The Use of a Cutting Balloon for Dilation of a Fibrous Esophageal Stricture in a Cat

Esophageal strictures are uncommon in cats with causes including medications, ingestion of caustic substances, or gastroesophageal reflux under anesthesia. Bougienage and balloon dilation are the main treatments for strictures but have variable success rates. This paper describes the novel use of a cutting balloon for dilation of a fibrous stricture in a cat that was previously refractory to treatment with traditional balloon dilation. 1. Introduction Esophageal strictures are uncommon in cats and dogs and are generally the consequence of esophagitis caused by gastroesophageal reflux secondary to anesthesia, esophageal foreign bodies, persistent vomiting, or esophageal retention of certain medications such as tetracyclines and clindamycin [1–3]. Strictures occur when the esophagitis extends into the submucosa or muscularis resulting in a fibroproliferative reaction. Clinical signs including regurgitation, ptyalism, and dysphagia typically appear within 7–10 days of the inciting event. Bougienage and balloon dilation are the most common nonsurgical techniques for treatment of strictures. Balloon dilation has been purported to offer an advantage due to the generation of only radial stretch forces without the concurrent longitudinal shear stress generated by bougienage, but retrospective studies in humans and a recent study in dogs have not shown any difference in clinical outcome [4–6]. The use of perendoscopic multiquadrant electrocautery has been reported for use in annular or recurrent strictures [7, 8]. Using an electrosurgical unit, three to four equidistant incisions are made in the fibrous ring followed by balloon dilation. The created incisions provide weak areas restricting the trauma of dilation to these sites and sparing the rest of the tissue [7]. Melendez et al. [8] noted an apparent benefit in decreasing the number of balloon procedures required using this technique. In this paper, we describe the use of a cutting balloon to create incisions for treatment of a refractory fibrous stricture in a cat. 2. Case Presentation A 12-year-old female spayed Ragdoll cat was evaluated for a 3-week history of vomiting, retching, and ptyalism. Four weeks prior to presentation, the cat was evaluated at another hospital for periocular erythema and edema. Due to suspected tooth root abscessation, the cat was anesthetized and the left maxillary third premolar extracted. An unknown oral antibiotic was prescribed. One week prior to presentation, the cat was seen at a second hospital for vomiting. Examination identified prolapse of the left third eyelid with mild