Esophagitis and esophageal strictures.

Esophagitis and esophageal strictures are important causes of esophageal disease in dogs and cats. Clinical suspicion is created when the clinician recognizes the clinical signs suggestive of esophageal disease and accounts for historical information and physical examination findings. Once suspected, the diagnosis of esophagitis and esophageal strictures is a fairly simple one in most cases. Although the benefit of diminishing secretion of gastric acid in patients with esophagitis is unquestioned, other questions regarding adjunctive medical treatments, such as sucralfate and glucocorticoids for dogs and cats with esophagitis, have not been answered through appropriate clinical studies. Esophageal strictures are readily treated with balloon dilation or esophageal bougienage, and clients can expect most patients to become functional, although dietary change may be necessary.     

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.     

Esophageal Disorders in 61 Horses: Results of Nonsurgical and Surgical Management

Obstructive esophageal disorders in 61 horses included feed or foreign body impaction (27 horses), strictures (18 horses), perforations (11 horses), and diverticula (5 horses). Horses with feed impaction were treated nonsurgically (25 horses) or by esophagotomy (2 horses). Survival to discharge was 78%, and 37% of these had persistent chronic obstruction at home. Long-term survival was 52%. Long-term survival of nine horses treated nonsurgically for esophageal strictures was 22%; for nine horses treated surgically it was 44%. Long-term survival of horses treated nonsurgically was significantly better in acute than chronic strictures. Surgical repair of esophageal mural strictures was more successful than repair of annular or mucosal strictures. One third of the horses with strictures were foals. Long-term survival for horses with strictures was 33%. Long-term survival was higher for the horses with perforations managed surgically (2 of 4) than nonsurgically (0 of 7). Long-term survival for this group was 18%. One esophageal diverticulum was managed nonsurgically, and four were treated surgically; all horses survived long term. Complications of obstructive esophageal disorders included aspiration pneumonia, chronic obstruction, esophageal mucosal ulceration, postoperative infection, pleuritis, laminitis, laryngeal paralysis, and Horner's syndrome.     

Esophageal disorders in 61 horses. Results of nonsurgical and surgical management

Obstructive esophageal disorders in 61 horses included feed or foreign body impaction (27 horses), strictures (18 horses), perforations (11 horses), and diverticula (5 horses). Horses with feed impaction were treated nonsurgically (25 horses) or by esophagotomy (2 horses). Survival to discharge was 78%, and 37% of these had persistent chronic obstruction at home. Long-term survival was 52%. Long-term survival of nine horses treated nonsurgically for esophageal strictures was 22%; for nine horses treated surgically it was 44%. Long-term survival of horses treated nonsurgically was significantly better in acute than chronic strictures. Surgical repair of esophageal mural strictures was more successful than repair of annular or mucosal strictures. One third of the horses with strictures were foals. Long-term survival for horses with strictures was 33%. Long-term survival was higher for the horses with perforations managed surgically (2 of 4) than nonsurgically (0 of 7). Long-term survival for this group was 18%. One esophageal diverticulum was managed nonsurgically, and four were treated surgically; all horses survived long term. Complications of obstructive esophageal disorders included aspiration pneumonia, chronic obstruction, esophageal mucosal ulceration, postoperative infection, pleuritis, laminitis, laryngeal paralysis, and Horner's syndrome.     

Balloon dilation of oesophageal strictures in two horses

Oesophageal strictures in 2 horses with chronic recurrent oesophageal obstruction or choke was diagnosed by endoscopy and contrast radiography. Balloon dilation of the strictures was performed under endoscopic and fluoroscopic guidance. Follow‐up endoscopic and radiological examinations performed 6 weeks after the procedure showed clear dilation of the strictures. Both horses did not have any recurrence during follow‐up periods of 10 and 12 months.     

