Intralesional steroid injection after endoluminal esophageal stricture dilatation in a cat

Background:

Benign esophageal strictures arise from various etiologies, mostly severe esophagitis. Although endoscopic balloon dilation is still the first-line therapy, refractory or recurrent strictures do occur and remain a challenge to the endoluminal treatment. The aim of this report was to communicate a recurrent esophageal stricture resolution in a cat treated with balloon dilatation and steroid injections in Ciudad de Buenos Aires, Argentina.

Case Description:

A 1-year-old spayed mix-breed female cat was consulted to the Veterinary Endoscopy Service for recurring regurgitation after two previous esophageal dilations. The cat had received doxycycline for Mycoplasma spp. infection and 20 days after the treatment consulted for dysphagia and regurgitation. Upper esophagogastroscopy (UGE) was performed with an Olympus CV-160 8.7 mm diameter endoscope; an annular 7 mm stricture was observed 3 cm caudal to the cranial esophagus sphincter. Three balloon dilatations procedures were performed with a Boston Scientific Controlled Radial Expansion (CRE) balloon 8–10–12 mm of 1 minute each. Because of ongoing clinical signs, another UGE was performed 15 days from the first procedure: a 3 mm stricture was encountered, balloon dilatation was repeated with 6–10–12 mm diameter, and a four-quadrant triamcinolone was injected in the submucosa. Clinically, the cat could eat with no alterations until day 20, where it started with mild dysphagia. Another UGE was performed, and the known stricture conserved a 11 mm diameter and balloon dilatation 12–15–16.5 mm with triamcinolone injection was repeated 30 days after the previous procedure. The cat could eat kibbles with no clinical signs in an 11-month follow-up.

Conclusion:

The alternative to triamcinolone injection after balloon dilatation presented in this clinical report was successful and it could be a therapeutic option for recurrent esophageal strictures in cats as it is in human medicine.

Fluoroscopic and endoscopic diagnosis of a lower esophageal ring causing foreign body impaction in a dog

A dog was presented because of regurgitation over a 3-day period. Radiographic examination revealed a bean-shaped filling defect and an annular narrowing at the level of the gastroesophageal sphincter. The contractile ring-like structure was sharply demarcated, and its appearance varied according to gastroesophageal distension. Endoscopic findings revealed lower esophageal ring and foreign body impaction.

Feasibility of flexible endoscopic evaluation of swallowing in healthy dogs

OBJECTIVE

To assess feasibility of flexible endoscopic evaluation of swallowing (FEES) in awake dogs, determine whether specific variables associated with the oropharyngeal phase of swallowing can be recognized, and evaluate the safety and tolerability of FEES.

ANIMALS

6 healthy client-owned large- and giant-breed adult dogs.

PROCEDURES

A topical anesthetic was applied to the nasal passage of each dog, and a fiberoptic endoscope was passed transnasally until the tip of the scope was positioned in the oropharynx. All dogs voluntarily drank colored water followed by consumption of a commercial canned diet and then a kibble diet mixed with food color. During each swallow, laryngeal and pharyngeal anatomic structures were evaluated and depth of bolus flow prior to the pharyngeal phase of swallowing was assessed. Evidence of bolus retention in the vallecula or pyriform sinuses and laryngeal penetration of the bolus were recorded.

RESULTS

FEES was completed without major adverse events and was tolerated well by all 6 dogs. Mild, self-limiting epistaxis was noted for 2 dogs. The nasopharynx, oropharynx, and hypopharynx were observed in all dogs; movement of food boluses through the esophagus was observed in 2 dogs, and food boluses in the stomach were visible in 1 dog. Pharyngeal and laryngeal function was considered physiologically normal in all dogs.

CONCLUSIONS AND CLINICAL RELEVANCE

FEES appeared to be a feasible diagnostic tool for use in large- and giant-breed dogs. Studies are warranted in dogs with oropharyngeal dysphagia to determine whether FEES can be tolerated and whether it can augment videofluoroscopy findings.

