Mack Rebekah M, Staiger Benjamin, Langlois Daniel K, Mehler Stephen J, Lam Nathaniel, Moore Trevor, Brown Andrew, Beal Matthew W
Upstate Veterinary Specialists, 393 Woods Lake Road, Greenville, SC, 29607.
Red Bank Veterinary Hospital, 210 Route 206 S, Hillsborough, NJ, 08844.
J Vet Emerg Crit Care (San Antonio). 2016 Sep;26(5):646-53. doi: 10.1111/vec.12506. Epub 2016 Jul 18.
To develop and describe a technique for percutaneous radiologic gastrojejunostomy tube placement in the dog.
Prospective technique development study.
University teaching hospital.
Six healthy adult male Beagles.
Following anesthetic induction, fluoroscopic and ultrasound guidance were used to identify an appropriate gastropexy site on the left lateral abdomen. Gastropexy was performed using gastrointestinal suture anchors. An over-the-wire catheter technique using fluoroscopic guidance was used to achieve jejunal access. An 18F/8F, 58 cm, dual-lumen gastrojejunal feeding tube was placed via serial over-the-wire dilation of the body wall using an 18F peel-away introducer kit. Tube location was determined radiographically immediately following placement and on days 2, 4, after emesis on day 4, and at time of gastrojejunal feeding tube removal (day 16-18).
Percutaneous radiologic gastrojejunostomy (PRGJ) tube placement was successful in all dogs. Median time to pyloric passage with the guide wire was 23.5 minutes (range, 9-93 minutes). Median total procedure time was 53 minutes (range, 49-113 minutes). Significant tube migration was not observed at any point during the study. One dog developed linear foreign body obstruction secondary to the tube on day 5 that was relieved by release of the jejunal component. Other complications were minor and included mild-to-moderate peristomal inflammation in all dogs and removal of the feeding tube on day 3 by 1 dog. Feedings were well tolerated in all dogs.
PRGJ tube placement in the dog is a safe and minimally invasive technique that allows for jejunal feeding without surgery or endoscopy. The high success rates, acceptable procedural times, and minimal complications are appealing for use in critically ill patients. Although additional evaluations are needed, PRGJ tube placement may be considered for dogs that require postpyloric feeding with or without gastric decompression.
研发并描述一种用于犬经皮放射学胃空肠造口管置入的技术。
前瞻性技术研发研究。
大学教学医院。
6只健康成年雄性比格犬。
麻醉诱导后，使用荧光镜和超声引导在左侧腹部确定合适的胃固定部位。使用胃肠缝合锚钉进行胃固定。采用经导丝导管技术并在荧光镜引导下实现空肠通路。使用18F剥离式导入器套件通过对体壁进行连续经导丝扩张，置入一根18F/8F、58厘米的双腔胃空肠饲管。饲管置入后立即通过放射成像确定其位置，并在第2天、第4天、第4天呕吐后以及胃空肠饲管拔除时（第16 - 18天）进行确定。
所有犬经皮放射学胃空肠造口术（PRGJ）管置入均成功。导丝通过幽门的中位时间为23.5分钟（范围9 - 93分钟）。总操作中位时间为53分钟（范围49 - 113分钟）。研究期间任何时间均未观察到明显的管移位。1只犬在第5天出现因饲管继发的线性异物梗阻，通过松开空肠部分得以缓解。其他并发症较轻微，包括所有犬均出现轻度至中度造口周围炎症，1只犬在第3天拔除了饲管。所有犬对喂食耐受性良好。
犬PRGJ管置入是一种安全且微创的技术，无需手术或内镜检查即可进行空肠喂食。高成功率、可接受的操作时间以及极少的并发症使其适用于重症患者。尽管需要进一步评估，但对于需要进行幽门后喂食（无论是否伴有胃减压）的犬可考虑采用PRGJ管置入。
