Esophageal foreign body entrapment is fairly common in dogs and occurs occasionally in cats. This difference in frequency has been attributed to the more indiscriminate eating habits of dogs. Studies1–5 have shown that bones are the most common EFB (47% to 100%) in dogs, and other entrapped objects include toys, wooden sticks, fishhooks, and food material.
Clinical signs vary with size, location, and duration of the entrapment. The most common clinical manifestations are hypersalivation, retching, gagging, vomiting, regurgitating, signs of pain, respiratory distress, and restlessness.6,7 Chronically affected dogs may remain bright and alert but lose weight and have periodic bouts of regurgitation and inappetence. Sharp or chronic EFB entrapment can result in esophageal perforation, pneumomediastinum, pneumothorax, mediastinitis, pleuritis, pyothorax, mediastinal abscess, esophageal diverticulum formation, or bronchoesophageal or tracheoesophageal fistulas, with resultant pyrexia, depression, and respiratory distress.4,7,8–11 Respiratory distress may also be associated with aspiration pneumonia or impingement of the EFB on the upper airway.
Esophageal foreign bodies most commonly lodge at the thoracic inlet, heart base, and caudal esophageal region, where extraesophageal structures restrict esophageal dilation. Retrospective case series4,14 have revealed that EFB entrapments in canine referral patient populations are most commonly located between the heart and diaphragm (58% to 88%) and over the base of the heart (12% to 29%), and less commonly located in the cervical region (13% to 14%). On the other hand, a case series7 revealed that 41% of dogs in a non-referral population had cervical EFB entrapment. This difference in findings between populations suggests that patients with more complicated and distally located EFBs are likely referred to secondary or tertiary centers for treatment. Type of EFB may also influence site of the entrapment, with the pharyngeal portion of the esophagus (34%) and heart base (30%) being the most common sites for fishhooks, and with the thoracic inlet and caudal esophageal region being less common sites (11% and 5%, respectively) in a case series.3
Endoscopic retrieval of the EFB is the recommended initial noninvasive treatment option for affected dogs. Reported success rates for retrieval or pushing of the digestible material into the stomach range from 65% to 92%.2,4,12,15 Balloon catheter–assisted removal, by which the balloon tip is passed distal to the EFB and inflated to allow traction of both the catheter and EFB, has also been described.16 Surgical intervention is recommended in situations in which endoscopic retrieval is unsuccessful or substantial perforation of the esophagus is identified.
The veterinary literature1,2,15,17 indicates complication rates ranging from 15% to 22% for EFB removal from dogs. Reported short-term complications associated with EFB include esophagitis, perforation, aspiration pneumonia, pyothorax, pneumothorax, pneumoperitoneum, pneumomediastinum, mediastinitis, pleuritis, abscess formation, and damage to the adjacent organs.2,8,17–19 Esophageal stricture, diverticulum formation, esophageal fistula, and mediastinal abscess formation are reported longer-term complications.8,13,20 These complications typically require medical or surgical intervention, increase morbidity and mortality rates, and may affect the final outcome. Esophageal stricture is the most commonly encountered longer-term complication.
Despite the use of dilatory procedures, such as ballooning or bougienage and medical management, 10% to 30% of animals with esophageal stricture reportedly die or are euthanatized and approximately 15% to 30% must be maintained on slurry diets.21–25 A negative association between duration of clinical signs and complications has been shown in previous studies.2,15 The objective of the study reported here was to identify factors that could predict the need for surgical intervention, complications, and outcome in dogs with an EFB.
The authors thank Gabrielle Monteith for assistance with statistical analyses.
Esophageal foreign body
GIF 130, GIF P140, or GIF XP160, Olympus America Co, Melville, N Y.
SAS, version 9.3, SAS Institute, Cary, NC.
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