Canine Esophagostomy Tubes

by Dr. Jared Jaffey DVM, MS – Small Animal Internal Medicine, Resident

The recommendation to place a feeding tube in a dog is typically received with angst and trepidation from dog owners. Many owners find it difficult to conquer the mental hurdle of their dog having a feeding tube.  Hundreds of thousands of children around the world with numerous different conditions rely on some form of tube feeding to thrive (www.feedingtubeawareness.org).  Dogs also have many diseases in which their quality of life would be enhanced with an esophagostomy tube. Like children with feeding tubes, dogs can eat, drink, run, and play to their hearts content.

Below are some of the most common questions and answers that have helped people in their decision to place an esophagostomy tube.

How invasive is the procedure to place an esophagostomy tube?

The entire procedure typically takes 15-20 minutes to complete and requires a single skin incision no larger than 2cm.

What are some complications associated with esophagostomy tubes?

Complications with esophagostomy tubes are rare. One of the most common complications is infection of the area where the tube enters the skin. This complication is usually preventable if clients clean the area once a day. I provide clients with gauze soaked in a diluted cleaning solution. It is important that you use a cleaning product approved by your veterinarian.

Does my dog have any activity restrictions with an esophagostomy tube?

Dogs with esophagostomy tubes do not have any activity restrictions. They can enjoy all of the same fun activities that dogs without tubes do. I have many patients that still run amuck at dog parks, and go for long hikes with their owners.

What happens if the tube gets yanked out?

This is a common fear that people have. They are convinced that their dog will somehow find a way to remove the tube, or possibly another dog in the house removes it. While it is a common fear, it actually does not happen very often. However, it is not an emergency if it does. There is no reason to panic. I instruct clients to take a breath, wipe the area with the gauze soaked in diluted cleaning solution, and come in to the office for me to put the tube back in.

Will the esophagostomy tube prevent my dog from eating or drinking?

The tube does not stop a dog from eating and drinking on their own. They can eat and drink as much as they’d like.

How long can my dog’s esophagostomy tube stay in?

This depends on the type of tube used and its intended purpose.  The type of tubing I use can be used for years without needing to be changed.  I have several dogs and cats that have had tubes in for more than 3 years.  The other variable that determines how long a tube stays in is its intended purpose. I have had dogs with acute diseases like pancreatitis, that can have their tubes removed once they recover. Then I have had dogs with diseases like chronic kidney failure that keep the tube in long-term.

 Is it uncomfortable for my dog to have an e tube?

There is no pain from the site; the only reason for discomfort is if the bandaging is done improperly or too snugly. It is a little tricky to master getting the bandages just right. For this reason, I recommend/suggest to owners to utilize a Kanine Kollar®, which is less restrictive (it does not require compression in order to stay in place) while still being secure, and makes it much easier for the owner to clean and maintain the site.

What are the real benefits of an esophagostomy tubes?

This is by far the most common question I have been asked. I like to break it down into 3 sections, nutrition, medications, and water.

Nutrition:

Nutrition is a very important aspect of treatment for our canine patients. It is common that an essential part of treatment of a particular disease revolves around a dog eating a specific diet. It is also common for dogs to not cooperate and eat the diet that they need. I’m sure many of you have been sick with the flu and would not touch a piece of food unless someone persuaded you to. Unfortunately, you cannot reason with your dog and convince them that eating food will make them feel better. In many cases, the esophagostomy tube is a temporary measure to provide adequate and appropriate nutrition until the patient feels good enough to eat on their own.

Nutrition also plays a significant role in long-term diseases like chronic kidney failure. At times it can be difficult to convince a dog to eat a prescription kidney diet. Dogs don’t tend to listen, even if you give an in-depth explanation that the reduced protein, phosphorous restriction, and omega-3 fatty acid formulation will help him/her feel better. The esophagostomy tube allows you to provide adequate and appropriate nutrition, while allowing your dog to eat and enjoy other foods. The esophagostomy tube does not prevent them from eating food on their own

Medications:

I have had countless people thank me for convincing them to place an esophagostomy tube because it makes administration of medications easy. You can administer most medications through the esophagostomy tube. Gone are the days where you waste time attempting to trick your dog by placing medications in a treat, shoving the medication in the back of their throat, or watching them run away and hide when they see you with the pill bottle.

Treating a dog long-term with multiple medications can be difficult. The tube allows you to administer medications without a fight. Many clients have stated that the tube improved their relationship with their dog because they don’t have to struggle with medications anymore.

Water:

Dogs with chronic kidney failure have a decreased ability to concentrate their urine.  One of the most common early clinical signs is an increase in thirst and urination. The reason they urinate large volumes is because their kidneys have a reduced ability to concentrate the urine. Early in the disease a dog does not become dehydrated, despite urinating large volumes, because they are able to drink enough water to compensate.

As their disease progresses, so does what little concentrating ability their kidneys had left. This results in incredible volumes of urine and over time a dog simply cannot drink enough water to compensate and they become dehydrated. When a dog with chronic kidney failure becomes dehydrated their limited kidney function worsens and they start to feel very sick. At this point it is common for a veterinarian to recommend that fluids be given under the skin once a day to help a dog maintain hydration.

Subcutaneous fluid administration is not an option for every client. Some clients cannot stand the sight of needles, while others can’t imagine sticking their dog with a needle. Some dogs absolutely hate subcutaneous fluid administration and simply will not tolerate it. Esophagostomy tubes allow an easy way to give extra water to maintain hydration, without having to administer subcutaneous fluids.