Page 2243 - Cote clinical veterinary advisor dogs and cats 4th

1116 Foreign Body Removal, Esophageal (Endoscopic)

results in dislodging the object, another warrants close radiographic and clinical
attempt can be made to retrieve it. monitoring.
VetBooks.ir cuffed catheter (e.g., Foley catheter) can Postprocedure
○ With smooth, round foreign bodies, a
• If esophageal mucosa is damaged (suspected
be passed past the object, the cuff inflated
on the aboral side, and the catheter used
for pulling the object toward the mouth. on endoscopic observation of darkened/
discolored esophageal mucosa, deep mucosal
○ Fishhooks embedded in the mucosa can be lacerations, or after prolonged, difficult
removed if the tip can be grasped and the procedure; confirmation radiographically)
hook gently pulled through the mucosa. ○ Lacerations that do not extend through
Fishhooks that penetrate the wall must the full thickness of the esophageal wall
be removed surgically. The surgeon cuts can be left to heal by epithelialization.
the protruding tip, and the endoscopist ○ Full-thickness tears and necrosis require
removes the endoesophageal section, immediate surgical intervention.
thereby avoiding the need to cut into • Withhold food and water for 24 hours.
the esophagus. • Maintain hydration and electrolyte balance.
○ If retrieval is not possible, an attempt • Pain management, antibiotics (as described),
could be made to push the foreign body prokinetic agents, glucocorticoids, and/or
into the stomach. gastric antacids may be indicated (p. 380).
○ The esophageal mucosa is carefully • Gastrostomy feeding tube is placed distal
FOREIGN BODY REMOVAL, ESOPHAGEAL examined endoscopically after removal to the site of the foreign body if pro-
(ENDOSCOPIC) Polypectomy snare used to retrieve of the foreign body. longed withholding of food is indicated
a palm seed. • Rigid proctoscope technique (p. 1109).
○ Lubricate proctoscope. • After recovery, introduce liquids, followed
○ Pass the proctoscope into the esophagus by gruel if no adverse reactions are noted
to the level of the foreign body, visualizing after liquids have been introduced.
• Insert mouth gag/speculum. the foreign body and assessing the integrity
• Flexible fiberoptic endoscope technique: of the surrounding esophagus. Alternatives and Their
○ For medium-size or larger dogs, a rigid ○ Lubricant can be placed at the site of Relative Merits
lubricated stomach tube can be placed the foreign body, using a polyethylene • Advancement of foreign body into stomach
to assist in dilating the esophagus. catheter. followed by gastrotomy
The endoscope is passed through this ○ Using grasping forceps, the foreign ○ Sharp objects and objects such as toys
tube. body is brought close to the end of the should not be pushed into the stomach
○ Lubricate the endoscope. proctoscope. (risk of esophageal perforation). Follow-
○ Pass the endoscope to the level of the ○ If the foreign body is small enough, up radiography is advised to ensure that
foreign body, visualizing the foreign body it can be pulled into the lumen of the foreign bodies were digested or passed
and assessing the integrity of the adjacent proctoscope. through the digestive tract.
esophagus. ○ The foreign body, proctoscope, and • For cases in which esophageal perforation and
○ Insufflation of air will allow dilation of grasping forceps are pulled out together its complications have already developed (p.
the esophagus around the foreign body. by gentle manipulation and traction and 309), surgical removal of the foreign body
This may be useful in dislodging foreign with adequate lubrication. by thoracotomy is the only alternative.
bodies such as bones that are embedded ○ Continuous visualization and gentleness of • Fluoroscopy-guided removal with balloon
in the esophageal wall. traction are essential to ensure that com- extraction or forceps manipulation
○ Lubrication can be placed at the site of the plications such as esophageal laceration ○ Disadvantages: not freely available in prac-
foreign body, using a catheter or feeding or perforation are noticed immediately tice; lack of post-procedure visualization
tube. and that retrieval can be stopped and the of esophageal mucosa
○ A retrieval instrument is passed through foreign body repositioned or the procedure
the endoscope operating channel. aborted. Pearls
○ Grasp or snare the foreign body, and pull ○ If retrieval is not possible, an attempt could • Preferred method makes use of flexible
it close to the endoscope. be made to gently push the foreign body endoscopes.
○ The endoscope, forceps, and foreign body into the stomach using a well-lubricated • The use of biopsy forceps is discouraged
are gently pulled out together through the stomach tube, provided no evidence because damage to the instrument is possible.
mouth while ensuring adequate esophageal of esophageal devitalization (e.g., deep
dilation and lubrication. mucosal lacerations and discolorations, SUGGESTED READING
○ In cases where an overtube was inserted, other signs of possibly imminent perfora- Tams TR, et al: Endoscopic removal of gastrointestinal
an attempt is made to pull the foreign tion) are seen and the foreign body does foreign bodies. In Tams TR, et al, editors: Small
body into the tube, preventing it from not have pointed or sharp protrusions on animal endoscopy, ed 3, St. Louis, 2011, Mosby,
causing damage during removal. its surface. 228-248.
○ If the foreign body is lodged and cannot ○ Careful examination of the esophageal AUTHOR: Mirinda Nel van Schoor, BVSc, MMedVet
be retrieved easily, an attempt could be wall after foreign body removal; any sus- EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
made to rotate it gently. If the maneuver picion of possible esophageal perforation Thompson, DVM, DABVP

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