Ch 90 Esophagus Flashcards
Grimes JAVMA 2020
Characteristics and long-term outcomes
of dogs with gastroesophageal intussusception
Median age of dogs with GEI was 13.2 months, and males (72% [26/36]) and German Shepherd Dogs (33% [12/36]) were most common.
Ten of 36 (28%) dogs were euthanized without treatment, and 26 (72%) underwent treatment (25 surgically and 1 endoscopically).
Twenty-three of the 26 (88%) treated dogs survived to discharge; median survival time was 995 days. At last follow-up, 15 of the 23 (65%) surviving dogs remained alive and 8 (35%) had died for reasons related to persistent regurgitation (n = 6) or reasons unrelated to GEI (2).
Of the 10 dogs for which owners were contacted, 7 had persistent regurgitation, the severity of which was reduced through managed feedings.
Dogs with acute (≤ 7 days) clinical signs or a previous diagnosis of megaesophagus were more likely to have persistent regurgitation than were dogs without these factors.
CONCLUSIONS AND CLINICAL RELEVANCE Treatment should be considered for dogs with GEI given the high rate of survival to discharge and median survival time. Although persistent regurgitation was common after treatment, a satisfactory outcome was possible with medical management, including managed feedings and medications.
Grimes JAVMA 2020
Characteristics and long-term outcomes
of dogs with gastroesophageal intussusception
Grimes JAVMA 2020
Characteristics and long-term outcomes
of dogs with gastroesophageal intussusception
Hosgood JAVMA 2021
Circumferential esophageal hiatal rim reconstruction
for treatment of persistent regurgitation
in brachycephalic dogs: 29 cases (2016–2019)
Circumferential esophageal hiatal rim reconstruction involved apposition of the medial margins of the left and right pars lumbalis dorsal to the esophagus (reconstructing the dorsal margin) and ventral to the esophagus (reducing the ventral hiatal aperture and completing the circumferential reconstruction).
Data collection included preoperative, intraoperative, and postoperative (short- and long-term outcomes [≤ 14 days and ≥ 6 months, respectively]) data.
RESULTS
In all dogs, substantial laxity of the left and right pars lumbalis and failure of dorsal coaxial alignment were observed, and circumferential esophageal hiatal rim reconstruction and esophagopexy were performed.
Results of short-term follow-up indicated reduced regurgitation frequency; however, 7 of 29 dogs continued to have mild regurgitation, which was attributed to esophagitis and resolved with medical management.
Long-term follow-up information was available for 19 dogs: regurgitation had resolved in 16 dogs and occurred once weekly in 3 dogs. No ongoing medication was required for any dog.
CONCLUSIONS AND CLINICAL RELEVANCE Circumferential hiatal rim reconstruction combined with esophagopexy substantially reduced regurgitation frequency in dogs of the present study, and we recommend that this procedure be considered for brachycephalic dogs presented with a history of regurgitation unresponsive to medical management
Hosgood JAVMA 2021
Circumferential esophageal hiatal rim reconstruction
for treatment of persistent regurgitation
in brachycephalic dogs: 29 cases (2016–2019)
Beer JAVMA 2022
Complications
associated with and outcome
of surgical intervention for treatment
of esophageal foreign bodies in dogs
RESULTS 54 of the 63 (85.7%) dogs underwent surgery after an unsuccessful minimally invasive procedure or subsequent evidence of esophageal perforation was identified.
Esophageal perforation was present at the time of surgery in 42 (66.7%) dogs.
Most dogs underwent a left intercostal thoracotomy (37/63 [58.7%]).
Intraoperative complications occurred in 18 (28.6%) dogs, and
[The most common intraoperative complication was hypotension (n = 10 [15.9%]), followed by hypoxemia (5 [7.9%]), respiratory arrest (2 [3.2%]), cardiopulmonary arrest (2 [3.2%]), hypoperfusion (2 [3.2%]), and ventricular tachycardia, accidental extubation while the patient was being moved, substantial regurgitation, and profuse hemorrhage when the EFB was removed (1 [1.6%] each). Seven dogs had > 1 intraoperative complication]
28 (50%) dogs had a postoperative complication.
[Of the 56 dogs that survived surgery, 16 (28.6%) had a short-term postoperative complication. In 14 (25%) dogs, this was a major complication, and 9 dogs with major complications died, including cardiopulmonary, septic pleural effusion, poor oxygen saturation, acute kidney failure and respiratory distress syndrome, abscess at the surgical site necessitating surgical debridement, chewed through the gastrostomy tube and underwent surgical revision, and 2 dogs with aspiration pneumonia that received continuous oxygen supplementation and antimicrobial treatment. The 2 dogs with minor short-term complications developed surgical site infections 6 and 10 days after surgery. Both recovered with antimicrobial treatment.]
Postoperative complications were minor in 14 of the 28 (50%) dogs.
Dehiscence of the esophagotomy occurred in 3 dogs.
