Ch. 90: Esophagus Flashcards
Sterman JAVMA 2018
Likelihood and outcome of esophageal perforation secondary to esophageal foreign body in dogs
MC FB and %?
% with perf? How many fishhooks? most perf where?
Perf sig more likely with what? two RF for perf?
% survival to dc? how many fishhook surv? how many not surgical?
Most common EFB: bones 44%, fishhooks 30%,
12% had perforation (10/15 were fishhooks); 27% fishhook cases perfed
Perf sig more likely with fishhook vs other ESFB - OR 6.1
Interval from ingestion to evaluation was sig longer for dogs with perf vs without (makes sense, .. sat on FB for longer)
13/15 (87%) with perf survived to d/c (including 10/10 fishhook) - 8/13 survivors didn’t need sx
RF for perf: fish hooks, delay between ingestion and initial eval
Bongard JVECC 2019
Abi?? UMN paper
Retrospective evaluation of factors associated with degree of esophagitis, treatment, and outcomes in dogs presenting with esophageal foreign bodies (2004-2014): 114 cases
Overall success fb removal via scope? Comp rate?
FB present >24 h associated with what?
Feeding tubes in what %?
FB type associations?
PQ success of scope
- Overall success of FB removal via esophagoscopy 95% (excluding gastric) *
- complication rate 22%
Duration FB present >24 h significant associated with esophagitis, feeding tube placement, and major complications
- feeding tubes places in 14%
FB type didn’t predict esophagitis or comps, however fishhook sig more likely to require sx removal
Barash JVIM 2022
Outcomes of esophageal and gastric bone foreign bodies in dogs
MC in what age?
Eso FB mostly treated how?
% eso fb w erosions? where & when?
gastric bone fb - tx?
Dogs with E-bone FBs were younger than dogs w/ gastric bone FBs
42/45 esophageal foreign bodies were resolved non-surgically and 3 by esophagotomy.
28/45 (62%) dogs w/ E-FBs had esophageal mucosal erosions, and these were more likely w/ distal entrapment & longer duration.
62/84 (74%) of gastric bone FBs were left in situ.
Endoscopic removal was successful in 20/22 attempts – 1 left in the stomach & 1 removed via gastrotomy
Beer JAVMA 2022
Complications associated with and outcome of surgical intervention for treatment of esophageal foreign bodies in dogs
Vast majority had surgery why / after what?
Perf in %?
Majority had what surgical approach?
Intraop comp %?
Post op comp %? Minor vs Major? What was reported major comp?
% survival to discourage?
RF for decreased survival?
86% had surgery after trying minimally invasive procedure or perforation was identified
Perforation present in 67%
59% had left intercostal thoracotomy
Intraop complications 29%
Postop complications 50% (50% of these were minor .. assuming this means 50% major?)
Dehiscence of esophagotomy in 3 dogs (3/28 ~10%)
75% survived to discharge
Presence of esophageal perforation preop, thoracotomy, and whether a gastrostomy tube was placed were associated with not surviving
Conte VSURG 2020
Computed tomographic comparison of esophageal hiatal size in brachycephalic and non-brachycephalic breed dogs
EH:Ao higher in what group?
EH measurements higher in what group of weight matched dogs?
Conclusion?
brachycephalic (group 1) and nonbrachycephalic dogs of similar body size (<15 kg) without respiratory or gastroesophageal (GE) signs (group 2)
Esophageal hiatus:aortic ratio calculated.
In the second part of the study, absolute EH measurements were also compared in weight-matched (WM) dogs (8-10 kg) from groups 1 and 2.
Mean (±SD) of EH:Ao values for group 1 (brachy) (8.1 ± 2.8) were higher (P < .0001) than those for group 2 (3.7 ± 1.1).
EH measurements of 20 WM dogs in group 1 were higher than those of 20 dogs in group 2
EH cross-sectional SA in brachys is larger than non brachys of similar size - maybe anatomy is related to functional GE alternations (R+) in brachys
Grobman JVIM 2020
Detection of silent reflux events by nuclear scintigraphy in healthy dogs
How many dogs had reflux? Did recumbency matter?