Endoscopic removal of esophageal and ruminal foreign bodies in 5 Holstein calves

Endoscopic removal of esophageal and ruminal foreign bodies was successfully performed in 5 Holstein-Friesian calves under sedation or general anesthesia by using an electrocautery snare or a wire-guided Dormi basket. This report describes the endoscopic manipulations, treatment, and outcomes of esophageal foreign body removal in these calves.

Idiopathic esophagopathies resembling gastroesophageal reflux disease in dogs

OBJECTIVE

Pathologic gastroesophageal reflux (GER) has been demonstrated experimentally in dogs, and it is suspected to occur naturally in dogs, yet its clinical significance is unknown. The aim of the study was to demonstrate clinical indicators of pathologic GER in dogs with idiopathic esophagopathies.

MATERIALS AND METHODS

Dogs with clinical signs suggestive for esophageal disease (regurgitation, ptyalism, or dysphagia) and where extraesophageal and specific esophageal diseases had been ruled out, were retrospectively diagnosed with idiopathic esophagopathies. History, physical examination findings, clinicopathologic, radiographic, and endoscopic data, and treatment results were obtained from medical records, reviewed and evaluated.

RESULTS

Out of 67 dogs with anamnestic esophageal signs, 12 (17.4%) dogs were identified as having idiopathic esophagopathies and were included in the study. Median age was 3.0 years (range 1.0-11.0), and median bodyweight was 28.2 kg (range 8.2-44.0). The most frequent anamnestic esophageal signs were ptyalism (10/12 dogs), regurgitation (8/12 dogs), signs of discomfort, pain (8/12 dogs), and cough (5/12 dogs). The most common radiographic abnormality was segmental esophageal dilation (8/12 dogs). Esophagoscopy revealed single mucosal surface defects at the gastroesophageal junction in 3/12 dogs. In dogs with altered esophageal motility, cytological and microbiological examinations of bronchial aspirates showed goblet cell hyperplasia (8/8 dogs), neutrophilic infiltration (5/8 dogs) and culturable bacteria (4/8 dogs), respectively. All dogs were treated with omeprazole (median 0.7 mg/kg once per day, range 0.5-1.2). Reported median treatment duration until remission of the main clinical signs was 20.0 days (range 8.0-54.0 days). This endpoint was reached in 11/12 dogs.

CONCLUSION AND CLINICAL RELEVANCE

Results suggest that in some dogs with esophageal clinical signs, and where no primary disease could be identified, clinical indicators of pathologic GER such as pain, mucosal lesions and motility disturbances of the esophagus, respiratory complications, and response to therapy can be observed.

[Endoscopy in cattle]

Endoscopy in the field of buiatrics has gained growing importance in recent years. Parts of the upper respiratory and gastrointestinal tract, the urethra and urinary bladder, the abdomen and the teat are all accessible by means of endoscopy. The direct visualisation of inner or outer organ surfaces allows for rapid diagnosis and even prognosis of different pathological conditions. Flexible endoscopes of different dimensions are used for endoscopic examination of the upper respiratory tract. Examining this region, endoscopy is in some cases superior to other imaging techniques because of the direct visualization of surfaces and their pathological conditions and the possibility of collecting biopsies under visual control. The same is documented for diseases of the oesophagus. On the other hand, rumenoscopy is of experimental character so far. Urethrocystoscopy is mainly performed for diagnostic purposes with either flexible or rigid optics. Theloscopy represents the "gold standard" for surgical intervention in cases of disturbance of milk flow, since mucosal tissue can be removed under visual control. Therefore, this indication is one of the most important applications for endoscopy performed by practitioners. Another important field for the application of therapeutic endoscopy is the treatment of left displaced abomasum by repositioning and fixation to the abdominal wall under endoscopic control.

Surgical repair of an oesophageal stricture and prestenotic dilatation in a horse

Prestenotic oesophageal dilatation and stricture were diagnosed in a horse with a history of trauma in the cervical area and recurrent oesophageal obstruction. The diagnosis was established on the basis of the clinical examination, endoscopy, and positive contrast oesophagography. Conservative treatment was unsuccessful and surgical intervention was necessary. Oesophageal myectomy combined with myoplasty was performed, simultaneously relieving the dilatation and the stricture. No abnormalities were detected 8 weeks after surgery. The horse was on a normal diet and oesophageal obstruction did recur in the subsequent 14 months.

