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310 Esophageal Stricture (Benign)

Analysis of pleural effusion, if present (p. 1 mg/kg IV q 12-24h) to decrease gastric complications and is specifically influenced
acid production
1164): cytologic analysis of fluid and bacterial ○ Motility agents (metoclopramide 0.2- by the presence or absence of
VetBooks.ir anaerobic) 0.5 mg/kg SQ or PO q 6-12h or cisapride • Development of pyothorax
• Mediastinitis/mediastinal abscess formation
culture and susceptibility testing (aerobic and
• Development of esophageal stricture
0.1-1 mg/kg PO q 8-12h) to promote
normal gastroesophageal sphincter tone
TREATMENT
(reduce gastroesophageal reflux and PEARLS & CONSIDERATIONS
Treatment Overview esophagitis) and gastric emptying
Treatment approach depends on the location • Nutritional support until esophagus has Comments
of the perforation and the severity of associated healed and normal function has returned: Endoscopic evaluation and removal of
problems. Surgical intervention other than percutaneous endoscopic gastrostomy (PEG) esophageal foreign bodies must be performed
abscess drainage may or may not be indicated feeding tube (p. 1109) to bypass esophagus, carefully, with special attention paid to the
for cervical perforation, but it is required for all typically for 10-14 days patient’s ventilatory pattern, oxygen saturation,
thoracic perforations to avoid life-threatening heart rate, and blood pressure. Insufflation of
consequences associated with leakage of con- Chronic Treatment the esophagus with air in the presence of a
tents (e.g., pyothorax). Nutritional support that Treatment of pyothorax (p. 857): long-term perforation can lead to tension pneumothorax
bypasses the damaged esophagus is essential antibiotic therapy, based on accurate identifica- and acute cardiopulmonary compromise of
after medical or surgical management, as is tion of organism(s) involved. Up to 3 months anesthetized patients.
medical management of esophagitis to reduce of therapy may be required.
the risk of stricture formation. Prevention
Possible Complications Do not let dogs and cats eat foreign objects
Acute General Treatment • Dehiscence of esophageal repair causing that have the potential to become lodged in
• Correction of fluid and electrolyte deficits recurrent leakage the esophagus.
• Antimicrobial therapy • Esophageal diverticulum formation secondary
○ Empiric therapy using an antibiotic with a to the presence of a foreign body Technician Tips
broad spectrum of aerobic activity, such as • Esophageal stricture formation secondary • Post-treatment nutritional support by PEG
cefazolin 22 mg/kg IV q 6h or ampicillin- to damage caused by foreign body, surgical tube feeding is necessary for these patients
sulbactam 30 mg/kg IV q 8h technique, or esophagitis while the esophagus heals.
○ Definitive antimicrobial therapy should be ○ Be familiar with PEG tube use and how
based on results of microbiologic culture Recommended Monitoring to educate clients on use of the tube.
and susceptibility testing of pleural fluid • If PEG tube has been placed, removal may be ○ Ensure that patient is receiving correct
and/or mediastinal abscess possible in 10-14 days; 7-10 day minimum amount of food and water.
• Surgical intervention required before removal to allow proper adhe- • Knowledge of and experience in working with
○ Removal of foreign body if underlying sion of the stomach to the abdominal wall thoracostomy tubes is important in those
cause • Ensure that normal esophageal function patients who have undergone thoracotomy.
○ Repair of perforation: primary closure returns. Esophageal stricture, if it occurs,
+/− resection and anastomosis usually becomes clinically apparent 3-4 SUGGESTED READING
○ Debridement and lavage if mediastinal weeks after injury (increasing problem of Gianella P, et al: Oesophageal and gastric endoscopic
abscess, pyothorax regurgitation). foreign body removal: complications and follow-up
• Treatment of esophagitis of 102 dogs. J Small Anim Pract 50:649-654, 2009.
○ H2 antagonists (e.g., famotidine 0.5 mg/ PROGNOSIS & OUTCOME
kg IV q 12-24h) or preferably, antisecre- AUTHOR: MaryAnn G. Radlinsky, DVM, MS, DACVS
EDITOR: Elizabeth A. Swanson, DVM, MS, DACVS
tory agents (e.g., omeprazole 0.7 mg/kg Prognosis associated with esophageal perfora-
by feeding tube q 24h or pantoprazole tion is guarded due to multiple possible

Esophageal Stricture (Benign) Bonus Material Client Education
Sheet
Online

BASIC INFORMATION RISK FACTORS Clinical Presentation
• Gastroesophageal reflux during anesthesia HISTORY, CHIEF COMPLAINT
Definition • Dogs: esophageal foreign objects that cause • Regurgitation is the classic presenting sign.
Scar tissue that forms after deep esophageal deep, circumferential ulceration Distinguish from vomiting: regurgitation
injury (esophagitis with inflammation extending • Cats: administration of medications not classically involves no prodromal signs,
into submucosal and muscular layers) (pp. 312 followed with water or food (capsules or no active retching, no bile or digested
and 642) uncoated tablets are the most common blood.
medications that lodge and cause esophagitis • Difficulty swallowing or pain associated with
Epidemiology or stricture) swallowing (repeated swallowing efforts)
SPECIES, AGE, SEX • Ptyalism/hypersalivation
Strictures due to foreign bodies and anesthesia- ASSOCIATED DISORDERS • Inappetence
associated acid reflux are more common in dogs, • Esophagitis (common) • Lethargy (primarily if there is severe, con-
and strictures secondary to esophagitis caused • Esophageal foreign bodies (common) comitant esophagitis)
by pills composed of caustic agents are more • Weight loss (if the condition is long-
common in cats. standing)

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