Benign esophageal strictures in dogs and cats are uncommon. They most often arise secondary to esophagitis and are usually associated with gastroesophageal reflux during anesthesia or vomiting of gastric contents. Benign esophageal strictures also occur secondary to esophageal foreign body or other traumatic event to the esophagus. Stricture formation occurs when inflammation extends into the submucosal and muscular layers of the esophagus and stimulates production of fibrous connective tissue. [1] Stricture formation results in frequent regurgitation and malnutrition.
Diagnosis of Esophageal Strictures
Diagnosis is confirmed by a barium contrast esophagram, contrast assisted fluoroscopic barium swallow, or direct visualization with esophagoscopy.
Treatment of Esophageal Strictures
A variety of techniques have been used to address these strictures when they occur. In the past, various stents have been developed to be deployed in the esophagus to try and prevent stricture reformation. On the whole these have been met with disappointing results and are currently not employed as a common practice in management of these strictures.
Bougienage, the passage for sequentially larger rods or bougies through the stricture to break it down, has been largely replaced by esophageal balloon dilation which are thought to be safer and more effective than bougienage.
Studies have been published using both fluoroscopically-assisted balloon dilation and balloon dilation under direct endoscopic guidance [1-2]. Endoscopic is likely the more commonly performed technique due to the fact there is greater access to endoscopic equipment than there is fluoroscopy. And while there is no consensus as to which technique is more effective, recently released information argues that fluoroscopically-assisted balloon dilation is a more effective technique than endoscopically assisted balloon dilation alone.[3]
Regardless of the technique used, it is not uncommon for multiple (>10 in some cases) anesthetic events and dilation procedures be necessary to treat the stricture. Even then, most patients never regain normal esophageal function and will therefore still require special diets or feeding techniques to minimize regurgitation.
Recently a, one-stage esophageal balloon dilation feeding tube (B-tube) has been developed to decrease the amount of balloon dilation procedures needed and provide adequate nutrition during the treatment process. The B-Tube is a non-compliant esophageal balloon dilation device mounted on a commercially available and commonly used esophageal feeding tube. Once a traditional balloon dilation has been performed this tube is placed and, once calibrated, allows the pet owner to inflate the balloon in an a- home setting twice a day to prevent the reformation of the stricture. [4]
Initial results in both dogs and cats have been promising and may provide a way to prevent the multiple procedures often necessary to treat this condition with traditional balloon dilatation techniques. The B-Tube is typically removed approximately four to six weeks later, often under general anesthesia, for repeat esophagoscopy to confirm stricture resolution but can be removed in the awake patient.[4]
At MedVet Columbus, as well as many other MedVet locations, we can perform both endoscopically-assisted and fluoroscopically-assisted balloon dilation for management of esophageal strictures in both dogs and cats. We also currently stock variety off B-tube sizes for placement and use in the management of esophageal strictures. Should you have a question about these treatment options, we encourage you to call.
References
- Leib MS, et. al. Endoscopic Balloon Dilation of Benign Esophageal Strictures in Dogs and Cats. J Vet Int Med. 2008;15:547-552.
- Harai BH, Johnson SE, Sherding RG.Endoscopically Guided Balloon Dilatation of Benign Esophageal Strictures in 6 Cats and 7 Dogs. J Vet Int Med. 1995;9:332-335
- Weisse C. Advancements in Esophageal Strictures: Bougies, Balloons, Stents, and B-Tubes. In: Seattle: American College of Veterinary Internal Medicine Forum Proceedings; 2018.
- Weisse, C, Berent, A. Esophageal Balloon-Dilation Feeding Tube (BE-Tube) Instructions For Use. Retrieved from https://www.milainternational.com/media/wysiwyg/BE_Tube_IFU.pdf
