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JAVMA 2020
Janet A. Grimes, Jeremy T. Fleming, Ameet Singh, et al.
Background
This study investigated gastroesophageal intussusception (GEI) in dogs, a rare condition where the stomach invaginates into the esophagus, often leading to severe morbidity. The study aimed to characterize GEI's clinical presentation, evaluate diagnostic and treatment outcomes, and identify factors influencing prognosis.
Methods
A retrospective review included 36 dogs diagnosed with GEI across 16 veterinary hospitals from 2000 to 2018. Data on clinical signs, diagnostic imaging, surgical findings, and outcomes were collected. Associations between these variables and survival outcomes were statistically analyzed using Fisher's exact test, Kaplan-Meier analysis, and Cox proportional hazard models.
Results
-Demographics: Median age of affected dogs was 13.2 months; males (72%) and German Shepherd Dogs (33%) were most common.
-Clinical Signs: Vomiting (67%), regurgitation (33%), and anorexia (28%) were typical. Megaesophagus was present in 36% of cases.
-Diagnostics: Thoracic radiography identified GEI in 88% of cases, with endoscopy and contrast imaging providing further confirmation.
-Treatment and Survival:
-72% of dogs underwent treatment (mostly surgical gastropexy), with an 88% survival rate to discharge.
-Median survival time after treatment was 995 days. Persistent regurgitation occurred in 10 of 23 long-term survivors.
-Recurrence of GEI was not reported in treated dogs.
Limitations
The study's retrospective design and reliance on owner-reported follow-ups may introduce bias. Variability in diagnostic and treatment approaches across institutions complicates standardization. The sample size limited statistical power for certain analyses, such as factors influencing long-term survival.
Conclusions
Surgical treatment for GEI is highly successful, with long-term survival achievable despite frequent complications such as persistent regurgitation. Appropriate medical management, including dietary adjustments and elevated feedings, is critical for improving quality of life. Further research is needed to refine diagnostic techniques and treatment protocols.
Figure 1—
Right lateral (A) and ventrodorsal (B) radiographic views of the thorax of a dog with GEI. Notice the fluid and gas dilatation of the esophagus (double-headed arrows), which is displacing the trachea ventrally (arrow), and the soft tissue opacity in the mid-to-caudal thoracic region (asterisk). No stomach is visible in the cranial abdominal region. There is no evidence of aspiration pneumonia.
Figure 2—
Left lateral (A) and ventrodorsal (B) radiographic views of the thorax of the same dog in Figure 1 after oral administration of positive contrast medium. Notice the rugal folds of the stomach highlighted by the contrast medium within the esophagus (arrows), which is a finding diagnostic for GEI.
Figure 3—
Endoscopic images of the esophagus in the same dog as in Figures 1 and 2. Notice the rugal folds of the stomach visible within the esophageal lumen, which is a finding diagnostic for GEI.
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