Prospective evaluation of an indwelling esophageal balloon dilatation feeding tube for treatment of benign esophageal strictures in dogs and cats

Oesophageal stricture in a cat with true pleuroperitoneal hernia

A 2-year-old neutered male Bengal cat presented with solid food dysphagia and chronic regurgitation for >5 months. There were no clinical abnormalities on haematological or radiographic examinations. Thoracic radiography revealed a soft tissue opacity mass adjacent to the diaphragm in the caudoventral thorax. Ultrasonography revealed a protruding liver lobe surrounded by a hyperechoic lining from the diaphragm towards the thorax, and a pleuroperitoneal hernia was diagnosed. An endoscopy was performed to examine the cause of regurgitation, and an oesophageal stricture was observed. Endoscopic balloon dilation of the oesophageal stricture was performed, and the regurgitation was resolved immediately. However, regurgitation relapsed 2 months later, and computed tomography was performed to ascertain the cause. Computed tomography revealed oesophageal mural thickening and true pleuroperitoneal hernia with partial liver lobe herniation. A second endoscopy with balloon dilation was performed to treat the relapsing oesophageal stricture, and the clinical signs resolved without the need for herniorrhaphy. Nevertheless, oesophageal stricture could occur due to gastroesophageal reflux related to a pleuroperitoneal hernia; however, a definite link could not be elucidated in this case. This report describes a case of oesophageal stricture and concurrent true pleuroperitoneal hernia in a cat.

The use of Savary-Gilliard dilators in the treatment of an oesophageal stricture in a cat

Oesophageal strictures in cats and dogs are relatively rare and the cause of this disorder can be multifactorial. However, the most common cause in cats is an inflammatory process.Conservative treatment strategies for this disorder includes image-guided interventions. Endoscopic methods are a form of a minimally invasive surgical treatment of the oesophageal strictures. Several endoscopic methods for the therapy of this condition are known, one of them is Savary-Gilliard dilators technique.In the present study of a case of oesophageal stricture in a cat, caused probably by doxycycline treatment without water administration, the authors used the Savary-Gilliard dilators as a therapy for its condition. The animal underwent 3 endoscopy procedures, where in the third one no abnormality in the oesophagus was observed. Moreover, the cat was asymptomatic 6 months after the last oesophagoscopy.In the authors opinion, based on the present case, some experience of the authors and previously described studies, the Savary-Gilliard dilators seems to be a safe, effective, relatively cheap and minimally invasive method of the oesophageal stricture therapy in the cat.

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.

Surgical treatment of a distal oesophageal stricture by mucosal radial incision and dilation in a kitten with secondary megaoesophagus

Case summary

A 7-month-old intact female Maine Coon cat was presented with a 2-month history of regurgitations. Contrast radiographic and endoscopic examinations revealed a diffuse megaoesophagus secondary to a severe lower oesophageal stricture. An epiphrenic diverticulum was noted. Endoscopic balloon dilation was unsuccessful. Gastrotomy was thus performed in order to incise the oesophageal wall radially along the stricture site, and then to dilate the stricture. A diameter of 20 mm was reached. With the aim of preventing stricture recurrence, submucosal injections of triamcinolone acetonide were performed. An 18 Fr oesophagogastric feeding tube was placed and a left gastropexy was performed in order to exert some traction on the gastroesophageal junction, with the aim of reducing the oesophageal diverticulum. Twelve months postoperatively, clinical signs had completely resolved and follow-up radiographs revealed marked improvement of the oesophageal dilatation.

Relevance and novel information

Lower oesophageal strictures should be considered when evaluating regurgitations or megaoesophagus in a kitten. Surgical mucosal radial incision is a therapeutic option in cases of lower oesophageal stricture refractory to balloon dilation, and can lead to a marked improvement of clinical signs and of the oesophagus diameter leading to clinical success.

Successful treatment of a dog with phenobarbital-responsive sialadenosis and an oesophageal stricture

Background

Phenobarbital‐responsive sialadenosis (PRS) can cause nausea and vomiting, and is rarely reported in dogs.