Esophagitis and esophageal strictures

Esophagitis and esophageal strictures are relatively uncommon but significant diseases in companion animals. Often, an esophageal disorder is suspected on the animal's medical history and clinical signs. Esophagitis and acquired esophageal strictures are caused by prolonged contact of caustic substances or foreign bodies with the esophageal lining, leading to mucosal injury. In cases of stricture, damage extends into the submucosal and muscular layers. Timely detection and appropriate management of esophagitis and esophageal strictures significantly improve nutritional status, dysphagia, and pain and often return the animal to a normal quality of life. This article reviews the current literature and focuses on the diagnosis and treatment of esophagitis and esophageal strictures caused by fibrosis secondary to esophageal inflammation.

Reconstruction of thoracic esophagus with pediculated diaphragmatic flap in dogs

PURPOSE

To verify whether pediculated diaphragmatic flaps were suitable to correct iatrogenic wounds in dog's esophagus injuries.

METHODS

Seven dogs were submitted to resection of a segment of the esophageal wall, which was then corrected by suturing a pediculated diaphragm flap. Endoscopic evaluation of the esophageal wall was done forty days after the surgical procedure.

RESULTS

Three animals died, one due to implant ischemia, caused by strangulation of the phrenic artery; other due to wound infection; and the last, due to mediastinitis. Scar retraction was observed, however, there was no stenosis, allowing the passage of a 9,8 mm probe with no difficulty. The limits between the implants and the native esophagus were indistinguishable, and the implant was covered by esophageal mucosa.

CONCLUSION

The diaphragmatic flaps are suitable on the restoring of continuity in dog's thoracic esophagus.

Oesophagoscopy and detection of viral nucleic acids in oesophageal biopsies--A contribution to BVDV diagnosis

The endoscopic appearance of the oesophagus of animals infected with bovine virus diarrhoea virus (BVDV) but without signs of acute mucosal disease (MD) was investigated for any common or 'early warning' lesions. Thirty-seven BVDV-infected animals [36 persistently infected (PI) and one transiently infected] were examined clinically and endoscopically for typical erosions of the oronasal and oesophageal mucosa, respectively. During oesophagoscopy, mucosal biopsies were taken and tested for pestivirus-specific nucleic acids by reverse transcription polymerase chain reaction (RT-PCR). The results were compared with those of RT-PCR with various sample materials (blood, nasal and conjunctival swabs and faecal samples) usually used for routine diagnosis of BVDV infection. The average age of the 36 PI animals was 13.5 months, eight animals were 24 months or older. None of the PI animals had clinically visible erosions of the oronasal mucous membranes. During oesophagoscopy, all animals showed a reddening but unexpectedly no erosions or ulcerations of the oesophageal mucosa. Although in 21 of 36 PI animals all samples tested positive, the oesophageal biopsies were with no exception constantly RT-PCR positive in contrast to all other materials investigated. Remarkably, in the transiently infected animal all samples tested negative except for the oesophageal biopsy. Hence, this infection would have been missed by conventional diagnostic sampling.

Clinical signs and clinicopathologic abnormalities in dogs with clinical spirocercosis: 39 cases (1996-2004)

OBJECTIVE

To determine clinical signs and clinicopathologic abnormalities in dogs with naturally occurring clinical spirocercosis.

DESIGN

Retrospective case series.

ANIMALS

39 dogs with spirocercosis.

PROCEDURES

Medical records were reviewed, and information on signalment, residence (rural vs urban), owner complaints, physical examination findings, clinicopathologic abnormalities, radiographic and endoscopic findings, and concurrent systemic diseases was recorded.

