Ch. 91: Stomach Flashcards
Fox-Alvarez JAVMA 2019
Evaluation of a novel technique involving ultrasound-guided temporary, percutaneous gastropexy & gastrostomy catheter placement for providing sustained gastric decompression in dogs with GDV
Difference in success?
Differences in intragastric P?
TG = T fastener gastropexy; GC = gastrostomy catheter
Successful decompression didn’t differ between TTG +GC & trocar groups; median procedure 3.3 & 3.7 min
Decrease in intragastric pressure by 5 min after trocar or GC similar between groups
For TTG+GC group no significant difference in intragastric pressure btwn 5 & 60 min after GC insertion
Complications – inadvertent splenic or jejunal placement in 2 dogs (TTG +GC group) & malpositioned/ ineffective trocar in 1 dog (trocar)
All dogs survived at least 2 weeks
Lhuillery VSURG 2022 PQ
Outcomes of dogs undergoing surgery for gastric dilatation volvulus after rapid versus prolonged medical stabilization
PQ Which group needed more partial gastrectomy?
Any differences in rates of torsion degrees?
PQ Mortality difference between groups?
PQ What parameter assoc with mortality?
Immediate group = stabilized for 90 minutes then surgery, delayed = 5 h of stabilization
- medical stabilization was gastric decompression and indwelling nasogastric tube in all
- No diff = 6% had partial gastrectomy in immediate and 5% in delayed group
In the immediate group, 19 had 0, 52 had 180, and 9 dogs had 270 gastric torsion
Whereas in the delayed group, 27 dogs with 0, 32 with 180, and 5 dogs had 270 gastric torsion.
- No diff = Survival rates did not differ between groups at dc or at 1 month post-op
[79% immediate vs 82% delayed at discharge] - Hyperlactatemia 24h after initiation of fluid therapy was associated with an increased in-hospital mortality risk *
- Tachycardia during hospitalization was associated with death at 1 month postop *
White JAVMA 2021 (& Sartor - my surgeon mate!) PQ
Evaluation of a staged technique of immediate decompressive and delayed surgical treatment for gastric dilatation-volvulus in dogs
Tx groups?
Overall mortality for delayed sx group?
Time associations with survival? Time associations with gastric health?
What was associated with non survival?
What was associated with intra-op gastric health & mortality?
6 dogs had corrective sx in same anesthetic session as decompression and stabilization (2/6 had gastric necrosis)
35 had staged procedures w/ corrective sx ~22hrs after presentation (2/35 had gastric necrosis)
mortality for delayed sx patients was 9%
time from presentation to sx was not associated w/ subjective surgeon assessment of gastric health status or mortality rate
intraop ID of gastric necrosis was associated w/ nonsurvival
single plasma lactate and % change in serial lactate conc. were associated w/ intraop gastric health & mortality rate
conclusion: observed mortality rate for delayed corrective sx was similar to rates for other GDV tx techniques. Delayed sx may be appropriate in some cases, but there were no reliable preop selection criteria ID’d
- best to know it all
Duffy VSURG 2021 PQ
Evaluation of staple line reinforcement after partial gastrectomy closure in an ex vivo canine model
Groups?
What groups had highest max leak pressure?
Which group had highest initial LP?
PQ What technique had highest leak pressure?
Leakage from where?
PQ What additional step could be done in the inferior technique to improve strength?
stapled closures alone (group 1)
double-layer suture closure (group 2)
Placement of a Cushing suture (group 3)
Placement of a Cushing suture (group 3) increased ILP and MLP by 3.2-fold and 2.8-fold, respectively, compared with stapled closures alone (group 1)
Constructs closed with double-layer suture closure (group 2) reached ILP and MLP 4.5-fold and 3 fold greater, respectively, compared with those with stapled closures alone (group 1)
- Maximal leakage pressure did not differ between groups 2 and 3; Initial leakage pressure was higher in group 2 compared to 1 and 3 *
Leakage occurred from the inverting suture line in all constructs of groups 2 and 3 and from staple holes in six of eight group 1 constructs.
Conc: Double-layer suture closure of canine partial gastrectomies achieved superior biomechanical properties compared with stapled closure techniques.
* Reinforcing staple closures with an inverting suture line improved resistance to leakage. *
Webb VSURG 2019 PQ
Influence of length of incision and number of suture lines on the biomechanical properties of incisional gastropexy
loads to failure diff bw one suture and two suture lines?
2cm vs 4cm?
correlation bw load to failure and suture bite #?
conclusion?
One suture line sustained loads to failure of 54 N and two suture lines 53.3 N
2 cm suture lines load to failure 49.7 N and 4 cm suture line 57.3 N - stat sig.