Endoscopic balloon dilation of benign esophageal strictures in dogs and cats

Endoscopic balloon dilation of benign esophageal strictures was performed in 18 dogs and 10 cats with a median age of 4 years. Stricture formation was associated with a recent anesthetic episode in 18 patients. Regurgitation was the most common clinical sign and was present a median of 4 weeks before dilation. Most animals had a single stricture; median diameter was 5 mm, and median length was 1 cm. Esophagitis and mucosal fibrosis were detected in 9 patients each. Dilation was performed with progressively increasing diameter balloons, from 6 to 20 mm. After dilation, mucosal hemorrhage was mild to moderate in most patients. Esophageal perforation was the only serious complication and occurred in 1 patient. Postdilation therapy consisted of administration of cimetidine, metoclopramide, sucralfate, and prednisone in most animals. The median number of dilation procedures performed in each animal was 2, with a range of 1-5. The median interval between dilations was 13 days. Stricture diameter markedly increased with subsequent dilations. Median duration of follow-up was 131 weeks. A successful outcome occurred in 88% of patients, with most animals able to eat canned, mashed, or dry food without regurgitation. Mucosal fibrosis was associated with a better clinical response score, while increasing age was weakly associated with fewer dilations. The dilation protocol used in this group of animals was safe and efficacious.     

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.     

Intralesional corticosteroid injection in addition to endoscopic balloon dilation in a dog with benign oesophageal strictures

A three-year-old female spayed Golden retriever presented with a two-week history of regurgitation due to oesophageal stricture formation. Further diagnostics revealed two oesophageal strictures located at the thoracic inlet and caudal to the heart base, respectively. Endoscopic balloon dilation was performed four times at weekly intervals but recurrence of stricture formation was noted clinically within a few days after each procedure and was confirmed endoscopically. Finally, intralesional injection of triamcinolone acetonide was performed in combination with the fifth balloon dilation procedure. The dog recovered clinically and a final endoscopic examination performed 16 weeks after the injection did not reveal any evidence of oesophageal strictures.     

Endoscopic Balloon Dilation of Esophageal Strictures in 9 Horses

Background

Medical treatment of esophageal strictures in horses is limited and the use of balloon dilatation is described in few cases. Long‐term follow up after balloon dilatation and the use of intralesional corticosteroids has not been evaluated.

Objectives

To describe the use of endoscopic guided, esophageal balloon dilatation in horses for cervical and thoracic esophageal strictures and administration of intralesional corticosteroids at the time of dilatation.

Animals

Nine horses from the hospital population with benign esophageal strictures.

Methods

Retrospective study: Medical records were reviewed from horses presented to the William R. Pritchard, Veterinary Medical Teaching Hospital at UC Davis from 2002 to 2013. Records were searched using the key words: equine, horse, balloon dilatation, bougienage, and esophageal stricture.

Results

Nine horses with esophageal strictures were treated with esophageal balloon dilatation. Five horses survived (survival at writing ranged from 2 to 11 years after discharge) and all nonsurvivors were <1 year of age and presented with concurrent problems or developed complications including megaesophagus, unresolved esophageal obstruction requiring esophagostomy, or severe aspiration pneumonia. Four horses were treated with intralesional corticosteroids with no adverse effects noted in the survivors (n = 3). Four horses available for long‐term follow up were alive at 2, 5, 6, and 11 years after presentation and 3 of these horses were being fed a hay‐based diet.

Conclusions

Resolution of esophageal strictures in the horse can be performed successfully, safely, and under standing sedation using balloon dilatation. Intralesional corticosteroids might reduce the incidence of recurrent strictures.     

Double-balloon enteroscopy in two dogs

It is difficult to insert a flexible endoscope deep into the small intestine. A new method, double-balloon enteroscopy, has been developed to improve access to the small intestine, and the aim of this study was to evaluate its usefulness for examination of the small intestine of dogs. The method uses two balloons, one attached to the tip of the endoscope and another attached to the tip of an overtube. The double-balloon endoscope is advanced through the intestine by being held alternately by the balloon on the endoscope and the balloon on the overtube. The technique was applied in two dogs of medium size, using both oral and anal approaches, and it was possible to examine the whole surface of the mucosa of their small intestines.     

