The Use of a Percutaneous Endoscopic Gastrotomy (PEG) Tube To Reverse Fatal Fasting Syndrome in a Cynomolgus Macaque (Macaca fascicularis).

An aged, overweight, female cynomolgus macaque (Macaca fascicularis) was diagnosed preliminarily with fatal fasting syndrome based on a history of chronic anorexia, weight loss, hepatomegaly, elevated serum alkaline phosphatase, bilirubinuria, and diffuse increased hepatic echogenicity. Histopathologic examination confirmed the diagnosis of severe hepatic lipidosis. A percutaneous endoscopic gastrotomy (PEG) tube was inserted after a month of orogastric tube feedings failed to stimulate normal appetite. Within 2 weeks of twice daily PEG tube feedings, the animal began to eat voluntarily, and PEG tube feedings were discontinued. The PEG tube was removed without incident. Periodic percutaneous ultrasound-guided hepatic biopsies revealed partial resolution of the hepatic lipidosis during the following 18 months. PEG tube placement should be considered as an alternative treatment to provide nutritional support in macaques with fatal fasting syndrome.