March 2025
by Amanda M. Shelby, RVT, VTS (Anesthesia & Analgesia), VETgirl Senior CE Specialist and Dr. Amy Kaplan-Zattler, DACVECC, MRCVS, VETgirl CE Program Manager

In this VETgirl online veterinary continuing education blog, we review how to place an esophagostomy tube (E-tube) in a cat. Placement of these tubes can help with provision of long-term enteral nutrition to patients that are either disinterested (e.g., chronic nausea) or unable to eat (e.g., oral trauma).

How to Place an Esophagostomy Tube in a Cat

Prepare by gathering the following supplies:
• clippers
• surgical scrub
• sterile gloves
• scalpel blade
• curved hemostats (find long ones if possible)
• red rubber, polyurethane or silicone feeding tube (10-14F; 12-F fits most average-sized cats)
• feeding tube adapter
• nylon suture
• non-adherent dressing and bandage material or E-tube neck wrap

Patients are placed under general anesthesia for this procedure and positioned in right lateral recumbency.

1. Shave and aseptically prepare the neck between the mandible and thoracic inlet.

Patient clipped and aseptically prepared for E-tube placement. **Please note, metal spring-loaded mouth gags should be used with caution and for limited time or avoided completely in cats. Photo courtesy of Justine Lee

2. Pre-measure the length of feeding tube from about midway down the neck to about the 7-8th intercostal space. Marking this level with a permanent marker can be helpful.

3. Insert curved hemostats though the mouth into the esophagus. Apply pressure downward to the handle, which elevates the hemostat tips within the esophagus and visibly elevates the skin in the lateral neck.

4. Taking care to have hemostat tips dorsal to the jugular vein, use a scalpel blade to incise over the hemostat tips through skin and esophagus.

Use of a scalpel blade to incise over the hemostat tips through skin and esophagus. Photo courtesy of BluePearl/VETgirl

5. Open the hemostats, grasp the distal end of the E-tube firmly, and pull this through the skin and out the mouth until just the tip of the feeding tube is visible from the mouth.

Demonstration of hemostats pulling E-tube through the mouth.

6. Redirect the tip of the E-tube to aim towards stomach, clamp the distal tip firmly, and advance the E-tube down the esophagus. *You may feel a ‘flip’ as the tube passes the insertion site.

Redirecting E-tube towards the stomach. Photo courtesy of Amanda M. Shelby

7. Advance the tube to the premeasured length.

8. Using non-absorbable suture, place a purse string suture around the tube insertion site, followed by a finger trap to anchor the tube in place.

9. Cap the tube with feeding adapters as needed.

10. Confirm placement with radiographs (at least a lateral view).

11. Place a non-adherent dressing over the insertion site and wrap with a protective bandage or pre-made E-tube neck wrap.

Finger trap suture securing an E-tube in a cat. Photo courtesy of Justine Lee

When appropriate (e.g., the patient is recovered, signs of gastrointestinal distress are resolved), the patient can be started on a liquid diet (e.g., Recovery) or a grueled canned food (depending on the size of the feeding tube).

Royal Canin Recovery Liquid Diet Types

*Please note for instructional purposes, medical specimens were used in select photographs.

For tips on how to perform the finger trap suture pattern, check out this VETgirl video.
For additional resources on how to place an E-tube, read along with this VETgirl blog or follow along with another VETgirl video.


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