Article of the Week
We will be posting commentaries on articles relating to internal medicine and endocrinology that we think are of interest.
May 6th, 2022
Outcomes of esophageal and gastric bone foreign bodies in dogs
Gastric bone foreign bodies (G-bFBs) have been studied less than E-bFBs. In a case series of gastric and esophageal foreign bodies in 102 dogs, only 2 G-bFBs were evaluated, and in a retrospective evaluation of gastrointestinal foreign body surgeries, only 5 bones were identified in 208 cases. Although bones can cause gastric perforation, their higher digestibility compared to non-organic foreign bodies is unique, supporting the argument to leave them in situ. Despite potential complications associated with foreign material in the stomach, in some cases E-bFBs actively or passively advanced into the stomach are considered successfully resolved. A comparative evaluation of removal of the bone per os versus gastric advancement of the bony material has not been performed, and little data exist regarding outcomes of gastric bone digestion in dogs.
The objectives of this retrospective study were to (a) describe dog characteristics, bone attributes (bone type and number, duration, location, and relative size), and outcome, for dogs with esophageal or gastric bone foreign bodies removed by endoscopy, surgery, or advancement into the stomach; (b) determine factors associated with presence of esophageal erosions in dogs with E-bFBs; and (c) determine factors associated with the decision to remove G-bFBs.
Background: Bone foreign bodies are commonly encountered in small animal practice. Esophageal bone foreign bodies (E-bFBs) warrant removal, whereas gastric bone foreign bodies might not.
Objectives: Describe management and outcomes for dogs with esophageal or gastric bone foreign bodies.
Animals: One hundred twenty-nine dogs with esophageal (n = 45) or gastric (n = 84) bone foreign bodies.
Methods: Retrospective review of medical records.
Results: Dogs with E-bFBs were younger than dogs with gastric bone foreign bodies (median age esophageal, 4 years [IQR 2-8]; median age gastric, 6 years [IQR 3-10]; P = .03), and had a higher bone cross-sectional area relative to body weight (median esophageal, 98.21 mm2/kg [IQR 48.25-142.6]; median gastric, 28.6 mm2/kg [IQR 17.25-64.28]; P < .001). Forty-two of 45 esophageal foreign bodies were resolved non-surgically and 3 by esophagotomy. Esophageal erosions were more likely with distal entrapment (OR 12.88, [95% CI 31.95-129.29], P = .01) and longer duration (OR 18.82 [95% CI 2.22-273.97], P = .01). Sixty-two of 84 bone gastric foreign bodies were left in situ. Endoscopic removal was successful in 20 of 22 (91%; 95% CI 70-99) attempts.
Conclusions and Clinical Importance: While all E-bFBs were dislodged either by advancement into the stomach, endoscopic removal, or esophagotomy, the majority of gastric bone foreign bodies were left in situ for dissolution, with no reported complications. Gastric advancement of E-bFBs should be considered when oral removal is not feasible, and dissolution can be considered even with large bones.