Forty-seven (74.6%) dogs survived to discharge. Presence of esophageal perforation preoperatively, undergoing a thoracotomy, and whether a gastrostomy tube was placed were significantly associated with not surviving to discharge.
Follow-up information was available for 38 of 47 dogs (80.9%; mean follow-up time, 46.5 months).
Infrequent vomiting or regurgitation was reported by 5 of 20 (25%) owners, with 1 dog receiving medication.
CLINICAL RELEVANCE Results suggested that surgical management of EFBs can be associated with a high success rate. Surgery should be considered when an EFB cannot be removed safely with minimally invasive methods or esophageal perforation is present.
Da Riz JSAP 2021
Outcome of dogs and cats with benign
oesophageal strictures after balloon
dilatation or stenting: 27 cases
(2002–2019)
Eighteen dogs and nine cats were included, representing 39 strictures.
Balloon dilatation was used as first-line therapy, with a good outcome in 59% of cases.
Stents were placed in eight cases due to stricture recurrence; 88% had a long-term satisfactory outcome.
Short-term complications occurred in six of eight cases; migration and aberrant mucosal reaction were uncommon.
In three cases, progressive mesh cutting during follow-up reduced discomfort and trichobezoars formation and improved long-term stent tolerance.
Overall median survival time was 730 days.
Clinical Significance: Long-term prognosis of balloon dilatation as a first-line therapy for esophageal strictures and of stenting as a rescue therapy was considered satisfactory. Although discomfort associated with stenting was frequent, tolerability might be improved by per-endoscopic adjunctive techniques.
Da Riz JSAP 2021
Outcome of dogs and cats with benign
oesophageal strictures after balloon
dilatation or stenting: 27 cases
(2002–2019)
Securing stent with suture
Da Riz JSAP 2021
Outcome of dogs and cats with benign
oesophageal strictures after balloon
dilatation or stenting: 27 cases
(2002–2019)
Failure of stent epithelialization, cutting of stent, trichobezoar
Vangrinsven JSAP 2021
Diagnosis and treatment of gastrooesophageal
junction abnormalities in
dogs with brachycephalic syndrome
To determine whether there is a benefit of using pre- and postoperative antacid treatment in dogs undergoing surgery for brachycephalic syndrome.
To assess the use of an obstruction manoeuvre during endoscopy for the detection of dynamic gastro-oesophageal junction abnormalities.
Materials and Methods: Thirty-six client-owned brachycephalic dogs were prospectively included in a randomised trial. Antacid treatment was randomly prescribed in 18 dogs before and after surgery while the other 18 dogs did not receive any gastrointestinal medical treatment.
At presentation, at the time of surgery and at recheck, digestive clinical signs and gastro-oesophageal junction abnormalities were assessed using specific scores.
Gastro-oesophageal junction abnormalities were assessed during endoscopy in standard conditions as well as during endotracheal tube obstruction. This manoeuvre was also applied in an unrelated control group.
[The GJA score was determined in two consecutive situations: in standard conditions (GJA-standard score) and during endotracheal tube obstruction (GJA-obstruction score). The latter was performed by manual obstruction of the endotracheal tube during up to three spontaneous breathings within a period of maximum 30 seconds to reproduce deep inspiratory efforts as occurring during episodes of upper respiratory obstruction. The stomach was not insufflated before assessment of the GJA. At T1 and T2, a clinical history and physical examination was performed to re-evaluate the digestive clinical score and the GJA score (standard and during obstruction) was also re-assigned during control oesophagoscopy).]
Results: The results suggest a beneficial effect of antacid treatment on the improvement of digestive clinical signs and lesions in dogs with brachycephalic syndrome undergoing surgery.
At postsurgical control 83% of dogs had a digestive clinical score ≤1 in the treated group in contrast to 44% in the non-treated group and
39% of dogs had a gastro-oesophageal abnormalities score (during obstruction manoeuvre) ≤1 in the treated group in contrast to 16.7% in the non-treated group.
The use of the obstruction manoeuvre during endoscopic assessment in a control group revealed that gastro-oesophageal junction movements are negligible in healthy animals.
Clinical Significance: The addition of antacid treatment during the pre- and postoperative period for brachycephalic dogs undergoing surgery may result in a faster and greater improvement in treated dogs. The obstruction manoeuvre is an interesting technique to improve detection of gastro-oesophageal junction abnormalities.
Vangrinsven JSAP 2021
Diagnosis and treatment of gastrooesophageal
junction abnormalities in
dogs with brachycephalic syndrome
Vangrinsven JSAP 2021
Diagnosis and treatment of gastrooesophageal
junction abnormalities in
dogs with brachycephalic syndrome
endoscopic views of esophagus
Rossanese JSAP 2022
Clinical findings, surgical treatment
and long-term outcome of dogs and
cats with double aortic arch: four cases
(2005–2022)
Two dogs and two cats
CT angiography confirmed double aortic arch in three of these and the right aortic arch was larger and appeared more well developed compared with the left aortic arch in all based on CT or surgical findings. Surgery was performed via a left fourth intercostal thoracotomy; ligation and transection of the lesser left aortic arch was performed.
