GDV compresses major blood vessels (eg, caudal vena cava, portal vein, splanchnic vasculature), thus compromising the cardiovascular system. Because of cardiovascular compromise, gastric decompression is vital to GDV treatment. The 2 gastric decompression methods studied here included passage of a large-bore silicone orogastric tube and gastric trocarization via insertion of a 14-gauge over-the-needle IV catheter through the skin and into the most distended part of the stomach.

The 116 dogs in this study had been diagnosed with GDV with a right lateral abdominal radiograph, had the method of decompression noted in the medical record, and had undergone surgical correction: 31 were decompressed with an orogastric tube, 39 with trocarization, and 46 with both methods. Orogastric tubing was successful in 75.5% and trocarization in 86% of cases. In 1 case, trocarization resulted in splenic laceration that did not require surgical correction. The study concluded that both methods are safe and effective; thus, either can be used in GDV management.

In the GDV patient, gastric decompression is never a substitute for and should never delay fluid resuscitation and analgesia administration. Complete gastric emptying is not necessary before surgical intervention, and it is more effectively performed with orogastric intubation during anesthesia. Preoperative gastric decompression is intended to reduce intraabdominal pressure, increase venous return, and provide relief from pain associated with severe gastric distention during resuscitation. With the limited sample size, this retrospective study indicated that either method of preoperative gastric decompression is safe in the GDV patient. However, compared with orogastric intubation, percutaneous trocarization may be less stressful on the patient, more easily and rapidly performed, and require less restraint.—Elke Rudloff, DVM, DACVECC

Global Commentary
As a gastroenterologist with a special interest in GI motility, I have had a long-time interest in the underlying cause(s), treatment, and prophylaxis for GDV. More than 20 years ago, with the support of the Morris Animal Foundation, a global leader in animal science research, I convened and chaired a panel of experts from human and veterinary medicine to reexamine this frustrating and enigmatic disease. That panel and the subsequent call for research proposals led to a much better understanding of the cause and treatment. Even so, we are, alas, still in the dark about its underlying cause. We know that gastric myoelectrical activity and contractility are disrupted with an associated delay in emptying and occur after GDV, but what actually initiates the process? Why do some large-breed, deep-chested, older dogs become aerophagic and yet fail to eliminate the air, rapidly leading to dilation and then torsion?

These authors nicely summarized the tenets of initial therapy and demonstrated the safety and success of initial decompression by either trocarization or gastric intubation. Both work well; what is critical is that intragastric pressure must be relieved before surgery. However if we knew the cause and could prevent it, much of this would be unnecessary.—Colin F. Burrows, BVetMed, PhD, Hon FRCVS, DACVIM

Assessment of two methods of gastric decompression for the initial management of gastric dilatation-volvulus. Goodrich ZJ, Powell LL, Hulting KJ. J SMALL ANIM PRACT 54:75-79, 2013.