Risk Factors for Death in Dogs Treated for Esophageal Foreign Body Obstruction: A Retrospective Cohort Study of 222 Cases (1998–2017)

Abstract

BackgroundLimited data exist describing risk factors for death, and long‐term outcomes in dogs with esophageal foreign body (EFB) obstruction.Hypothesis/ObjectivesTo evaluate short‐ and long‐term outcomes, and analyze risk factors for death in dogs with EFB obstruction. We hypothesized duration of entrapment and treatment type would affect outcome.AnimalsA total of 222 dogs were treated for EFB obstruction at an emergency and referral hospital between March 1998 and March 2017.MethodsMedical records for dogs with EFB were retrospectively evaluated.ResultsForeign material most frequently was osseous (180/222 [81%]), with distal esophagus the most common location (110/222 [49.5%]). Duration of clinical signs was not associated with risk of death (OR = 1.08, 95% CI 0.99–1.17; P = 0.2). Entrapment was treated by endoscopy (204/222 [91.8%]), surgery after endoscopic attempt (13/222 [5.9%]), and repeat endoscopy after surgery was recommended but declined (5/222 [2.3%]). In‐hospital case fatality rate was 11/222 (5%). Risk of death was significantly higher with surgery (OR = 20.1, 95% CI 3.59–112.44; P = 0.001), and 5/5 (100%) of dogs died if undergoing endoscopy after surgery was recommended but declined. Increasing numbers of postprocedural complications (OR = 3.44, CI 2.01–5.91; P < 0.001), esophageal perforation (OR = 65.47, CI 4.27–1004.15; P = 0.003), and postprocedure esophageal hemorrhage (OR = 11.81, CI 1.19–116.77; P = 0.04) increased in‐hospital risk of death. Esophageal strictures were reported in 4/189 (2.1%) of survivors available for follow‐up.Conclusions and Clinical ImportanceDeath is uncommon in canine EFB; however, treatment type affects outcome, and these data should be used to guide decision‐making in dogs with EFB.

Endoscopic retrieval of gastric and oesophageal foreign bodies in 52 cats

“…, Sale & Williams , Burton et al . ). Complication rates of 14.3% to 63.6% have been reported with oesophagotomy in dogs and complications include oesophageal wound dehiscence and leakage, pyothorax, mediastinitis, pleuritis, and post‐operative stricture formation (Sale & Williams , Deroy et al .…”

“…, Burton et al . ). This difference underscores the importance of careful attention to radiographic signs that may suggest a foreign body, including focal oesophageal gas dilation or gastric contents in an anorexic cat.…”

“…Surgical risks are increased with OFB. Canine oesophagotomy mortality rates range from 7% to 42.3% (Houlton et al 1985, Sale & Williams 2006, Burton et al 2017. Complication rates of 14.3% to 63.6% have been reported with oesophagotomy in dogs and complications include oesophageal wound dehiscence and leakage, pyothorax, mediastinitis, pleuritis, and post-operative stricture formation (Sale & Williams 2006, Deroy et al 2015, Sutton et al 2016.…”

“…The most commonly retrieved foreign bodies were trichobezoars and ribbons, representing 42.6% of the ingested foreign material. In contrast, bone, which is readily visible on radiographs, is the most commonly ingested foreign material requiring endoscopic foreign body retrieval in dogs (Houlton et al 1985, Spielman et al 1992, Rousseau et al 2007, Gianella et al 2009, Juvet et al 2010, Thompson et al 2012, Burton et al 2017). This difference underscores the importance of careful attention to radiographic signs that may suggest a foreign body, including focal oesophageal gas dilation or gastric contents in an anorexic cat.…”

Medical management of esophageal perforation secondary to esophageal foreign bodies in 5 dogs

“…Bones and osseous material are the most commonly reported EFB with a prevalence of 47–94%; however, fish hooks, rawhide chews, pieces of plastic or metal, balls, and children's figurines have also been reported as EFBs . Typical locations for EFBs are where the esophagus is narrower: at the pharyngeal esophagus, the thoracic inlet, near the heart base, and the distal esophagus . Many studies suggest that the distal esophagus is the most common location for EFBs .…”