Intermittent At-Home Suctioning of Esophageal Content for Prevention of Recurrent Aspiration Pneumonia in 4 Dogs with Megaesophagus

Abstract

Background: Megaesophagus carries a poor to guarded prognosis due to death from aspiration pneumonia. Options for medical management of regurgitation are limited to strategic oral or gastrostomy tube feeding.

Objectives: To describe the use and efficacy of intermittent esophageal suctioning to prevent regurgitation and associated episodes of aspiration pneumonia in dogs with megaesophagus.

Animals: Four dogs with acquired idiopathic megaesophagus and recurrent aspiration pneumonia.

Methods: Retrospective review of medical records of dogs with megaesophagus in which intermittent suctioning of esophageal content was employed for management of recurrent aspiration pneumonia.

Results: Intermittent suctioning of the esophagus was initiated in 4 dogs after failure of strict gastrostomy tube feeding failed to prevent regurgitation and repeated episodes of aspiration pneumonia. Suctioning was accomplished by esophagostomy tube in 3 dogs and per os in 1 dog. After initiation of esophageal suctioning, dogs survived for a median of 13.5 additional months (range, 10-30 months) during which time 2 dogs had no additional episodes of aspiration pneumonia and 2 dogs had infrequent episodes of pneumonia, but aspiration was suspected to be a contributing factor in their death. Complications included clogging of the esophagostomy tube, esophagostomy site infections, and esophagitis.

Conclusions and clinical importance: Use of intermittent esophageal suctioning in dogs with megaesophagus that continue to regurgitate despite gastrostomy tube feedings can reduce or abolish clinical episodes of aspiration pneumonia.

Keywords: Esophagostomy; Regurgitation.

Figure 1

Histopathologic appearance of the esophagus of dog 3, 100× magnification. The esophageal stratified squamous epithelium is nearly completely absent and replaced by a thick tract of loose fibrosis and granulation tissue with admixed fibrin and necrotic debris. There is also infiltration of abundant inflammatory cells, including neutrophils, macrophages, lymphocytes and plasma cells, which variably extend into deeper tissues, such as submucosal glands. Scale bar represents 200 μm.