No interaction between length of incision & number of suture lines
Load to failure did not correlate with # of suture bites
Conclusion: Length of incision but not number of suture lines influenced the biomechanical properties of gastropexies in this acute cadaveric model.
Abrams VSURG 2019
Perioperative complications and outcome after surgery for treatment of gastric carcinoma in dogs: A VSSO retrospective of 40 cases (2004-2018)
Major post op comps?
Major intraop comps?
MST? 1 yr survival?
What associated with inc risk of death? With improved survival?
Survival to dc?
Partial gastrectomy 28 dogs, Billroth I 9 dogs, subtotal gastrectomy 2, submucosal resection 1
Major postop complications in 8/40 dogs (20%) – septic peritonitis 2nd to dehiscence in 4 dogs, then CPR 2
7.5% major intraoperative complications (all led to septic peritonitis)
15% minor intraoperative complications,
15% minor postop complications
Median progression free interval 54d,
MST 178d (1-1902) (greater than previous lit); 1 yr survival rate 18%
Intraoperative complication associated with increased risk of death (HR 3.5)
Giving adjuvant chemotherapy correlated with improved survival (HR 0.4)
No pulmonary metastasis, local LN enlargement 10/40 dogs (25%)
Survival to discharge 85%;
Seim-Wikse JAVMA 2019
Comparison of BCS & other minimally invasive biomarkers between dogs with gastric carcinoma & dogs with chronic gastritis
Biomarkers for carcinoma?
Dogs with carcinoma significantly older and had significantly lower BCS, lower serum folate, & greater serum C reactive protein vs dogs with gastritis / controls
Dogs with > 8 yr, BCS < 4, serum CRP > 25 mg/L, & low serum folate useful biomarkers
Zuercher VRU 2021
Comparison of the clinical, ultrasound, and CT findings in 13 dogs with gastric neoplasia
CT identified how many tumors? US? CT did what better?
Complete agreement between everything?
Lymphoma appeared how? AdenoCa?
CT was successful in identification of 92% of gastric tumors, while US identified only 69%
CT identified more locations of lymphadenopathy and correctly identified the location of gastric tumors (69%) more frequently than US (39%) when compared to the surgical, endoscopic, or necropsy reports.
Only 5/13 cases (39%) had complete agreement on tumor location between CT, US, and direct visualization via surgery, endoscopy, or necropsy.
Lymphoma had a lower mean attenuation in CT than the other gastric tumors and was the only gastric tumor to not have complete loss of the gastric wall layering on US.
As expected, adenocarcinoma appeared as gastric wall thickening with regional lymphadenopathy.
Treggiari JSAP 2023
Canine gastrointestinal stromal tumours treated with surgery and imatinib mesylate: three cases (2018-2020)
Conclusions?
Surgical and medical treatment resulted in a positive outcome in these cases of canine GIST.
Imatinib treatment was well tolerated and resulted in a measurable response and a low spectrum of toxicities
Tanaka VRU 2023
Contrast-enhanced CT features of pyloric lesions in 17 dogs: Case series
Benign lesions affected what layer?
Apperance of ACA?
Appearance of GIST?
Retrospective case series study to assess the CT findings of canine pyloric lesions- to help differentiate malignant neoplasia from chronic hypertrophic pyloric gastropathy
17 dogs had the following final diagnoses:
5 Hyperplasia
5 Adenoma
3 Adenocarcinomas
2 GISTs
1 Polyposis & 1 pyogenic granuloma
Hyperplasia, adenoma, and polyposis formed mass lesions that involved the mucosal layer.
All adenocarcinomas formed a wall-thickened lesion that involved the outer layer, w/ lymphomegaly.
All GISTs formed a mass lesion that involved the outer layer.
CT facilitated the characterization of canine pyloric lesions using contrast enhancement, based on the involved area & lesion shape. However, polyposis may require caution in dx based on CT findings alone.
Grimes JAVMA 2020 PQ
Characteristics and long-term outcomes of dogs with gastroesophageal intussusception
MC CS?
Survival to dc %?
MST?
Follow up complication reported?
PQ MC post-po complication? RF for it?
Median age 13.2 mo, males (72%) and GSD (33%) most common
Vomiting 67%, regurgitation 33% most common CS
28% dogs euthanized w/o treatment, 72% had treatment (25 sx & 1 endoscopy)
88% treated survived to discharge; MST 995d, at last FU 65% surviving dogs remained alive & 35% died reasons related to persistent regurgitation or reasons unrelated
Of 10 dogs with owners contacted - 7 had persistent regurgitation – severity reduced through managed feedings
- MC post-op comp: regurgitation:
Dogs with acute (< 7 d) CS or previous dx of megaesophagus more likely to have persistent regurgitation than dogs w/o these factors *
White JSAP 2020
CT findings in dogs with gastric malposition: 6 cases (2016-2019)
Presenting timeline?
