Page 2232 - Cote clinical veterinary advisor dogs and cats 4th

1111.e2 Feeding Tube Placement: Percutaneous Endoscopic Jejunostomy (PEJ)

the remaining stoma often closes over in 4
to 8 hours after the tube is removed.
VetBooks.ir Alternatives and Their
Relative Merits
• Nasojejunostomy tubes are placed with
endoscopic or fluoroscopic assistance.
They have the advantage of not requiring a
gastrostomy tube. However, nasal irritation,
short duration of use (often a few days),
difficulty in placing the tip distally enough
in the jejunum, and retrograde migration
can be problematic.
• Laparoscopic-assisted jejunostomy tubes
can be placed at the end of a diagnostic
FEEDING TUBE PLACEMENT: PERCUTANEOUS or therapeutic laparoscopy. This technique
ENDOSCOPIC JEJUNOSTOMY Endoscopic image. involves exteriorizing a loop of jejunum,
Luminal view of duodenum shows the jejunostomy/ which then is held with four stay sutures
PEJ tube over the guide wire (not seen). (Courtesy while a purse-string suture is placed in the
Dr. Al Jergens.) antimesenteric side. The jejunostomy tube
is placed through an incision in the center
of the purse-string suture. This suture is
FEEDING TUBE PLACEMENT: PERCUTANEOUS tightened when the tube has been placed
ENDOSCOPIC JEJUNOSTOMY Gastrojejunos- • Begin enteral nutrition through the PEJ tube successfully (using fluoroscopy to confirm
tomy combined kit from Wilson-Cook. (Courtesy Dr. 12 hours after PEG tube placement. location and aboral direction). A box suture
Al Jergens.) • Monitor stoma site; expect mild inflamma- technique is used for creating an adhesion
tion and swelling. Discharge from stoma of the intestine to the body wall that secures
may appear serous or mildly purulent, but the safe position of the jejunostomy tube.
cytologic analysis should reveal no bacteria. Problems can involve aboral migration
Cleanse stoma gently with sterile saline and or confusion in the direction for place-
gauze squares as needed. Surgical scrub can ment of the tube in addition to PEJ tube
be used if needed but should be rinsed off complications.
completely.
• PEJ tube may be used as long as it remains Pearls
functional and needed; often used for days • Organize the team ahead of the procedure.
to many weeks. • Have a large enough inventory of materials
• Enteral feedings as slow boluses or constant to allow for defects, different sizes or lengths,
infusion are started with goal of one-third and potential errors.
of daily caloric requirements being given the • Coordination of team, supplies, and equip-
first day, two-thirds the second day, and full ment is essential. A preliminary run through
feedings by the third day. and check of supplies is very valuable for
• After removal of the PEJ tube, the remain- this procedure
ing PEG tube may be used for nutritional
support if appropriate. SUGGESTED READING
• The PEG tube is left in place a minimum Jergens AE, et al: Percutaneous endoscopic gastro-
of 10 days to ensure adequate adhesion of jejunostomy tube placement in healthy dogs and
FEEDING TUBE PLACEMENT: PERCUTANEOUS cats. J Vet Intern Med 21:18-24, 2007.
ENDOSCOPIC JEJUNOSTOMY Endoscopic image. stomach to the abdominal wall.
Luminal view of stomach shows the gastrostomy/PEG • The PEG tube is removed by gentle progres- AUTHOR: Mark E. Hitt, DVM, MS, DACVIM
tube with jejunostomy/PEJ tube inserted. (Courtesy sive traction in a caudal direction that is EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
Dr. Al Jergens.) also directed slightly away from the body; Thompson, DVM, DABVP

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