RESULTS

Hellenic hounds and mixed-breed dogs were overrepresented, compared with a group of 117 control dogs without spirocercosis that were examined because of gastrointestinal tract disease, and mean body weight of dogs with spirocercosis was significantly higher than mean body weight of control dogs. Odynophagia (34 [87%]), regurgitation (24 [62%]), and excessive salivation (14 [36%]) were the most common clinical findings. The most common radiographic abnormalities were a mass in the caudodorsal aspect of the mediastinum (15/35 [43%]) and spondylitis of the caudal thoracic vertebrae (10 [29%]). Parasitic nodules were seen during esophagoscopy in all 39 dogs. Normocytic, normochromic, nonregenerative anemia; neutrophilic leukocytosis; hyperproteinemia; and high alkaline phosphatase activity were significantly more common in dogs with spirocercosis than in a control group of 56 healthy dogs. Concurrent systemic diseases, mainly leishmaniosis, dirofilariosis, and monocytic ehrlichiosis, were documented in 14 (36%) dogs.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that clinical spirocercosis occurs more often in young-adult, large-breed dogs. Nonregenerative anemia, neutrophilic leukocytosis, hyperproteinemia, and high alkaline phosphatase activity may be useful clinicopathologic indicators of this disease.

Prevalence of gastrointestinal tract lesions in 73 brachycephalic dogs with upper respiratory syndrome

OBJECTIVES

To determine the prevalence of gastrointestinal tract lesions in brachycephalic dogs with upper respiratory tract disease.

METHODS

The gastrointestinal tract and respiratory disorders of 73 brachycephalic dogs presented with upper respiratory signs were evaluated. Clinical signs and endoscopic and histological anomalies of the upper digestive tract were analysed.

RESULTS

A very high prevalence of gastrointestinal tract problems in brachycephalic dogs presented with upper respiratory problems was observed clinically, endoscopically and histologically. Endoscopic anomalies of the upper digestive tract were present even in dogs without digestive clinical signs. Furthermore, histological evaluation of the digestive tract sometimes showed inflammatory lesions not macroscopically visible at endoscopy. Statistical analysis showed a relationship between the severity of the respiratory and digestive signs. This was significant in French bulldogs, males and heavy brachycephalic dogs.

CLINICAL SIGNIFICANCE

These observations show a correlation between upper respiratory and gastrointestinal tract problems in brachycephalic breeds with upper respiratory disease. Surgical treatment of respiratory disease could improve the digestive clinical signs, and/or gastro-oesophageal medical treatment could improve the outcome for surgically treated brachycephalic dogs.

Diagnosis and management of reflux esophagitis

Esophagitis has generally been considered rare in dogs and cats. However, it may not be as uncommon as previously thought due to the increased awareness of the disease and the increasing availability of endoscopy. Esophagitis can be caused by gastroesophageal reflux, trauma, foreign bodies, ingestion of caustic substances, structural abnormalities (ie, hiatal hernia, neoplasms), and chronic vomiting. This article will focus on the diagnosis and treatment of esophagitis secondary to gastroesophageal reflux. This is a diagnosis based on clinical signs, exclusion of other causes of esophagitis, and typical radiographic, endoscopic, and histopathologic findings.

[Endoscopic removal of foreign bodies from cats or dogs]

Foreign bodies in the airways or intestines of dogs or cats are a common problem in companion animal practice. Improved endoscopic techniques, together with their greater availability, mean that it is often possible to remove the foreign body endoscopically, making surgery unnecessary. This article describes 53 cats and dogs in which a foreign body was detected and, where possible, removed. Results are compared with those in the literature. Practical guidelines for foreign body removal in specific cases are described, focusing on therapy and prognosis.

Fatal hemothorax following management of an esophageal foreign body

A 10.8-year-old, spayed female toy poodle presented with an esophageal foreign body. The foreign body was removed endoscopically, and a gastrostomy tube was placed to provide nutritional support during esophageal healing. The gastrostomy tube was later removed by endoscopic retrieval of the bulb through the esophagus. Immediately afterward, the dog developed hemothorax and eventually died. It was determined that many small arterial branches were avulsed from the aorta. The involved sections of aorta histopathogically evidenced medial necrosis, which was believed to be related to a prior disruption of blood flow through the vasa vasorum.

