Congenital esophageal stenosis in a Labrador retriever.

A 1-year-old neutered male Labrador retriever was presented for investigation of chronic regurgitations that had started at weaning. Contrast radiographs and fluoroscopy of the thorax identified a focal narrowing of the proximal intrathoracic esophagus. Examination with CT-angiography excluded extraluminal causes for the narrowing, e.g., vascular ring anomaly. Esophagoscopy revealed the presence of a muscular stenosis with the appearance of a sphincter at the level of the proximal intrathoracic esophagus, without evidence of stricture. A diagnosis of congenital esophageal stenosis was made, suspected secondary to fibromuscular hypertrophy. Regurgitation resolved with conservative management and the dog was well at a 2-year follow-up examination. This case represents one of few small animal cases of congenital esophageal stenosis reported and apparently the only case successfully managed conservatively. Key clinical message: This report describes the clinical presentation, diagnostic imaging findings, and treatment of a rare case of congenital esophageal stenosis in a Labrador retriever. Medical and conservative therapies alone may be sufficient for treatment of congenital esophageal stenosis depending on presentation and suspected histopathological type. These therapies should be considered before initiating interventional procedures.

Sténose congénitale de l'oesophage chez un Labrador retriever. Un Labrador mâle castré âgé de 1 an a été présenté pour une investigation de régurgitations chroniques qui avaient commencé au sevrage. Les radiographies de contraste et la fluoroscopie du thorax ont identifié un rétrécissement focal de l'oesophage intrathoracique proximal. L'examen par tomodensitométrie-angiographie a exclu les causes extraluminales du rétrécissement, c'est-à-dire une anomalie de l'anneau vasculaire. L'oesophagoscopie a révélé la présence d'une sténose musculaire avec apparition d'un sphincter au niveau de l'oesophage intrathoracique proximal, sans signe de rétrécissement. Un diagnostic de sténose congénitale de l'oesophage a été posé, en raison d'une suspicion d'hypertrophie fibromusculaire. La régurgitation s'est résolue avec une gestion conservatrice et le chien allait bien lors d'un examen de suivi à 2 ans. Ce cas représente l'un des rares cas de sténose congénitale de l'oesophage rapportés chez les petits animaux et apparemment le seul cas traité avec succès de manière conservatrice.Message clinique clé :Ce rapport décrit la présentation clinique, les résultats de l'imagerie diagnostique et le traitement d'un cas rare de sténose congénitale de l'oesophage chez un Labrador. Les thérapies médicales et conservatrices seules peuvent être suffisantes pour le traitement de la sténose congénitale de l'oesophage en fonction de la présentation et du type histopathologique suspecté. Ces thérapies doivent être envisagées avant d'entreprendre des procédures interventionnelles.(Traduit par Dr Serge Messier).

IMAGING DIAGNOSIS-USE OF RADIOGRAPHY, COMPUTED TOMOGRAPHY, AND ENDOSCOPY IN THE DIAGNOSIS OF ESOPHAGEAL PERFORATION BY AN EXTRA-LUMINAL TRACHEAL RING PROSTHESIS IN A GOLDEN RETRIEVER.

A 6-year-old neutered male, Golden retriever presented with regurgitation and excitement-induced coughing. Two years prior, extra-thoracic tracheal collapse was diagnosed and extra-luminal tracheal ring prostheses were placed. Radiographs at presentation showed mineralized and undulant cervical tracheal cartilages. A dorsally broad-based soft tissue opacity bulged into the caudal cervical tracheal lumen. Esophageal dysmotility and barium accumulation were identified at this level on contrast esophography. Computed tomography showed migration of a prosthetic tracheal ring, resulting in perforation of the esophagus. Hair, foreign material, and dynamic tracheal narrowing were identified on esophagoscopy and tracheoscopy, respectively. Esophagostomy and foreign body removal were performed.

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.

