Esophageal Flashcards
Sterman, JAVMA, 2018:
Esophageal perforation secondary to esophageal foreign body
What % of dogs had esophageal perforation?
What was associated with increased likelihood of esophageal perforation?
What % of esophageal perforations were diagnosed on routine thoracic radiographs?
What % of esophageal perforations did not require surgical intervention?
Sterman, JAVMA, 2018:
12% had esophageal perforations
Delay in seeking veterinary attention increased the likelihood of esophageal perforation
27% of esophageal perforations were diagnosed on routine thoracic radiographs
60% of esophageal perforations did not require surgical intervention, suggesting rapid sealing of esophageal defects
Brisson, JAVMA, 2018:
Esophageal foreign bodies
Most common esophageal foreign body?
Most common location of esophageal foreign bodies?
Most common location of fish hook foreign bodies vs bone foreign bodies?
Factors associated with a poor outcome?
What % developed esophageal strictures?
Brisson, JAVMA, 2018:
Most common esophageal FB was bone (60% of cases)
Most common location of esophageal FBs was caudal esophagus (58% of cases), followed by the heart base (23% of cases)
Most common location for fish hook FBs was cervical esophagus, most common location for bone FBs was caudal esophagus
Factors associated with a poor outcome: longer duration of FB entrapment, esophageal perforation, older age
11% developed esophageal strictures
Bongard, JVECC, 2019:
Esophageal foreign bodies
Overall success rate for foreign body removal via esophagoscopy?
Complication rate?
Dogs with foreign bodies present for >24 hours were more likely to have what?
What type of foreign body was more likely to require surgical removal?
Bongard, JVECC, 2019:
Overall success rate for FB removal via esophagoscopy: 95%
Complication rate: 22%
Dogs with foreign bodies present for >24 hours were more likely to have severe esophagitis and major complications
Fish hooks were more likely to require surgical removal
Nathanson, JVIM, 2019:
Complications associated with esophageal feeding tubes
Overall complication rate?
What % of cats vs dogs developed signs of infection at the tube site?
What % of cats vs dogs developed regurgitation of food through the tube stoma?
Nathanson, JVIM, 2019:
44% complication rate
18% of cats vs 14% of dogs developed signs of infection at the tube site
1% of cats vs 7% of dogs developed regurgitation of food through the tube stoma
Bongard JVECCS 2019
Which risk factors were found in this study regarding esophageal foreign bodies?
Small breed dogs were overrepresented (Yorkies, WHWT, Shih Tzu)
Dogs w/ FB present for more than 24 hours were significantly more likely to have severe esophagitis and major complications
FB type did not predict degree of esophagitis or complications, though fishhooks were more likely to require surgery and more likely located in cervical esophagus/thoracic inlet
FB more commonly lodged in distal esophagus
Feeding tubes (15 gastrostomy, 1 NE) were placed in 14% of dogs are more likely placed if FB had been present for more than 24 hours
Overall success rate for removal via scope was 95% and complication rate 22%
78% survival rate with no complications
Binvel JSAP 2018
What was found in this study in regards to endoscopic retrieval of esophageal/ gastric FB?
Total of 33 cases ( 2 cats & 31 dogs)
Most common location: prox esophagus (36%) and stomach (33%)
Endoscopic retrieval was successful in 82% of cases
Esophageal perforation occurred in 18% of cases (3 treated medically and 3 treated surgically)
Surgery performed in 18% of cases and no early complications were noted
Survival rate was 100% overall
No breed predisposition (other studies describe a high % in small breeds- terrier and poodles)
Brisson JAVMA 2018
Terrier breeds most common (30.5% of 233 dogs)
Duration of EFB entrapment, body wt, anorexia, lethargy, rectal temp, and esophageal perforation were assoc. with need for sx
Older age, longer duration of EFB entrapment, and perforation were assoc. with poorer prognosis
Endoscopy or advancement into stomach was a success in 83.6% EFBs
11.2% resulted in postprocedural esophageal stricture
Mortality rate was 5.4%
88.2% of dogs with a median follow-up period of 27 months had excellent outcomes
Burton JVIM 2017
81% osseous foreign body, 49.5% distal esophagus
duration of c/s not assoc w/ risk of death*
91.8% endoscopy, 5.9% sx, repeat endoscopy 2.3%
In hospital case fatality rate was 5% (23.1% Sx, 1.5% Endo)
Risk of death was higher with surgery and 100% dogs died - repeat endoscopy bc sx was declined
Increasing numbers of postprocedural complications, esophageal perforation, and post procedure esophageal hemorrhage increased in-hospital risk of death
Esophageal strictures in 2.1% of survivors available for follow-up
Cinti JSAP 2019
Megaesophagus due to Aberrant R subclavian artery
2 different approaches because 1 also had a PDA
1 esophagoscopy
Know the pics
Nathanson JVIM 2019
-Esophagostomy tube complications
100 patients (44.4%) experienced a complication related to tube placement, with a similar complication rate among dogs (43.1%) and cats (45.5%).
