Complications of Percutaneous Endoscopic Gastrostomy in Dogs and Cats Receiving Corticosteroid Treatment

2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat

PRACTICAL RELEVANCE

Inappetence may have many origins and, as a presenting sign or observation in the hospitalised patient, is common in feline practice. Nutritional assessment of every patient is encouraged, to identify the need for, and appropriate type of, intervention indicated. The impact of malnutrition may be significant on the feline patient, perpetuating illness, delaying recovery, slowing wound healing and negatively impacting gut health and immunity. Delayed intervention may result in the cat's deterioration; hence prompt control of contributing factors such as the underlying illness, pain, nausea, ileus and stress is vital to optimise voluntary food intake. Management is multimodal, comprising reduction of stress, medications and assisted nutrition in the form of tube feeding or parenteral nutrition. Use of antiemetic, analgesic, prokinetic and appetite stimulant medications may restore appetite, but placement of feeding tubes should not be delayed. Feeding tubes are generally well tolerated and allow provision of food, water and medication with minimal stress, although clinicians must be aware of complications such as stoma site infections and refeeding syndrome.

CLINICAL CHALLENGES

Cats are vulnerable to malnutrition owing to their unique metabolism and specific nutritional requirements. Moreover, their nature as a species means they are susceptible to stress in the hospital environment, which may result in reduced food intake; previous negative experiences may compound the problem. In particular, an inappropriate clinic environment and/or handling may cause or exacerbate inappetence in hospitalised patients, with negative impacts on recovery. Postponing interventions such as feeding tube placement to await improvement, owing to clinician or caregiver apprehension, may hinder recovery and worsen nutritional deficits.

EVIDENCE BASE

The 2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat have been created by a panel of experts brought together by the International Society of Feline Medicine (ISFM). Information is based on the available literature, expert opinion and the panel members' experience.

Surgical management of a cervical esophageal diverticulum in and long-term outcome for a five-month-old cat

CASE DESCRIPTION

A 5-month-old domestic shorthair cat was presented for recurrent regurgitation and hypersalivation after eating, which had been evident since adoption 2 months earlier.

CLINICAL FINDINGS

Physical examination was unremarkable. Plain thoracic radiography, positive contrast esophagography, endoscopy, CT, electromyography, and blood analysis were performed. A caudal cervical esophageal diverticulum, likely congenital, was diagnosed.

TREATMENT AND OUTCOME

A diverticulectomy was performed with a surgical stapler while an endoscope was in the esophageal lumen. No intra- or postoperative complications were reported. Postoperative and short-term outcomes were excellent, with resolution of clinical signs and no endoscopic esophageal abnormality 3 months after surgery. The cat remained without clinical signs 8 months after surgery.

CLINICAL RELEVANCE

An esophageal diverticulum in a cat is rare. The cat of this report had a good outcome following surgical management of a cervical esophageal diverticulum. Surgery is worth considering for similarly affected cats, but additional cases are required to confirm the benefit of surgery versus conservative management.

Biomechanical comparison of two percutaneous gastropexy techniques for securing percutaneous endoscopic gastrostomy tubes in canine cadavers

OBJECTIVE

To biomechanically assess outcomes for 2 percutaneous gastropexy techniques and determine the amount of time necessary to perform the techniques for securing percutaneous endoscopic gastrostomy (PEG) tubes in canine cadavers.

ANIMALS

18 canine cadavers.

PROCEDURES

6 cadavers were assigned to each of 3 groups (PEG tube only, PEG tube with T-fastener gastropexy, and PEG tube with U-stitch gastropexy). Time to completion of placement of a PEG tube and gastropexy was recorded. After tubes were placed, the stomach and body wall on the left side of the abdomen were removed and biomechanically tested. Maximum tension at the time of initial failure of the PEG tube or gastropexy was recorded.

RESULTS

Significantly more force was required to induce failure for the T-fastener and U-stitch techniques than for the PEG tube only technique. In addition, both the T-fastener and U-stitch techniques required significantly more time for placement than did the PEG tube only technique.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that performing a T-fastener or U-stitch gastropexy may decrease the risk of early dislodgement of a PEG tube in dogs. However, studies conducted with these techniques in live dogs would be necessary to confirm this hypothesis. The additional amount of time needed to perform the T-fastener or U-stitch gastropexy would likely be clinically unimportant.

Esophageal feeding tube placement and the associated complications in 248 cats

Background

Esophageal feeding tubes are commonly used to provide enteral nutrition to cats, but their use is associated with adverse effects.

Objectives

To evaluate the complications associated with e‐tube placement in cats and to identify factors predisposing to these complications.

Animals

Cats that had an esophageal feeding tube placed (n = 248).

Methods

This was a retrospective case review in which clinical records were interrogated across 2 referral centers to identify records of cats that had esophageal tubes placed. Clinical data were collected for signalment, clinical indication, method of placement, time of removal, and any complications. Logistic regression was then employed to assess the odds of an increase in complications, including infection and death.

Results

For those cats that survived to discharge, tubes were in place for a median of 11 days, ranging from 1 to 93 days. Complications occurred in 35.8% of the cats, with the most common being tube dislodgement (14.5%), followed by stoma site infections (12.1%). Cats receiving glucocorticoids or oncolytic agents (OR = 3.91; 95% CI, 1.14‐13.44) and with discharge at the stoma site (OR = 159.8; CI, 18.9‐1351) were at an increased odds of developing a stoma site infection, whereas those with a lower weight (OR = 1.33; 95% CI, 1.02‐1.75) or (pancreatic [OR = 4.33; 95% CI, 1.02‐18.47], neoplastic [OR = 15.44; 95% CI, 3.67‐65.07], respiratory [OR = 19.66; 95% CI, 2.81‐137.48], urogenital [OR = 5.78; 95% CI, 1.15‐28.99], and infectious diseases [OR = 11.57; 95% CI, 2.27‐58.94]) had an increased odds of death. The duration of time in place and the cat being discharged with the tube in place were not associated with an increased risk of infection or death.

Conclusions and clinical importance

Owners should be made aware of the potential risks involved and their predisposing factors.