Treatment of experimental ureteral strictures by endourological ureterotomy and implantation of stents in the porcine animal model

The objective of this study is to evaluate the dilation of the ureter using endoureterotomy and an expanding-sheath double pigtail ureteral stent in the treatment of experimentally induced ureteral strictures in the porcine animal model. This is a new treatment in the ureteral strictures resolution in Veterinary Urology, although it is not a common affection, it usually appears as a consequence of ureteritis and in the iatrogenic female genital surgery. The experimental study is design in three phases: induction of experimental stricture, diagnosis and treatment of the stricture and follow-up. We have used 10 healthy Large White female pigs. The internal ureteral diameter was measured prior to laparoscopic ligature stricture induction using retrograde ureteropyelography (RUPG). Experimental stricture was diagnosed 4 weeks after intervention, using RUPG and ultrasound, and treated by endoureterotomy and subsequent placement of a double pigtail ureteral stent, which was removed 6 weeks later. The study finished 4 weeks later with measurement of ureteral diameters using RPUG and ultrasound evaluation. Except in one case, all ureters displayed permanent dilation of the strictured area for 10 weeks after treatment (6 weeks with ureteral stent and 4 more weeks without stent). Finally, this technique proved to be effective in cases of short-length and short-living ureteral strictures, and represents a viable alternative to conventional surgery in animals.     

Conservative treatment of acquired oesophageal strictures by endoscopic‐guided balloon dilation in two horses

Oesophageal stricture is an uncommon condition in horses that results in an obstructive syndrome with regurgitation of food and possible aspiration pneumonia. Currently, in both human and small animal practice, one of the preferred treatment options for oesophageal strictures consists of pneumatic or hydrostatic balloon dilation. The aim of this article is to report 2 cases of severe oesophageal stricture in the horse, successfully treated with endoscopic‐guided hydrostatic balloon dilation.     

Esophageal achalasia and secondary megaesophagus in a dog

A 5-year-old, castrated male, golden retriever was presented with a history of regurgitation. An esophagram revealed normal peristalsis with failure of the lower esophageal sphincter to open, supporting the diagnosis of esophageal achalasia. Prior to surgery, the dog developed megaesophagus. Heller's esophagomyotomy resolved the clinical signs and the esophageal dilation.     

Use of endoscopy for examination of the sacral epidural space in standing cattle

OBJECTIVE: To develop an epiduroscopic technique for use in standing cattle and describe the endoscopically visible anatomic structures of the epidural space in the sacrococcygeal area. ANIMALS: 6 healthy nonlactating, nonpregnant cows (mean +/- SD age, 60 +/- 18.5 months; mean weight, 599.7 +/- 63.87 kg) and 3 bovine cadavers. PROCEDURES: Cadavers were used to allow familiarization with the equipment and refinement of the technique. Following these experiences, procedures were performed in live animals. Each cow was restrained in a stock. After sedation with xylazine (0.03 mg/kg, IV), 2% lidocaine hydrochloride (0.25 mg/kg) was injected epidurally in the first intercoccygeal or the sacrococcygeal intervertebral space. By use of an introducer set (guidewire and dilation trocar and shaft), a flexible endoscope (length, 75 cm; diameter, 2.3 mm) was inserted through the dilation shaft into the epidural space. To obtain an optimal view, small amounts of air were insufflated into the epidural space through the working channel of the endoscope via a syringe with special filter. RESULTS: Anatomic structures of the epidural space that were viewed by means of the endoscopic procedure included blood vessels, connective tissue, fat, nerves, and the spinal dura mater. No adverse events were detected during epiduroscopy, and it was tolerated well by all 6 cows. CONCLUSIONS AND CLINICAL RELEVANCE: In ruminants, epidural structures can be viewed via endoscopy. Such epiduroscopic procedures may be useful in anatomic studies as well as for the diagnosis of disease or therapeutic interventions in ruminants.     

