Gastric dilatation volvulus in dogs is an acute and potentially fatal condition of uncertain etiology that results from a gastric malposition; it primarily affects largeand giant-breed dogs. Risk factors for developing GDV include breed, age, rapid eating, nervousness, and having a first-degree relative with a history of GDV.1–3 The condition is considered an emergency and requires immediate surgical intervention. In dogs, estimates of GDV-associated mortality rate range from 15% to 43%.4–6 Early recognition of the condition combined with rapid gastric decompression, appropriate treatment for hypovolemic shock and reperfusion injury, and management of cardiac dysrhythmias decreases the risk of death associated with the disease.4–6 If untreated, intragastric pressure will increase and, in turn, often result in cardiogenic shock and eventual death. Medical treatment alone is inadequate, and as many as 81% of affected dogs die within a year of initial treatment if surgery is not performed.7,8 Additionally, during the surgical procedure to reposition the stomach, it is necessary to permanently affix the stomach to the body wall with one of several available gastropexy techniques to prevent recurrence. Failure to perform a gastropexy at the time of surgery results in a recurrence rate > 50%; when a gastropexy is performed, the recurrence rate is 6% to 10%.7,9,10 Given the unacceptably high risk of recurrence without gastropexy, it is considered the standard of care to perform that procedure at the time of surgical treatment of GDV.8 The lifetime risk of certain predisposed dogs to develop GDV has been estimated to be 4% to 37%.8 Because GDV is such a serious disease and a certain subset of dogs are predisposed to the disease, the recommendation of many veterinarians is that gastropexy should be performed prophylactically in predisposed breeds.10–15
As with surgery in humans, veterinary surgery has slowly made progress toward developing minimally invasive surgical techniques to decrease postoperative complications such as pain, hospitalization time, incision size, and inflammation.16–18 Typically, techniques used to perform gastropexies during emergency surgeries are also used for prophylactic gastropexies. These procedures have the inherent disadvantage of requiring a relatively large laparotomy. To date, there are few less-invasive alternative methods of performing a gastropexy currently available to veterinarians; these include a grid gastropexy and a laparoscopically assisted gastropexy. However, both of these procedures are relatively time consuming and the laparoscopically assisted gastropexy requires a considerable amount of instrumentation.12,13,19–21
By use of endoscopically assisted gastropexy, veterinarians can potentially perform an otherwise invasive procedure in a shorter period of time, compared with that required for other gastropexy procedures. The development of such a procedure would establish a quick, inexpensive, repeatable, and minimally invasive method of performing a prophylactic gastropexy. This technique would also have the advantage of requiring less equipment in contrast to that required for currently used gastropexy procedures. The purpose of the study reported here was to evaluate the use of endoscopy in conjunction with the gastropexy technique in dogs as a potential aid in prevention of GDV.
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