Diagnostic fluoroscopique et endoscopique d'un anneau œsophagien inférieur causant la surcharge d'un corps étranger chez un chien. Un chien a été présenté en raison de régurgitation pendant une période de 3 jours. L'examen radiographique a révélé un défaut en forme de haricot et un rétrécissement annulaire au niveau du sphincter gastro-œsophagien. La structure contractile en forme d'anneau présentait une délimitation marquée et son apparence variait selon la distension gastro-œsophagienne. Les résultats de l'endoscopie ont révélé un anneau œsophagien inférieur et la surcharge d'un corps étranger.(Traduit par Isabelle Vallières).

Thoracoscopy with Concurrent Esophagoscopy for Persistent Right Aortic Arch in 9 Dogs.

OBJECTIVE: To report the diagnosis, treatment, and short-term outcome in dogs with suspected persistent right aortic arch (PRAA) undergoing thoracoscopy with concurrent esophagoscopy. STUDY DESIGN: Multi-institutional retrospective case series. ANIMALS: Dogs with suspected PRAA (n=9). METHODS: Medical records were reviewed from 2012 to 2016. Dogs undergoing thoracoscopy for PRAA at 3 referral hospitals were included. Signalment, clinical signs, diagnostic imaging, anesthesia protocol (including the use of one-lung ventilation), surgical approach, complications, and short-term outcome were recorded. Dogs underwent a left-sided intercostal thoracoscopic approach with concurrent intraoperative esophagoscopy. The ligamentum arteriosum (LA) and constricting fibers were divided using a vessel-sealing device using a 3 or 4 port thoracoscopy technique. Visualization and dissection of the LA was aided by transesophageal illumination by esophagoscopy. RESULTS: Thoracoscopy confirmed PRAA in 9 dogs, with an aberrant left subclavian artery (LS) identified in 5 dogs. Major complications occurred in 2 dogs: postoperative hemorrhage from the LS and esophageal perforation, which resulted in euthanasia. Median follow-up was 250 days (range, 56-1,595). Regurgitation resolved in 4 of 8 surviving dogs. One dog had recurrence of regurgitation 1,450 days postoperatively, esophageal compression by the LS was identified, and regurgitation resolved following LS transection. CONCLUSION: Esophagoscopy aided identification and dissection of the LA in all cases. Due to the potential for the LS to cause clinical esophageal constriction postoperatively, a recommendation for LS transection may be warranted. Vascular clips can also be considered as an alternative for vessel ligation to avoid complications associated with vessel-sealing device use.

Upper esophageal incompetence in five horses after prosthetic laryngoplasty.

OBJECTIVE: To describe a complication observed endoscopically in horses after prosthetic laryngoplasty (LP). STUDY DESIGN: Case series. ANIMALS: Horses (n = 5) that had previous LP. METHODS: Four horses had endoscopic examination as part of a larger prospective study and had saliva emanating from their upper esophageal opening. One other horse was referred with clinical signs of severe upper esophageal obstruction 2 months after LP. RESULTS: Four horses were observed to have saliva emanating from their upper esophageal opening during endoscopic examination 21-58 months after LP. Esophageal reflux was noted endoscopically at rest (n = 1) and during exercise (4). All 5 horses were reported to cough postoperatively, and 2 horses coughed severely when eating. On necropsy, the horse referred with signs of esophageal obstruction had dilation of the proximal esophagus associated with food impaction and had fibrosis and thickening of the left cricopharyngeus and thyropharyngeus muscles. CONCLUSIONS: Iatrogenic damage to the caudal pharyngeal constrictor muscles, the intrinsic musculature of the upper esophagus, or their innervation, or damage to the peri-esophageal fascia or esophageal adventitia may cause upper esophageal incompetence in horses after LP.

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.

Trans-oral endoscopie pour retirer un corps étranger oesophagien ou ruminal chez 5 veaux Holstein. L'extraction d'un corps étranger oesophagien ou ruminale a été effectuée par endoscopie à l'aide d'un lassot ou d'un panier endoscopique (Dormi) avec succès chez cinq veaux de race Holstein, sous sédation ou anesthésie générale. Ce rapport de cas décrit les manipulations endoscopiques, les traitements et le pronostic suite à l'extraction endoscopique du corps étranger chez ces veaux.(Traduit par les auteurs).