Fluoroscopic and endoscopic localization of an esophagobronchial fistula in a dog

A 10-month-old, intact male Chihuahua presented for a 7-month history of regurgitation and coughing. Survey radiographs revealed a soft-tissue opacity within the distal esophagus. A contrast study confirmed the presence of an esophagobronchial fistula. Endoscopic removal of foreign material within the esophagus allowed for visualization of an esophageal diverticulum. Bronchoscopic examination revealed the presence of an abnormal opening in a right caudal tertiary bronchus. Passage of a cardiac guidewire was accomplished, confirming the presence of the fistula and aiding its subsequent surgical removal.

Endoscopic evaluation of the esophagus and stomach in three loggerhead sea turtles (Caretta caretta) and a Malaysian giant turtle (Orlitia borneensis)

Three loggerhead sea turtles (Caretta caretta) and a Malaysian giant turtle (Orlitia borneensis) were presented with suspected or confirmed esophageal foreign bodies. Esophagoscopy was performed on all turtles, and gastroscopy was performed on three turtles. In all cases, endoscopy was easy to perform, and allowed visualization of most upper gastrointestinal features. The papillated esophagus was easy to navigate, but mucosal papillae in the loggerhead sea turtles prevented examination of the underlying mucosa. The stomach was easily entered and examined in both species, but the working endoscope length (100 cm) prevented inspection of the pyloric antrum and the duodenum in all turtles. The turtles in this report may serve as references for future endoscopic examinations of these species.

A retrospective study of oesophageal endoscopy in cattle - oesophagoscopy for diagnosis of mucosal disease

Oesophageal endoscopy in cattle has been rarely reported in the literature. It has, however, been used for many years as an aid to the diagnosis and treatment of illnesses of the upper gastrointestinal tract in small animals and horses. We have assessed the potential value of oesophagoscopy on 120 bovine patients presented at the 2nd Medical Clinic for Ruminants and Swine at the University of Veterinary Medicine, Vienna, over a period of three years. In the course of the study, cattle exhibiting symptoms such as salivation, regurgitation or swelling in the neck region were referred for endoscopic examination. The main indication was to confirm or exclude bovine virus diarrhoea virus infection in calves, in which typical erosions were visible endoscopically on the mucosa of the oesophagus in infected animals. In addition, endoscopy proved to be useful for the diagnosis of diverticula, ruptures and inflammation of the oesophagus. Oesophagoscopy can be considered to be a valuable supplementary aid to clinical examination and, in many cases, can facilitate diagnosis.

Esophagomyotomy and esophagopexy to create a diverticulum for treatment of chronic esophageal stricture in 2 horses

We report use of esophagomyotomy and esophagopexy to create a diverticulum for relief of chronic type I esophageal stricture in 2 horses. After esophagomyotomy, the mucosa was dissected free from the muscularis for approximately 180 degrees around the myotomy. Then, the tunica muscularis of esophagus was sutured to the sternocephalicus muscle ventrally and the periesophageal tissues dorsally to create a diverticulum without disruption of the esophageal mucosa. Clinical signs of esophageal stricture were relieved, and the horses were fed normal diets without further esophageal obstruction.

Esophagoscopy

Esophageal pathology is one of the areas that had the major benefits from the advent of endoscopy. Esophagoscopy is a highly reliable diagnostic method for evaluating esophageal disorders that affect the mucosa or alter the lumen of the organ, such as foreign bodies, esophagitis, reflux disease, strictures, ulcers, fistula, and neoplasia. With endoscopy, the treatment of esophageal disorders has greatly improved as well, with the retrieval of foreign bodies and the dilation of esophageal strictures under direct visualization the main therapeutic indications.