Twenty-two cats (17.8%) and 14 dogs (13.7%) developed signs of infection at the E-tube site, with 5 cats (22.7%) and 5 dogs (35.7%) requiring
surgical debridement.
Regurgitation of food through the E-tube stoma was
noted in 7 dogs and 1 cat.
Three patients were euthanized as a result of tube-related complications
No statistically sig risk factors found
Reeve JSAP 2017
hiatal hernia and other esophageal abnormalities in brachiocephalic dogs
with use of fluoro: 16/36 (44%)had hiatal hernia
all were Frenchies
31 (86%)had delayed esophageal transit time
27 (75%) had gastro-esophageal reflux
4 (11%) had redundant esophagus
Risselada JAVMA 2018
Various gastrojejuostomy tube constructs
review
The 20F/8F, 24F/8F, 28F/8F, and 28F/10F (gastrostomy tube/jejunostomy tube) constructs allowed for injection and aspiration of all solutions.
The 5F jejunostomy tubes allowed only water to be injected, whereas the 8F
jejunostomy tubes did not allow injection of the canned food–water mixtures.
The 20F/10F construct did not allow injection or aspiration through the gastrostomy tube, whereas the 18F/8F construct allowed injection but not aspiration through the gastrostomy tube.
Faster flow rates through the
gastrostomy tube were associated with larger gastrostomy tube diameter, smaller jejunostomy tube diameter, and smaller syringe size.
Faster flow rates through the jejunostomy tube were assoc with smaller jejunostomy
tube diameter
Robin JAVMA 2018
Esophageal leiomyoma treated with transcardial placement of a self-expanding, covered, nitinol esophageal stent
Consider benign causes
- Know images/ CT images
Smith JVECCS 2019
route and timing of nutrition for septic peritonitis cases
Nutritional strategy was categorized into 1 of 4 groups: voluntary, feeding tube, parenteral (PN), and combined feeding tube and PN.
Overall, 54/68 dogs survived (79%).
Survival Prediction Index 2 scores were not significantly different between groups.
Dogs receiving PN only were less likely to survive than
those receiving any enteral nutrition
Compared to dogs not receiving PN, dogs receiving any PN were significantly less likely to survive and were in hospital significantly longer
Metabolic complications (63%) associated with PN were frequent but not associated with increased length of hospitalization or survival to discharge.
5%- PN- complications: tube dislodgement
Sterman JAVMA 2019
Perforations secondary to esophageal FB in dogs
Bones [44%] and fishhooks [30%] were the most common
types of EFBs.
Fifteen (12%) dogs had an esophageal perforation (10
with a fishhook EFB and 5 with a bone EFB).
No association was identified
between dog body weight and esophageal perforation.
Esophageal perforation
was more likely in dogs with a fishhook EFB [27%] versus other EFBs [6%]
Median interval
from fishhook or bone ingestion to initial evaluation was significantly longer for dogs with (12 and 96 hours, respectively) versus without (1 and 24 hours, respectively) perforation.
87% dogs with esophageal
perforation survived to hospital discharge, including all 10 dogs with perforation secondary to fishhook ingestion.
8 survivors with esophageal perforation required no surgical intervention.