Follow-up time ranged from 360 to 1563 days.
All animals showed a marked improvement during the postoperative period, and all gained weight gradually.
Clinical Significance: Surgical ligation of the lesser aortic arch in dogs and cats with double aortic arch is associated with a favourable prognosis for recovery, resolution of clinical signs, and quality of life with only minor feeding modifications.
Rossanese JSAP 2022
Clinical findings, surgical treatment
and long-term outcome of dogs and
cats with double aortic arch: four cases
(2005–2022)
Surgical procedure images
Morgan JAVMA 2019
Review article vascular ring anomalies
Read the article
Conte Vet Surg 2020
Computed tomographic comparison of esophageal hiatal
size in brachycephalic and non-brachycephalic breed dogs
Client-owned dogs (n = 87). Methods:
Clinical records and images of dogs that underwent computed tomography between June 2015 and September 2018 were reviewed. For the first part of the study, EH and aortic (Ao) cross-sectional surface areas were measured in brachycephalic (group 1) and nonbrachycephalic dogs of similar body size (<15 kg) without respiratory or gastroesophageal (GE) signs (group 2) by using multiplanar reconstruction. Esophageal hiatus:aortic ratio was 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.
Results: Mean (±SD) of EH:Ao values for group 1 (8.1 ± 2.8) were higher (P < .0001) than those for group 2 (3.7 ± 1.1). In addition, EH measurements of 20 WM dogs in group 1 were higher than those of 20 dogs in group 2 (P < .05).
Conclusion: Esophageal hiatus cross-sectional surface area (directly and indirectly measured) in brachycephalic dogs was considerably larger than that in nonbrachycephalic dogs of generally similar body size.
Clinical significance: Results of this study provide evidence to support the existence of a specific anatomical factor that could likely correlate to functional GE alterations (eg, regurgitation, gastroesophageal reflux, and sliding hiatal hernia) commonly seen in brachycephalic dogs.
Conte Vet Surg 2020
Computed tomographic comparison of esophageal hiatal
size in brachycephalic and non-brachycephalic breed dogs
CT eso hiatus measurements
Monnet Vet Surg 2021
Laparoscopic correction of sliding hiatal hernia in eight
dogs: Description of technique, complications, and
short-term outcome
Six dogs were brachycephalic. Dogs were placed in right lateral
oblique recumbency. Four dogs were placed in a reverse Trendelenburg position
to visualize the esophageal hiatus. A single port was placed 2 cm caudal to
the last rib on the left side. An extra cannula was added in four dogs. A largebore
orogastric tube was introduced in five dogs and used in four dogs to
reduce the hernia. A unidirectional nonabsorbable barbed suture was used for
the closure of the esophageal hiatus and the esophagopexy. A left-sided
gastropexy was performed for all the cases. The gastropexy was performed with
a gastrostomy tube to bypass the esophagus in four dogs. Intraoperative complications
included pneumothorax in three dogs. Conversion was elective in
three cases and emergent in one case. Clinical signs were recorded as improved
in each dog. The median follow-up time was 16.5 days (range, 9-264).
Conclusion: Hiatal hernia repair was performed laparoscopically in this population.
Repair included a combination of esophageal plication, esophagopexy,
and left-sided gastropexy. Reverse Trendelenburg animal positioning and
orogastric tube placement facilitated the reduction of the hernia.
Clinical significance: Laparoscopy is an option for the treatment of sliding
hiatal hernia in dogs.
Winston Vet Surg 2023
Management and outcomes of 13 dogs treated with a
modified Heller myotomy and Dor fundoplication for lower
esophageal sphincter achalasia-like syndrome
Medical records and a client survey were used to assess frequency of vomiting/regurgitation, quality of life (QoL), bodyweight, and feeding modifications at the following time points: prior to referral, postoperatively from discharge to first recheck (4-6 weeks), and from first recheck to survey (48 months). Postoperative and gastrostomy tube complications were surveyed and recorded. Pretreatment and 4-6 weeks postoperative videofluoroscopic swallow studies (VFSS) were compared. Two-sided t-tests were used to compare outcomes between survey time points. Results: Postoperative VFSS scores (available in 9 dogs) improved over preoperative scores in 6 dogs, and 12/13 dogs survived to discharge. One dog was euthanized 3 days postoperatively due to aspiration pneumonia. Postoperative gastrostomy tube complications occurred in half of the dogs that survived to discharge. According to the owners, scores assigned to vomiting/regurgitation improved by 180% (P = .004), QoL by 100% (P = .004), and bodyweight by 63% (P = .035). 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 in our clinical setting. Oral sildenafil therapy discontinued postoperatively suggests that surgery was equally efficacious.
Winston Vet Surg 2023
Management and outcomes of 13 dogs treated with a
modified Heller myotomy and Dor fundoplication for lower
esophageal sphincter achalasia-like syndrome
Dor fundoplication image