What locations?
Conclusion?
Reflux detected in 12/12 dogs
No significant differences in outcome parameters with recumbency
Margination occurred to pharynx, and proximal, middle, and distal esophagus
Median frequency was 2 events / 5 minutes
Nuclear scintigraphy can document reflux in dogs. Reflux, but not aspiration, is common in healthy dogs and must be considered when interpreting results in clinically affected dogs
Winston III VSURG 2023
Management and outcomes of 13 dogs treated with a modified Heller myotomy and Dor fundoplication for lower esophageal sphincter achalasia-like syndrome
Videofluoro swallow study scores improved in how many?
% survival to dc? died why?
Most common post-op complication?
Owners reported what 3 things improved?
Conclusion ?
Retrospective, 13 dogs
Postoperative videofluoroscopic swallow studies (VFSS) scores (available in 9 dogs) improved over preoperative scores in 6 dogs (~50%)
12/13 dogs survived to discharge. (92%)
One dog was euthanized 3 days postop due to aspiration pneumonia.
Postop gastrostomy tube complications occurred in 6/12 of the dogs that survived to discharge. (50% in survivors)
According to the owners, scores assigned to vomiting/regurgitation improved by 180%,
QoL by 100%, and bodyweight by 63%
Conclusion: Modified Heller myotomy with Dor fundoplication and the use of a temporary gastrostomy tube improved clinical signs and owners’ perceived quality of life in half of the dogs treated for LES-AS
Da Riz JSAP 2021
Outcome of dogs and cats with benign esophageal strictures after balloon dilatation or stenting: 27 cases (2002-2019)
Balloon as first line therapy with good outcome %?
Stents placed why? Long term satisfactory outcome %?
Short term comp %? Most frequent? How was this improved?
MST?
Balloon dilatation as First-line therapy with good outcome in 59% of cases
Stents placed in 8/39 cases due to stricture recurrence
- 88% had a long-term satisfactory outcome
- Short-term complications occurred in 6/8 cases
(Migration (1 case, was not tacked) and aberrant mucosal reaction uncommon)
Poor tolerance most frequent complications
3 cases had progressive mesh cutting that reduced discomfort and trichobezoars formation- Improved long-term stent tolerance
MST 730 days
Cridge JVECC 2021
The clinical utility of neostigmine administration in the diagnosis of acquired myasthenia gravis
How many dogs had strong positive response?
What cases had weak positive?
How many cats responded?
What were the adverse events
16/22 diagnosed with acquired myasthenia gravis
13/16 strong positive response to neostigmine challenge
3/16 no response
2/3 of dogs with polymyositis strong positive response
Weak positive response:
1 intracranial neoplasia
1 DCM and coxofemoral joint disease
Cats
1 cat with MG had response
two cats had no response and had different conditions
AEs:
1 cat had premeds with glycopyrrolate and had mild sialorrhea and transient tremors
3/22 dogs
Sialorrhea and 1 dog with muscle tremors
viable alternative to the previously utilized edrophonium challenge
Forgash JVIM 2021
Clinical features and outcome of acquired myasthenia gravis in 94 dogs
What kind of drug treated majority? Other drug class?
Clinical remission in %?
No improvement in %?
Positive factors for CR?
Negative factors for CR?
Anticholinesterase drug 96%
67% sole treatment
Other drugs included immune modulators
Treatment outcome:
Clinical remission (lack of clinical signs >4 weeks after treatment cessation) in 31%
Clinical response (lack of clinical signs during treatment)15%
Clinical improvement 26%
No clinical improvement 29%
Immunological remission in 59% (27)
Clinical remission in all 27
Younger age, comorbid endocrine disease positively associated with clinical remission
Initial AChR Ab concentration and regurgitation negatively associated with clinical remission