Photodynamic therapy as a treatment for esophageal squamous cell carcinoma in a dog

Intrathoracic esophageal squamous cell carcinoma was diagnosed by endoscopy in an 11-year-old, castrated male Labrador retriever with signs of regurgitation and weight loss. Photodynamic therapy with photofrin was administered three times under endoscopic guidance over a two-month period. A partial response to photodynamic therapy was supported by a reduction in tumor size (noted on serial endoscopic examinations) and by a return to oral alimentation. The dog was euthanized due to recurrent regurgitation and aspiration pneumonia nine months after the onset of therapy. Necropsy revealed marked local invasiveness and regional lymph node metastasis of the esophageal squamous cell carcinoma in addition to pneumonia. The application of photodynamic therapy in the treatment of canine esophageal squamous cell carcinoma is discussed and compared with the human literature.

Oesophageal squamous cell carcinoma in two cats

Two cases of feline oesophageal squamous cell carcinoma are described. In both cases, diagnosis was achieved by radiography, endoscopy and cytology, and later confirmed by histology. One cat underwent oesophagectomy followed by end-to-end anastomosis, but died three days postsurgery; the second cat was euthanased after diagnosis.

Idiopathic distal esophageal dilation in a southern black rhinoceros (Diceros bicornis minor)

An adult female southern black rhinoceros (Diceros bicornis minor) experienced intermittent periods of regurgitation while eating, suggesting an esophageal disorder. Endoscopy for evaluation of the trachea, esophagus, and stomach revealed a 30-mm nasopharyngeal orifice with associated recess located in the caudodorsal pharynx and a 10-cm dilated segment of the distal esophagus that was presumably the cause of regurgitation. Dietary management of esophageal dilation through short-term utilization of a "soft feed" program successfully eliminated the regurgitation. This is the first report of esophageal dysfunction in a rhinoceros.

Endoscopic and surgical retrieval of fishhooks from the stomach and esophagus in dogs and cats: 75 cases (1977-1993)

Medical records of 3 cats and 72 dogs that had a fishhook endoscopically or surgically retrieved from the stomach or esophagus were reviewed. Endoscopic retrieval was successful in 41 of 62 (66%) animals, and retrieval time and hospitalization time for endoscopic retrieval were significantly shorter than times for surgical retrieval. Rate of failure of endoscopic retrieval was higher for animals with treble-barb, rather than single-barb, fishhooks. Whether a fishhook could be successfully retrieved endoscopically was independent of body weight, amount of time the fishhook had been present, location of the hook, and orientation within the esophagus.

Endoscopically guided balloon dilatation of benign esophageal strictures in 6 cats and 7 dogs

Benign esophageal strictures in 6 cats and 7 dogs were treated with endoscopically guided balloon dilatation. Six of 13 had a history of anesthesia within 3 weeks prior to the onset of signs; 8 animals had a single stricture, and 5 had multiple strictures, for a total of 19 strictures. Four of the 19 strictures were in the upper esophagus, 11 were in the middle esophagus, and 4 were in the lower esophagus. The luminal diameters ranged from 1 to 18 mm, with a mean of 5.1 mm. Twelve animals survived the immediate postprocedure period and had a total of 50 dilatation procedures performed; the mean number of procedures per animal was 4.2 (range, 2 to 8). Complications included mild bleeding and tearing (11 of 13), moderate bleeding (1 of 13), and esophageal perforation (1 of 13). The cat with the perforation was subsequently euthanized. Follow-up information was available on the 12 remaining animals; 9 were known to be alive 6 to 59 months (mean, 28.2 months) after dilatation. Two were euthanized, 1 for persistence of signs and the other for unrelated causes. One animal died of possible aspiration pneumonia. Three of 13 animals had complete and 9 had partial resolution of signs. Of the 9 animals with partial resolution, 7 were substantially better with dietary modification, 1 was moderately better, and 1 had minimal improvement. Eleven of 13 animals (85%) had a successful outcome with moderate to complete resolution of signs. Thus, it is concluded that endoscopically guided balloon dilatation is an effective and relatively safe treatment for benign esophageal strictures in dogs and cats.

Use of esophagoscopy in the diagnosis of esophageal squamous cell carcinoma in a horse

Esophagoscopy allowed visualization and biopsy of a lesion within a diverticulum of the esophagus in an adult horse. Although the biopsy specimen obtained was small, diagnosis of squamous cell carcinoma was possible from histologic examination of the esophageal tissue sample retrieved by use of endoscopy.