CT findings?
How many not treated for this?
Conclusion?
5/6 presented with either acute or chronic history of GI signs; 1-3 incidental
CT findings
Similar in all six cases
Pyloric canal and pyloric antrum located in the left cranial abdomen
Dorsal and to the left of the fundus in 5
Ventral and to the left in 1
Outcome
2 cases had exploratory laparotomy and preventative right-sided gastropexy
One euthanized for continued weight loss (had pulmonary mass); One lost to follow-up
1 case managed conservatively with good outcome
3 cases managed for other diseases with no specific treatment for gastric instability
Gastric malposition may be found as an incidental or chronic finding
Vangrinsven JSAP 2021
Diagnosis and treatment of gastro-oesphogeal junction abnormalities (GJA) in dogs with brachycephalic syndrome
Treatment groups?
Pre and post-op improvement in which group? Diff in digestive clinical score?
Conclusion?
36 Brachycephalic dogs – 58% FBD, 25% pugs, 17% EBD; Antacid treatment was randomly prescribed in 18 dogs before and after surgery while the other 18 dogs did not receive any gastrointestinal medical treatment.
Significant pre- and post-op improvement was only present in the treated group. At postsurgical recheck T2 83% of dogs (15/18) had a digestive clinical score ≤1 in the treated group in contrast to 44% (8/18) in the non-treated group
Results suggest a beneficial effect of omeprazole and magaldrate treatment on improvement of digestive clinical signs and lesions in dogs with BS undergoing surgery.
In contrast to standard endoscopy, the obstruction manoeuvre during endoscopy was able to detect more GJA in dogs with BS
Hosgood JAVMA 2021
Circumferential esophageal hiatal rim reconstruction for treatment of persistent regurgitation in brachycephalic dogs: 29 cases (2016-2019)
Procedures done?
All dogs had what finding of EH?
Short term R+ rates?
Long term R+ rates?
Conclusion?
Sx: circumferential hiatal rim reconstruction + esophagopexy
Left and right medial margins of pars lumbalis were isolated
Dorsal margins of right and left were reduced w/ 2-0 polyprolyene in a horizontal mattress pattern (2 sutures)
Next, horizontal mattress suture through the left and right ventromedial margins of the pars lumbalis
Appropriate aperture size was estimated at 1.5cm
Esophagopexy performed by placing 2-3 simple interrupted sutures of 2-0 polypropylene on either side of the esophageal hiatus b/w muscular layer of caudal portion of the esophagus and medial margin of pars lumbalis
all dogs had substantial laxity of the right & left pars lumbalis and failure of dorsal coaxial alignment of pars lumbalis (aorta adjacent to esophagus)
short term: 24% dogs had continued regurg that resolved by 14 days postop with MM (thought to be d/t esophagitis)
long term resolution: 84%
15% (3/19) dogs regurged 1x weekly, no one needed medical mgmt.
conclusion: circumferential hiatal rim reconstruction combined w/ esophagopexy substantially reduced regurg frequency in this population of dogs, the authors recommend this procedure be considered for any brachycephalic dog that has a hx of regurg not responsive to medical mgmt
Appelgrein JAVMA 2021
Quantification of gastroesophageal regurgitation in brachycephalic dogs
How many had reflex?
Associations found with distal pH time and resp grade, GI grade, LC grade, or previous upper airway sx?
What procedure did some have done?
Conclusion?
- esophageal reflux was defined as single pH <4; recordings also included reflux/hr, # of refluxes >5 min; duration of longest reflux (min), and % of time pH <4 for both sensors; probe measured proximal and distal esophagus
- dogs then underwent airway exam, upper GI endoscopy for first 10 dogs, mucosal biopsies, surgery (sutured staphylectomy, alarplasty, tonsillectomy, circumferential hiatal rim reconstruction)
- 84% of dogs had abnormal reflux with distal percentage time where pH < 4 of 6.4% (2.5-36.1)
- There was no significant association b/w distal percentage time where the pH < 4 and respiratory grade, GI grade (biopsies), laryngeal collapse grade or previous upper airway surgery
- 7 dogs had hiatal rim resection along with staphylectomy and alarplasty and 6 months later all 7 dogs had marked improvement with minimal to no reflux and a distal percentage time where pH < 4 score below 2 (were all above to preop, with medial of 6.2)
Conclusion: The occurrence of reflux is not associated with owner-assessed preoperative respiratory and gastrointestinal grade, laryngeal collapse grade, and previous airway surgery.
