Medical Management and Surgical Removal of Non-Responsive Equine Glandular Gastric Disease

Presentation Description / Summary: Some non-responsive equine gastric glandular disease (EGGD) cases progress to chronic gastric change (CGC) which is similar to human epithelial polyps. These lesions represent well defined non-neoplastic un-encapsulated architectural mucosal remodelling by well-differentiated, hyperplastic gastric glands, often lined by a single layer of tall columnar cells separated by fibrovascular stroma. Their surface can be intact columnar epithelium (quiescent) or be ulcerated with suppurative inflammation (active). This session will review the literature on chronic EGGD and equine polyps, interspersed with case examples requiring guided audience input providing a clinical useful approach.

The next section will review the human approach to gastric polyps based upon their clinical relevance and potential for progression to gastric cancer (emphasising that neoplastic progression in horses is extremely rare). A standard clinical approach will be described for CGC, again with case examples: How to define if the CGC clinically relevant, what makes CGC endoscopically relevant, how to assess the effect of CGC on gastric function.

Potential approaches which could be applied to the horse will be covered - medical (beyond standard EGGD treatment) aiming to reverse hyperplasia, and particularly surgical options to remove the polyp tissue. Minimally invasive surgical techniques (monopolar electrocautery snare loop retrieval, interstitial laser photo-ablation and non-contact laser photo-ablation) will be described in detail with video, still image and diagrammatic representation of the procedures aiming to provide a guide for internists wishing to perform them. Case examples of treatment and follow up will be given, along with tips to avoid complication and improve efficacy.