Removal of nasogastric tube fragments from three horses

Three horses were admitted for retrieval of polyurethane nasogastric tube fragments. The fragments were removed from the esophagus or stomach of 2 horses by manipulation of a snare introduced through the biopsy port of an endoscope. The fragments were surgically removed from the stomach of the third horse.

Complications of nasogastric intubation in horses: nine cases (1987-1989)

Pharyngeal or esophageal trauma was diagnosed in 9 horses after nasogastric intubation. Evidence of trauma (edema or ulceration) was detected in the pharynx of 3 horses and in the esophagus of 6 horses. Complications associated with nasogastric intubation were first observed in 5 horses while they were intubated and in 4 horses after extubation. Clinical signs of pharyngeal or esophageal trauma were similar, and included salivation, bruxism, coughing, and nasal discharge. Treatment, including extubation, enteral feeding through a small nasogastric tube, or esophagostomy distal to the affected site, was attempted in 6 horses. Three of 6 treated horses survived, but 4 of 5 horses with perforated esophagus were euthanatized.

Conservative treatment of oesophageal stricture in five foals

Three foals under four weeks old and two under six months old with a history of oesophageal obstruction, had oesophageal strictures of different characters in the rostral cervical oesophagus. One case, which was complicated by severe inhalation pneumonia, was euthanased without any treatment and in another initial treatment by bougienage under general anaesthesia was attempted without success. The four surviving cases were provided with progressively firmer and coarser food, starting with liquid only, over a period of three to four weeks. The treatment is recommended in the early stages of stricture maturation and for strictures which do not involve the deeper layers of the oesophageal wall.

Surgical repair of an intrathoracic esophageal pulsion diverticulum in a horse

An intrathoracic esophageal pulsion diverticulum causing repeated episodes of esophageal obstruction in a Morgan weanling colt was diagnosed by endoscopy, positive contrast radiography, and pleuroscopy. Surgical excision of the diverticulum alleviated clinical signs, and the horse was able to resume a normal diet by day 6. After 9 months the colt remains asymptomatic.

Use of gastrotomy to relieve esophageal obstruction in a horse

Esophageal obstruction of 1 week's duration in a gelding was diagnosed by contrast radiography and esophagoscopy. A food bolus was found at the junction of the caudal thoracic portion of the esophagus and the cardia. A gastrotomy was performed through a cranial abdominal incision and a phytobezoar was manually broken down and removed. The gelding was started on complete pellet food and water on the fifth day after surgery. The horse remained clinically normal more than 1 year after surgery.

Upper gastrointestinal endoscopy

Upper GI endoscopy is a frequently performed endoscopic procedure that is particularly suited for the diagnosis of upper GI diseases with a luminal or mucosal location. Contraindications are few and complications are rare. Procedures that can be performed during upper GI endoscopy include mucosal biopsy, brush cytology, aspiration of duodenal fluid for culture and cytology, foreign body retrieval, bougienage of strictures, and endoscopic placement of gastrostomy tubes. Unresolved issues that face veterinary endoscopists include the interrelationship between contrast radiology and endoscopy, the advisability of routine combination of upper and lower GI endoscopy, the reasons for discordance among clinical signs, endoscopic appearance, and biopsy findings, and the role of post-treatment biopsies.

Surgical correction of a traumatic esophageal diverticulum in a horse

A nine-year-old gelding was presented to the Auburn University Large Animal Clinic with discharge of saliva and food material from both nostrils. A diagnosis of esophageal diverticulum was made; treatment is described.

Fragments of nasogastric tubes as esophageal foreign bodies in two horses

Two horses were referred with fragments of nasogastric tubes as esophageal foreign bodies. Radiography and endoscopy were used to identify the location of the fragments. Portions of the tubes were retrieved by esophagotomy in 1 horse and by manual examination of the oral cavity in the other. Both tubes were friable in focal areas, but were quite pliable over most of the length of the tube.

