Risk Factors for Death in Dogs Treated for Esophageal Foreign Body Obstruction: A Retrospective Cohort Study of 222 Cases (1998-2017)

A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans

Swallowing impairment is a highly prevalent and clinically significant problem affecting people and dogs. There are myriad causes of swallowing impairment of which gastroesophageal reflux is the most common in both species. Similarities in anatomy and physiology between humans and canines results in analogous swallowing disorders including cricopharyngeus muscle achalasia, esophageal achalasia, hiatal herniation, and gastroesophageal reflux with secondary esophagitis and esophageal dysmotility. Accordingly, the diagnostic approach to human and canine patients with swallowing impairment is similar. Diagnostic procedures such as swallowing fluoroscopy, high-resolution manometry, pH/impedance monitoring, and endolumenal functional luminal imaging probe can be performed in both species; however, nasofacial conformation, increased esophageal length, and the difficulty of completing several of these procedures in awake dogs are inherent challenges that need to be considered. Human patients can convey their symptoms and respond to verbal cues, whereas veterinarians must rely on clinical histories narrated by pet owners followed by comprehensive physical examination and observation of the animal eating different food consistencies and drinking water. Dogs may also be unwilling to drink or eat in the hospital setting and may be resistant to physical restraint during diagnostic procedures. Despite the species differences and diagnostic challenges, dogs are a natural animal model for many oropharyngeal and esophageal disorders affecting people, which presents a tremendous opportunity for shared learnings. This manuscript reviews the comparative aspects of esophageal anatomy and physiology between humans and canines, summarizes the diagnostic assessment of swallowing impairment in both species, and discusses future considerations for collaborative medicine and translational research.

Outcomes of esophageal and gastric bone foreign bodies in dogs

Background

Objectives

Animals

Methods

Results

Conclusions and Clinical Importance

Complications associated with and outcome of surgical intervention for treatment of esophageal foreign bodies in dogs

OBJECTIVE

To identify complications associated with and short- and long-term outcomes of surgical intervention for treatment of esophageal foreign bodies (EFBs) in dogs.

ANIMALS

63 client-owned dogs.

PROCEDURES

Patient records from 9 veterinary hospitals were reviewed to identify dogs that underwent surgery for removal of an EFB or treatment or an associated esophageal perforation between 2007 and 2019. Long-term follow-up data were obtained via a client questionnaire.

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 28 (50%) dogs had a postoperative complication. 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.

Endoscopic-guided Esophageal Foreign Body Removal in a Donkey

Esophageal obstruction is a common disorder in equids usually caused by intraluminal impaction with roughage and/or other feed material. Esophageal obstructions can also be caused by foreign bodies, but they are rarely reported and information regarding diagnosis and management is lacking. This report describes an esophageal obstruction in a donkey caused by a metallic foreign body removed using endoscopic guidance. Recognition of the foreign body facilitated treatment and underscores the importance of imaging in such cases to prevent dislodgement of the object to more aboral sites where access would be limited, or gastrointestinal tract injury could be fatal.

Survey of Instruments and Techniques for Endoscopic Retrieval of Esophageal and Gastric Foreign Bodies in Cats and Dogs

Esophageal and gastric foreign bodies (EFB and GFB) are a common occurrence in cats and dogs. The objective of this study is to evaluate the endoscopic instruments and techniques used for foreign body retrieval by internists or criticalists based on type and location of the foreign body. An online, anonymous survey was created using a commercial software. The survey was distributed to diplomates of the ACVIM (SAIM) and ACVECC through each college's listserv. Data obtained included specialty, years in practice, practice type, available instruments, and preferred instrument for various foreign bodies by location and type. Two hundred sixty-eight surveys were completed with 74% from private referral practice and 21% from academic practice. For EFB, laparoscopic or endoscopic grasping forceps were used most commonly. For GFB, grasping forceps or loop snares were used most commonly. Fifty percent of respondents reported attempting duodenal FB removal. In practices with limited financial resources, endoscopic grasping forceps and loop snares may be prioritized for purchase as these instruments may have the most application for foreign body retrieval from the esophagus and stomach.

Outcome of dogs and cats with benign oesophageal strictures after balloon dilatation or stenting: 27 cases (2002-2019)

OBJECTIVES

Acquired oesophageal strictures remain challenging to manage in canine and feline patients. The aims of this study were to describe the treatment, complications, short-term outcome and long-term follow-up of benign oesophageal strictures treated by balloon dilatation or stenting in dogs and cats and to describe adjunctive techniques to minimise the complication rate of stent placement.

MATERIALS AND METHODS

Retrospective analysis of medical records of dogs and cats with benign oesophageal stricture diagnosed under endoscopy between 2002 and 2019.

RESULTS

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.

