Esophageal and Gastric Endoscopic Foreign Body Removal: Complications and Long-Term Follow Up of 102 Dogs
Division of Small Animal Internal Medicine from the Vetsuisse Faculty of the University of Bern
Esophageal and gastrointestinal foreign bodies (FB) are a relatively common problem in dogs. The purpose of this study was to investigate complications and long-term follow up of endoscopic FB removal in a large case number.
A total of 114 FB were endoscopically removed between 03/2001 and 11/2006. Six dogs were excluded due to FB in the nose (N=4) or lung (N=2). In the remaining 108 dogs, the FB was located in the esophagus (N=60), the stomach (N=38), or both (N=10). Thoracic radiographs were diagnostic for esophageal FB in all cases, whereas abdominal radiographs were diagnostic for gastric FB in 46/48 cases. The duration of clinical signs before presentation ranged from 2 hours to 40 days (51 dogs < 1 day, 20 1-3 days, 31 > 3 days, 6 not known). Only 18 dogs were known to have ingested foreign material at the time of presentation.
West Highland White Terrier (11/108), Yorkshire Terrier (9/108) and Bernese Mountain Dogs (9/108) were overrepresented compared to the hospital population. The most frequent clinical signs reported were vomiting (38%), retching/gagging (29%), cough and dyspnea (18%), anorexia (14%), and regurgitation (10%). Bony material accounted for 47% of the FB, followed by plastic (15%), metal (10%) and greenies (7%). Six dogs with esophageal FB underwent fluoroscopy due to contrast medium in the esophagus and were excluded. In the remaining 102 cases, endoscopy alone was successful in 92 dogs (90%) and a gastrotomy, but no esophagotomy, was required in 10 dogs.
Eight dogs (7.8%) had perforations (5 esophagus, 3 stomach), most commonly associated with bony FB (6/8). Four dogs died (3.9%) due to pneumothorax and cardiac arrest (2), respiratory arrest (1), or esophageal diverticle with sudden death (1), whereas 2 dogs were euthanized with pleural effusion and pneumothorax (1) or mediastinitis (1). Two dogs had aspiration pneumonia, whereof one required thoracotomy due to a periesophageal abscess. Only 1 dog developed an esophageal stricture and underwent successful endoscopic balloon dilations. Long term outcome was available for 75/96 patients, whereof only 4 (5.3%) showed some coughing and retching a few days after discharge. Eight dogs died due to unrelated problems and 2 had another FB later on.
In conclusion, this study further supports the use of endoscopic FB removal. Even though the overall complication rate is low, potentially life-threatening complications may develop. Clinical signs for more than 1 day prior to endoscopy is associated with increased morbidity.