Oesophageal foreign bodies in dogs.

The aim of the paper is to present own experience in diagnosis and endoscopic removal of foreign bodies from the oesophagus in dogs. The study was performed on 22 dogs of different breed and sex, aged 7 months to 17 years, with suspicion of a foreign body in the oesophagus. All the dogs were subjected to a radiography of the oesophagus and oesophagoscopy. The most commonly observed clinical signs were regurgitation and swallowing disorders. The best diagnostic method allowing detection of foreign bodies in the oesophagus was esophagoscopy.

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.

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.

[Endoscopy in cattle]. / Endoskopie beim Rind.

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.

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.

Risk factors and outcome of bougienage for treatment of benign esophageal strictures in dogs and cats: 28 cases (1995-2004).

OBJECTIVE: To determine outcome of bougienage for treatment of benign esophageal stricture (BES) in dogs and cats and identify risk factors for the condition. DESIGN: Retrospective case series. ANIMALS: 20 dogs and 8 cats with BES. PROCEDURES: Medical records were reviewed for information on signalment, clinical features, and outcome. Long-term outcome information was obtained with a questionnaire. RESULTS: Esophageal bougienage was performed with dilators ranging from 5 to 15 mm in diameter; median numbers of bougienage procedures were 3 (dogs) and 4.5 (cats). A good outcome, defined as tolerance of solid food with regurgitation less than once a week, was achieved in 14 dogs and 6 cats. Complications were minimal, with nonfatal esophageal perforation occurring in 1 cat. Four dogs and 1 cat were euthanized or died because of esophageal disease. Dogs with BES were more likely to be female, have a recent history of general anesthesia, have received an antimicrobial orally, or have a history of vomiting than were dogs in a reference population. Cats with BES were more likely to have a recent history of general anesthesia, vomiting, or gastrointestinal tract trichobezoars than were cats in a reference population. Doxycycline-induced esophagitis was the suspected cause of BES in 3 cats. Although general anesthesia was associated with development of BES in 18 dogs and 5 cats, concurrent potential causes of esophageal injury were common. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that esophageal bougienage was a safe and effective treatment for most dogs and cats with BES, with outcomes similar to those reported for balloon dilation.

Nonsurgical treatment of gastroesophageal intussusception in a puppy.

A 7-week-old, female Siberian husky was presented to Murdoch University Veterinary Hospital with an acute onset of respiratory distress and regurgitation. Thoracic imaging identified an intraluminal esophageal mass with concurrent aspiration pneumonia. Esophagoscopy identified the mass as stomach, and a diagnosis of gastroesophageal intussusception was made. The intussusception was reduced endoscopically, and fixation of the stomach to the abdominal wall was performed using a tube gastropexy. Gastroesophageal intussusception is an uncommon disease in small animals and traditionally has been managed surgically. This case report describes an alternative method of treatment associated with a good outcome in this puppy.

Esophageal diverticulum associated with a trichobezoar in a cat.

A 9-year-old, castrated male, domestic longhaired cat was evaluated for persistent regurgitation over the previous month. The cat had presented 9 months earlier and was diagnosed with esophageal obstruction secondary to a trichobezoar. The trichobezoar had been removed endoscopically, and the cat was subsequently fed a canned prescription diet. The owners noted only infrequent regurgitation over the following 9 months. After signs recurred, contrast radiography with fluoroscopy revealed an esophageal diverticulum at the thoracic inlet, with an ovoid filling defect. Decreased esophageal motility was noted distal to the diverticulum. Esophagoscopy confirmed the presence of a trichobezoar within an esophageal diverticulum. Following removal of the trichobezoar and therapy to prevent trichobezoar formation, the cat did well for 2 months until it died suddenly with signs of hyperventilation and open-mouth breathing.

Primary esophageal squamous cell carcinoma in a cat.

