Cervical esophagostomy in dogs: endoscopic, radiographic, and histopathologic evaluation of esophagitis induced by feeding tubes.

Prolonged tube feeding is frequently necessary in patients with head and neck cancer, facial trauma, or central nervous system disease. The advantages of cervical esophagostomy over nasogastric and gastrostomy tube feeding are established. One frequently overlooked complication of tube feeding is distal esophagitis and subsequent stricture formation. This complication has been widely reported in the medical literature although the pathophysiologic mechanism has in part been speculative. We have completed a prospective, randomized, controlled animal study in an attempt to delineate the mechanism of feeding tube esophagitis and to devise a method of avoiding it. Twelve dogs underwent cervical esophagostomy and were studied by endoscopy, contrast fluoroscopy, gross and microscopic pathology. The esophageal effects of placement of polyethylene and silicone rubber esophagostomy tubes in the customary position, through the cardioesophageal junction into the stomach, were compared with placement of the distal end of the tube only as far as the midesophagus. Midesophageal placement of silicone rubber tubes greatly reduced esophageal injury inherent is esophagostomy tube feeding. A new esophagostomy feeding tube is presented with advantages over previously used tubes.