Objectives

An 8‐year‐old neutered, male Pomeranian dog was presented to our teaching hospital with vomiting that began 2 years ago. The clinical signs repeatedly improved and deteriorated despite treatment.

Methods

The only abnormality found on physical examination was salivary gland enlargement, and no specific findings were observed on blood analysis and imaging tests. The results of the fine needle aspirate cytology from the salivary glands revealed possible sialadenosis. Phenobarbital was prescribed, and the patient's symptoms resolved. However, upon discontinuing drug, the patient's clinical signs recurred and did not improve even after re‐introduction of phenobarbital and the addition of other anticonvulsant drugs. An oesophageal stricture was observed on an oesophagram, and fibrosis was confirmed endoscopically. A balloon dilation was performed to expand the stenosis.

Results

After the first procedure, the patient's clinical signs initially improved, but relapsed 2 weeks later. A total of three oesophageal dilation procedures were performed using a sequentially larger diameter balloon. After the third procedure, the patient's clinical signs were managed without recurrence. The cause of recurrent gastrointestinal signs following the initial successful treatment of phenobarbital‐responsive sialadenosis was due to oesophageal stricture formation.

Conclusions

This case report demonstrates the successful management of PRS with subsequent oesophageal stricture formation in a dog.

Esophagostomy tube complications in dogs and cats: Retrospective review of 225 cases

Background

Esophagostomy feeding tubes (E‐tubes) are an essential tool for management of hyporexic patients' acute and chronic nutritional requirements. Despite their routine use, limited information is available regarding E‐tube complications, especially in the recent veterinary literature.

Objective

To provide an updated descriptive account of E‐tube complications in cats and dogs, and to evaluate potential prognostic factors to determine if certain patients are at increased risk for complications.

Animals

One hundred two dogs and 123 cats.

Methods

Retrospective study evaluating patients that had E‐tubes placed between March 2014 and March 2017.

Results

One hundred 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.

Conclusions and Clinical Importance

We have provided an updated descriptive review of complications associated with E‐tube placement in a large population of dogs and cats at a tertiary referral center. Although E‐tubes are essential tools that generally are safe and well tolerated, several complications can occur. We did not identify any specific factors that increase patient risk for these complications, and therefore it is important that all patients are closely monitored and clients are educated to pursue prompt veterinary assessment when such complications arise.

Prospective evaluation of an indwelling esophageal balloon dilatation feeding tube for treatment of benign esophageal strictures in dogs and cats

Background

Despite multiple dilatation procedures, benign esophageal strictures (BES) remain a recurring cause of morbidity and mortality in dogs and cats.

Objective

Investigate the use of an indwelling Balloon Dilatation esophagostomy tube (B‐Tube) for treatment of BES in dogs and cats.

Animals

Nine dogs and 3 cats.

Methods

Animals with BES were recruited for our prospective study. Endoscopic and fluoroscopic evaluation of the esophagus and balloon dilatation were performed under general anesthesia, followed by placement of an indwelling B‐Tube. The animals' owners performed twice daily at‐home inflations for approximately 6 weeks. Repeat endoscopy was performed before B‐Tube removal. Animals were reevaluated for changes in modified dysphagia score (MDS) after B‐Tube removal.

Results

The B‐Tube management was relatively well tolerated and effective in maintaining dilatation of a BES while in place. These animals underwent a median of 2 anesthetic episodes and were monitored for a median of 472 days (range, 358‐1736 days). The mean MDS before treatment was 3.1 ± 0.5/4.0 and final follow‐up MDS were significantly (P < .0001) improved at 0.36 ± 0.65/4.0. Eleven of 12 animals (91.7%) had improved MDS at the end of the follow‐up period, with 8/12 (66.7%) having an MDS of 0/4, 2/12 (16.7%) an MDS of 1/4, and 1/12 (8.3%) an MDS of 2/4. One dog died.

Conclusions and Clinical Importance

The B‐Tube offers an effective, and more economical method, and often decreased anesthetic time to repeated balloon dilatation procedures for the treatment of BES in dogs and cats.