Primary esophageal squamous cell carcinoma causing stricture was diagnosed in a cat via endoscopy and computed tomography. Difficulty in making this diagnosis via endoscopic biopsy alone is described. Although balloon dilatation was unsuccessful, supportive care via gastrostomy tube feeding and administration of piroxicam successfully allowed a 16-week survival from the time of presentation and a 4-week survival from the onset of treatment with piroxicam.

Esophageal stricture in a cougar (Puma concolor).

A 7-mo-old female cougar (Puma concolor) was presented with a 2-wk history of anorexia and a 1-wk history of regurgitation. Barium contrast esophagogram and gastroesophagoscopy revealed the presence of a segmental intraluminal esophageal stricture in the middle third of the esophagus. The stricture was potentially secondary to a previous anesthetic episode. Three endoscopic balloon dilations allowed increasing the luminal diameter to a size that enabled the cougar to eat food softened with water without any signs of discomfort or regurgitation. Two months after being discharged, the cougar was doing well, had gained weight and was eating horsemeat softened with water.

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.

Retrospective evaluation of factors associated with degree of esophagitis, treatment, and outcomes in dogs presenting with esophageal foreign bodies (2004-2014): 114 cases.

OBJECTIVE: To characterize a population of dogs presenting for esophageal foreign body removal and evaluate factors associated with degree of esophagitis and minor and major complications. DESIGN: Retrospective evaluation of dogs who presented for esophageal foreign body removal between January 2004 and December 2014. SETTING: University veterinary teaching hospital. ANIMALS: Data collected from 114 dogs included signalment, history, clinical signs, physical examination findings, duration and location of foreign body, degree of esophagitis, foreign body removal success, feeding tube placement, and clinical outcomes. Owners were contacted for outcome data not available in the medical record. Data were analyzed for breed predispositions, whether duration or type of foreign body was associated with degree of esophagitis or complications, and factors associated with feeding tube placement. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The overall success rate for foreign body removal via esophagoscopy was 95% with a complication rate of 22%. Small breed dogs were overrepresented. Dogs with a foreign body present for >24 h were significantly more likely to have severe esophagitis (P < 0.001) and major complications (P = 0.0044). Foreign body type did not predict degree of esophagitis or complications, though fishhooks were more likely to require surgical removal (P = 0.033). Feeding tubes (15 gastrostomy, 1 nasoesophageal) were placed in 14% of dogs and were more likely to be placed if the foreign body had been present for >24 h (P < 0.001). CONCLUSIONS: Consistent with previous studies, esophageal foreign bodies, appropriately identified and endoscopically removed, carry a good prognosis, particularly if they have been present for ≤24 h.

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.

Esophageal foreign body obstruction caused by a dental chew treat in 31 dogs (2000-2006).

OBJECTIVE: To evaluate the signalment, clinical signs, diagnosis, treatment, and outcome associated with esophageal obstruction caused by a dental chew treat in dogs. DESIGN: Retrospective case series. ANIMALS: 31 dogs. PROCEDURES: Medical records were contributed from 19 hospitals via responses to a questionnaire that was developed for veterinarians who managed the cases. RESULTS: Esophageal obstructions with the dental chew treat occurred primarily in small dogs (26/31 [83.9%]). The most common clinical signs were gagging, regurgitation, vomiting, anorexia, and lethargy. Diagnosis was usually made via survey thoracic radiography. Obstructions were most commonly located in the distal portion of the esophagus (23/31; 74.2%). Esophageal lesions were moderate or severe in 86.7% (26/30) of the dogs. Orad endoscopic removal of the foreign bodies was uncommon (8/31 [25.8%]); most were pushed into the stomach. Thoracotomy was necessary in 6 dogs. Esophageal strictures developed in 6 of 25 (24%) dogs that survived initial hospitalization. Overall mortality rate was 25.8%. CONCLUSIONS AND CLINICAL RELEVANCE: Esophageal obstructions with a dental chew treat were difficult to remove orally via endoscopy, resulted in moderate or severe esophageal damage, frequently were associated with stricture formation, and were associated with a high mortality rate.