Lethal acute hemorrhage from an aortoesophageal fistula following endoscopy-assisted esophageal foreign body removal in a dog

OBJECTIVE

To describe the clinical presentation of a dog with fatal hemorrhage from an aortoesophageal fistula (AEF) immediately following endoscopic removal of an osseous esophageal foreign body.

CASE SUMMARY

A 12-year-old, male mixed-breed dog presented to a university hospital with a 6-day history of gagging, hematemesis, and anorexia. Physical examination upon arrival was unremarkable. Blood work revealed leukocytosis without anemia. Thoracic radiographs from the referring veterinarian demonstrated the presence of an osseous esophageal foreign body at the level of the heart base. Subsequently, esophagoscopy was performed under general anesthesia. A triangular-shaped, osseous esophageal foreign body was visualized at the level of the heart base and successfully removed. Following its removal, a deep, nonbleeding, presumably nonperforated, esophageal ulcer was revealed. While recovering from anesthesia, the dog's condition acutely deteriorated, with absence of spontaneous respiration, severe tachycardia, hypotension, white-pale mucous membranes, and hypothermia. Severe anemia was present, with hypovolemic shock likely secondary to acute, postprocedural bleeding. Medical management included rapid packed red blood cell transfusion, crystalloid fluid therapy, and tranexamic acid. Despite initial stabilization, several hours later, the dog suffered cardiac arrest and cardiopulmonary resuscitation (CPR) was unsuccessful. At postmortem examination, a 1-mm AEF was identified on the ventral aspect of the aorta that communicated with the overlying esophagus.

NEW OR UNIQUE INFORMATION PROVIDED

Aortoesophageal fistulas should be considered in any patient with severe bleeding following esophagoscopy. A history of hematemesis in a dog with an esophageal foreign body should raise suspicion of an AEF and dictate case management accordingly.

Benign Duodenal Stricture Treated with Surgical Correction and Dietary Therapy in a Golden Retriever

A benign duodenal stricture is a well-documented condition of humans that has not been characterized in dogs. In this case report, the clinical, radiographic, ultrasonographic, endoscopic, surgical, and histopathologic findings of a single benign duodenal stricture in a Golden Retriever are reported. Definitive diagnosis was made possible with the utilization of esophagogastroduodenoscopy (EGD). Surgical correction of the stricture, paired with dietary therapy that utilized a highly digestible diet, resolved the clinical signs in the case reported. Several inciting causes were identified as possible drivers of stricture formation, including nonsteroidal anti-inflammatory drug (NSAID) administration, mucosal ulceration, traumatic injury, or inflammatory intestinal disease. A benign duodenal stricture should be considered an infrequent cause of intermittent, chronic gastrointestinal signs that may have a favorable outcome via surgical correction and dietary management.

Transdiaphragmatic Gastrotomy for the Extraction of Distal Esophageal Foreign Bodies in 13 Dogs (1997-2016)

The records of 13 dogs with distal esophageal foreign body obstruction not amenable to endoscopic management that had transdiaphragmatic gastrotomy (TG) for the foreign body extraction were reviewed. West Highland white terriers were over-represented. Mean age of the dogs at presentation was 38.6 mo, and mean duration of clinical signs associated with esophageal foreign bodies was 5.8 days. A TG was performed via an eighth or ninth left intercostal thoracotomy, and clinical results were successful in 12 dogs. In 1 dog, gastrotomy failed to retrieve a foreign body and esophagotomy was performed. Foreign bodies that were removed included 3 fishhooks and 10 animal bones. Postoperatively, all dogs developed esophagitis, 1 dog showed esophageal stricture, and 1 dog died of pyothorax associated with esophageal perforation 1 day postsurgery. Overall, 12 dogs survived and were free of clinical signs after a median follow-up time of 17 mo. TG is an effective surgical technique for the retrieval of distal esophageal foreign bodies.

Endoscopic retrieval of gastric and oesophageal foreign bodies in 52 cats

OBJECTIVES

To assess the outcomes and major complications in cats that require oesophageal and gastric endoscopic foreign body removal.

MATERIALS AND METHODS

The medical records of 52 cats with oesophageal and gastric foreign bodies that underwent endoscopic foreign body retrieval during a 13-year period (2006 to 2018) were retrospectively reviewed to characterise the clinical and radiographic signs, endoscopic findings, outcomes and major complications.

RESULTS

Endoscopic foreign body retrieval was successful in 49 of the 52 cats (94.2%). Radiographs confirmed the foreign material in 24 of the 50 cats (48%). Major complications occurred in eight of the 52 cats (15.4%) and included pleural effusion (n=2), aspiration pneumonia (n=2), unsuccessful removal of foreign material with endoscopy (n=3), oesophageal stricture formation (n=3) and cardiopulmonary arrest (n=1). Cats with oesophageal foreign bodies were more likely to experience major complications than those with gastric foreign bodies.