Surgical repair of an esophageal stricture in a horse

An esophageal stricture was diagnosed in a 9-month-old quarterhorse by esophagoscopy and positive pressure contrast esophagography. Medical management and two attempts at surgical intervention were unsuccessful. The initial surgical technique used was a linear esophagotomy, mucosal resection and anastomosis, and closure of the muscular tunic, which resulted in a more severe stricture. The second surgical procedure was interruption of the stricture cicatrix by a single linear esophagotomy and primary closure of only the esophageal muscular tunic. This technique resulted in an increased lumen diameter, but failed to adequately resolve the stricture. Successful resolution of the stricture with return to a normal diet was achieved by a two stage repair using formation of an esophagostomy to stabilize the esophagus, followed by fenestration of the mucosal-submucosal cicatrix. Six months postoperatively, the horse was asymptomatic on a normal diet.

Pleuroscopic diagnosis of gastroesophageal squamous cell carcinoma in a horse

A 15-year-old Quarter Horse gelding was examined because of chronic intermittent colic of 40 days' duration. The clinical signs included acute onset of depression, ptyalism, abdominal splinting, and rolling within an hour of eating. An intramural mass of the esophagus was identified during esophagoscopy. A large soft-tissue density surrounding the distal portion of the esophagus, creating a stricture, was identified on an esophagogram. With the horse slightly sedated, pleuroscopy was performed, allowing direct visualization and biopsy of the mass. The histopathologic diagnosis was squamous cell carcinoma.

Barium swallow as an aid to the diagnosis of grass sickness

Twenty-five horses, suspected on clinical grounds of having grass sickness, were given a barium swallow. Using image intensification the passage of the barium bolus was followed radiographically from the pharynx to the stomach. All 18 horses in which grass sickness was later confirmed at post mortem examination showed defective oesophageal motility. Although the specificity of the abnormality could not be proven, the technique offers a valuable aid to the ante mortem diagnosis of grass sickness.

Gastrointestinal endoscopy in the dog

Gastrointestinal endoscopy has proved to be an important tool in the diagnosis of gastrointestinal disease in the dog. An endoscope for the examination of oesophagus, stomach, and colon is described. Examination of the duodenum is also possible with this type of endoscope in the larger breeds of dogs. Indications, advantages, and disadvantages of the endoscopy are pointed out.

Esophageal healing in the pony: comparison of sutured vs nonsutured esophagotomy

Esophageal healing was evaluated in 10 ponies after sutured and nonsutured cervical esophagotomy techniques. Mucosal healing occurred significantly (P less than 0.005) faster after sutured esophagotomies (x = 7.5 days after surgery) than after nonsutured esophagotomies (x = 25.6 days after surgery), based on endoscopic and clinical evaluations. Although endoscopy was an accurate assessment of the return of normal passage of a food bolus through the esophagus, 4 of 10 ponies had radiographic evidence of a sinus tract after the mucosa was considered healed, based on endoscopic and clinical examinations. The surgical skin wound also healed significantly sooner after sutured esophagotomies (x = 10 days) than after nonsutured esophagotomies (x = 33.4 days). A traction diverticulum developed in all ponies with nonsutured esophagotomies, but occurred in only 1 pony with sutured esophagotomy. Minor complications were seen more frequently with sutured esophagotomy than with a nonsutured esophagotomy, but were resolved with local therapy. Saliva appeared to inhibit wound healing. All ponies were fed through esophagostomy tubes until the mucosa at the esophagotomy site was considered healed. Except for 1 sutured esophagotomy that dehisced, sutured esophagotomy was superior to nonsutured esophagotomy, because earlier establishment of a mucosal seal resulted in more rapid healing and reduced nursing care.

Fiberoptic esophagogastroscopy, brushings, and biopsy in rabbits (Oryctolagus cuniculus)

The esophagus and stomach of rabbits were examined with a pediatric fiberoptic endoscope. The procedure involved general anesthesia and placement of an endotracheal airway followed by endoscopy. Photography, biopsies, and brushings for histology, cytology, and microbiological cultures were accomplished using this procedure. Rabbits were endoscoped and brushed repetitively on successive days without inducing esophagitis.