Esophagus: balloon dilation in Cats (Felis) | Vetlexicon
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Esophagus: balloon dilation

ISSN 2398-2950

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Introduction

  • Resolution of esophageal stricture by means of a balloon dilation technique.

Uses

Advantages

  • Most cats can be expected to show improvement following this technique. The magnitude of the improvement depends on the severity of the underlying pathology.
  • Balloon catheter dilation is the treatment of choice: there is less risk of perforation than with bougienage and fewer dilation cycles are required to alleviate symptoms.

Disadvantages

  • Repeated dilations may be required, usually at 1-3 week intervals, in severe cases.
  • General anesthesia is always required.
  • Ideally, fluoroscopic guidance should be employed during dilation treatment. The availability of this modality is limited however.
  • An endoscope is required Esophagoscopy.

Alternative techniques

  • Bougienage: dilation of stricture by means of the passage of progressively larger bougies - smooth, metal dilators designed to stretch the esophagus and reduce the degree of narrowing.
  • The success rate is the same as, or slightly less, than that achieved with balloon catheters. However there is a greater risk of perforation and more frequent dilations may be required.
  • Surgical resection or creation of traction diverticulum have been described.
  • Transendoscopic argon laser therapy has also been used.

Time required

Preparation

  • No specific preparation is required, however the patient must be fasted in standard manner prior to anesthesia.
  • Underlying esophagitis should be addressed before stricture treatment.

Procedure

  • 15-20 min.

Decision taking

Criteria for choosing test

  • Esophagitis Esophagitis and any attendant complications, eg aspiration pneumonia, should be addressed prior to stricture treatment.

Requirements

Materials required

Minimum equipment

  • Endoscope.
  • Esophageal dilation balloon catheters/angioplasty catheters/Foley catheter.

Preparation

Restraint

  • General anesthesia in lateral recumbency.

Technique

Core procedure

Step 1 -

  • Locate and pass the endoscope Esophagoscopy to the stricture site (previously documented by radiographic and endoscopic studies).
  • Feed the balloon catheter through or alongside the endoscope until the center of the inflatable portion is near the center of the area of stricture.
    A guide wire may help. This can initially be fed through the biopsy channel of the endoscope. The endoscope is then withdrawn off the wire, which is kept in situ in the esophagus. The catheter is then fed along the wire to the stricture site, observed by the replaced endoscope.
  • The balloon is inflated for 60-90 seconds to achieve a lumen diameter appropriate for the size of the patient's esophagus and phase of treatment.
    Excessive dilation should be avoided, bearing in mind that a sequence of dilations may be required to achieve a lumen diameter sufficient to relieve clinical signs.
  • Progressively larger balloons can be employed to dilate the esophagus appropriately. Ensure that the balloon remains within the stricture area at all times otherwise no effective stricture dilation will be taking place.
  • Repeat the process after 5-28 days depending on severity of symptoms and patient progress.

Aftercare

Immediate Aftercare

General Care

  • Monitor for signs of esophageal perforation post-procedure.

Analgesia

  • Opiates such as morphine Morphine, pethidine Pethidine, butorphenol Butorphanol tartrate or papaveretum Papaveretum may be given as part of the premedication for anesthesia, and will therefore provide post-procedure analgesia.
    Non-steroidals should be avoided as corticosteroids form part of the treatment of this condition.

Antimicrobial therapy

Other medication

  • Corticosteroids (prednisolone Prednisolone 0.5-1.0 mg/kg) should be administered for 2-3 weeks post-procedure to help prevent stricture reformation, although their efficacy is highly debatable.
  • Cimetidine Cimetidine (5-10 mg/kg TID) may be administered as part of treatment for underlying esophagitis if present and active.
  • Particularly severe cases may benefit from esophageal rest and gastrostomy tube placement Gastrostomy: percutaneous tube (endoscopic) for 7-14 days.

Potential complications

Outcomes

Complications

Reasons for treatment failure

Prognosis

  • Most patients are improved by this procedure and it is therefore well worth pursuing since symptoms can be troublesome and distressing.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Harai B H, Johnson S E, Sherding R G (1995) Endoscopically guided balloon dilation of benign esophageal stricture in 6 cats and 7 dogs. J Vet Intern Med (5), 332-335 PubMed.
  • Willard M D, Delles E K, Fossum T W (1993) Iatrogenic tears associated with ballooning of esophageal strictures. JAAHA 30 (5), 431-5 VetMedResource.
  • Burk R L, Zawie D A & Garvie M S (1987) Balloon catheter dilation of intramural esophageal strictures in the dog and cat: a description of the procedure and a report of six cases. Semin Vet Med Surg (4), 241-7 PubMed.
  • Sooy T E, Adams W M, Pitts R P et al (1987) Balloon catheter dilation of alimentary tract strictures in the dog and cat. Radiology 28 (4), 131-7 VetMedResource.