Endoscopic lithotripsy of a urinary bladder calculus with the aid of a holmium-YAG-laser in a gelding

A 6 year old Haflinger gelding was presented to the reporting clinics with a history of chronic dysuria. A large cystic calculus (12 x 9 x 9 cm) was diagnosed cystoscopically. Lithotripsy was carried out endoscopically in the standing, sedated patient with a Holmium:YAG surgical laser (2100 nm, 0.5-3.5 J/pulse, 3-60 pulses/sec.). The endoscope was inserted into the bladder via perineal urethrostomy. Fragmentation of the urolith was carried out with a laser fiber (core diameter 600 microns) in contact mode. Healing proceeded uneventfully. On follow up examination 8 weeks post surgery, no signs of recurrence, cystitis or strictures of the urethra were present.     

Surgical Correction of a Persistent Right Aortic Arch in a Foal

A persistent right fourth aortic arch causing esophageal stenosis was diagnosed in a foal. Presenting signs included cervical swelling that developed following introduction to solid feed at weaning, and symptoms of chronic aspiration pneumonia. The esophagus was distended at the thoracic inlet; neither an endoscope nor a small nasogastric tube could be passed through the strictured esophagus at the heart base. The esophagus was seen to be dilated to the level of the heart base on plain and contrast radiographs. A left lateral thoracotomy through the fifth intercostal space was used to gain access for surgical correction of the defect. Radiographic and clinical evaluation of the foal 2 and 6 months following surgery showed a gradual decrease in size of the esophageal dilatation and an enlargement in the functional diameter of the esophagus at the previously strictured area at the heart base. Ten months following surgery the colt was eating normally and was of normal height and weight.     

Videofluoroscopy,CT angiography,and ultrasonography of congenital esophageal stenosis in a Labrador retriever

A 7‐week‐old Labrador retriever presented for further investigation into acute onset regurgitation, following weaning from liquid to solid food. A videofluoroscopic swallow study demonstrated a severe, focal esophageal dilation in the mid‐cervical region, with marked luminal narrowing distally. Computed tomography with angiography revealed esophageal stenosis, extending from C4–T2, secondary to circumferential esophageal wall thickening. With the concern for development of secondary aspiration pneumonia, the owners elected to euthanize the dog and consented to postmortem examination. A diagnosis of segmental, cervical esophageal muscular hypertrophy was made on necropsy, consistent with the fibromuscular thickening type of congenital esophageal stenosis reported in humans.     

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.     

Ultrasonographic and histopathological features in 8 cats with fibrotic small intestinal stricture

Benign stricture is an uncommon cause of chronic small intestinal obstruction in the cat. The purpose of this retrospective case series was to describe the ultrasonographic features, histopathological findings, and clinical presentation in a group of cats with benign small intestinal stricture. Inclusion criteria were cats presenting during the period 2010‐2017, and that had ultrasonography and small intestinal stricture confirmed at surgery. For each cat, clinical data and ultrasonographic findings were retrieved from the medical record, and histopathology, where available, was reviewed. Eight cats met the inclusion criteria. The location of strictures was duodenum (1/8), mid‐ to distal jejunum (4/8), and ileum (3/8). Ultrasonographic findings included gastric distension (8/8) and generalized (3/8) or segmental (5/8) intestinal dilation consistent with mechanical obstruction. Ingesta did not propagate beyond the strictured segment. Wall thickening was mild to moderate (3‐6 mm). Normal wall layering was disrupted in all cats. Strictures were predominantly hypoechoic (7/8) and associated with hyperechoic peri‐intestinal mesentery (6/8). Annular strictures (5/8) were less than 15 mm in length whereas long‐segment strictures (3/8) were greater than 15 mm in length. Histopathology showed transmural disease with fibrosis and inflammation (8/8), often (6/8) extending into the bordering mesentery. The mucosa was the most severely affected layer and epithelial injury accompanied the mucosal fibrosis/inflammation. Clinical presentation reflected delayed diagnosis of chronic bowel obstruction with debilitation (8/8), marked weight loss (8/8), and prerenal azotemia (5/8). Benign fibrostenotic stricture should be considered a differential diagnosis in debilitated young cats presenting with chronic bowel disease and ultrasonographic features of intestinal obstruction.