CLINICAL SIGNIFICANCE

Endoscopic foreign body removal in cats was associated with good overall outcomes and a low complication rate in this study sample. These results will help veterinarians better understand the outcomes of endoscopic foreign body removal in cats.

Prevalence of 25 canine behavioral problems and relevant factors of each behavior in Japan

Undesirable behaviors exhibited by dogs are called canine behavioral problems. Behavioral problems are common among dogs kept in ordinary homes; hence, veterinarians need to have sufficient knowledge of these problems, so as to advise owners. Among dogs kept in ordinary Japanese homes, only a few behaviors have been investigated regarding prevalence and relevant factors. To improve understanding of behavioral problems, a comprehensive survey is crucial. In this study, we distributed an online survey including general information and questions about 25 canine behaviors that can become problematic to owners, to investigate (1) the prevalence of behavioral problem, (2) the most common behavioral problems, and (3) the relevant factors of each behavior. We collected 2,050 valid responses. Among all dogs, 86.0% exhibited at least one behavioral problem. “Barking at noises inside the house”, “Barking at unfamiliar visitors”, and “Pica” were the most frequent behavioral problems. To reveal those factors related to the expression of each behavior, we performed multiple logistic regression analyses, with the presence of behaviors as objective variables and dogs’ general information as explanatory variables. Breed, age, the presence of other dogs in the household, sex, neutering status, source of acquisition, and type of residence were associated with 19, 16, 5, 4, 4, 4, and 1 behaviors, respectively. This study revealed the prevalence of 25 canine behavioral problems in Japan and relevant factors of each behavior. Our findings will be useful for veterinarians in advising owners about preventing behavioral problems.

Complications following removal of oesophageal foreign bodies: a retrospective review of 349 cases

AIM

To determine the incidence and types of complications associated with oesophageal foreign body (FB) removal in dogs, as well as to evaluate potential risk factors for the development of complications.

METHODS

Clinical records were searched within Animal Emergency Service and Veterinary Specialist Services databases between July 2001 and March 2017. Data were collected regarding signalment, FB type, method of removal, medical management and complications. Follow-up records from the referring veterinarian were then obtained by either phone call or email.

RESULTS

A total of 349 FB cases were reviewed. The majority of FBs were bones (77.4%), with Staffordshire Bull Terriers (12.3%) and West Highland White Terriers (9.8%) the most common breeds seen. Complications at the time of FB removal occurred in 20 cases (5.9%), with 14 cases of perforation. Persistent gastrointestinal signs were reported in 4.7% of cases within the initial 72-h period following FB removal and 11.9% cases outside this time period. Respiratory signs such as dyspnoea and coughing were also reported in 8 cases (2.3%), all of which occurred within 72 h after FB removal. Follow-up of at least 1 month was available in 151 cases. Delayed complications occurred in 11 cases (7.3%), with stricture occurring in 4 cases (2.6%); 16 animals were either euthanased (n = 14) or died (n = 2) post-FB removal, resulting in a case fatality rate of 4.6%.

CONCLUSION

Use of antacid medications and FB type did not have a statistically significant relationship with complications following FB removal.

Medical management of esophageal perforation secondary to esophageal foreign bodies in 5 dogs

OBJECTIVE

To describe 5 cases of conservative management of substantial esophageal perforation in dogs.

SERIES SUMMARY

Five dogs presented with an esophageal foreign body (EFB) and resultant esophageal perforation. Clinical signs at presentation included tachycardia, tachypnea, and increased respiratory effort. Thoracic radiography was performed in all cases, and in each case, pleural and mediastinal effusion was present, suggesting esophageal perforation prior to endoscope-guided removal. A full thickness esophageal defect was visualized after foreign body removal in 4/5 cases. Treatment included IV crystalloid fluid therapy, IV antimicrobials, analgesia, and proton pump inhibitors in all cases. Two dogs had a percutaneous endoscopically placed gastrostomy feeding tube placed and 1 dog received prednisolone sodium succinate IV because of marked pharyngeal inflammation. Complications after EFB removal included pneumothorax (n = 2) and pneumomediastinum (n = 4). Four of the 5 dogs survived to discharge and did not have complications 2-4 weeks following discharge. One dog was euthanized as result of aspiration pneumonia following EFB removal.

NEW OR UNIQUE INFORMATION PROVIDED

Traditionally, surgical management of esophageal perforations has been recommended. This can be a costly and invasive procedure and requires a high degree of surgical skill. In this report, conservative management of substantial esophageal perforation in 5 dogs is described; medical management may be a viable treatment option in dogs with perforation of the esophagus due to EFB.