Contributors: James Simpson, Kenneth Simpson
Species: Canine | Classification: Techniques
Introduction Requirements Preparation Procedure Aftercare Outcomes Further Reading
- Examination of the esophageal mucosal surface.
- Collection of mucosal biopsy samples from the esophagus.
- Detection and retrieval of foreign bodies Esophagus: foreign body from the esophagus.
- Esophageal stricture dilatation Esophagus: stricture.
- Detection/biopsy of esophageal masses.
- Definitive diagnosis of esophagitis.
- Investigation of:
- Regurgitation Regurgitation.
- Non-invasive technique requiring no surgical intervention.
- Well tolerated by sick dogs which would be unsuitable for esophagostomy.
- Requires only light general anesthesia - rapid recovery.
- Good visualization of the esophageal mucosa.
- Follow up examination well tolerated and useful for assessing response to treatment.
- Will not detect pathology lying under the mucosa.
- Cannot carry out surgical correction compared with thoracotomy but can remove esophageal foreign bodies.
- Expensive equipment.
- Technical difficulty in procedures.
- Radiography Radiography: thorax , fluoroscopy and contrast studies (barium series) fluoroscopy of the esophagus.
- Exploratory thoracotomy and esophagostomy Esophagostomy.
- Induction of anesthesia and/or sedation → 10-30 min.
- Depends on the experience of the endoscopist → esophagoscopy approximately 10 min.
- Low risk.
- See complications.
- Good level of competence required for assisting in procedures, monitoring anesthetic and assisting in biopsy collection and handling.
- High competence for care and cleaning of endoscopic equipment.
- Fully immersible fiber-optic, flexible or rigid (for foreign body retrieval) endoscope.
- One meter insertion tube length (depending on size of patient).
- Insertion tube diameter 7-9 mm.
- ONLY use an end viewing endoscope.
- Four way tip deflection.
- MUST have cold light source with air pump and water wash facility.
- Fenestrated biopsy forceps for collection of mucosal biopsy samples.
- Cleaning brushes for biopsy channels.
- Water leakage tester.
- video endoscope:
- Excellent magnified image presented on screen.
- Detection of lesions much easier.
- Allows for multiple person viewing.
- Excellent for video recording procedures and/or collecting still images.
- Excellent as a training aid.
- Xenon light source.
- Insertion tube diameter 7-9 mm.
- Suction unit for aspiration of unwanted gastrointestinal secretions.
- Cytology brushes, grasping forceps and balloon catheters.
- More than one endoscope for examination of different parts of the gastrointestinal tract.
- Endoscope cleaning trolly.
- Ultrasonic cleaner for biopsy forceps.
- Clean water.
- Endoscope disinfectants.
- Household detergent.
- Formal saline, card and containers for preservation of biopsy samples.
Care and maintenance
- Storage of endoscopes:
- ALWAYS store endoscopes in a safe location where accidental knocks can be avoided.
- ALWAYS store endoscopes with insertion tube hanging vertically.
- Do NOT store endoscopes in their carrying case.
- See supplier for further details of endoscope 'hangers'.
- Cleaning and disinfection:
- Follow the manufacturers recommendations at all times.
- Use an endoscope cleaning bath wherever possible.
- Use whatever disinfectant the manufacturer recommends. Gigasept, Cidex and Dettol endoscopic disinfectants are available.
- Follow health and safety rules regarding use of these products.
- Suitable pre-medication Anesthetic premedication: overview.
- Nil by mouth for 6 hours prior to procedure.
- Light general anesthesia General anesthesia: overview.
Step 1 - Patient preparation
- Following induction of anesthesia - it isessentialto intubate patient.
- Tie endotracheal tube to mandible (not maxilla) to assist with the passage of the endoscope.
- Lay patient in left lateral recumbancy.
- Place mouth gag to protect endoscope.
Step 1 - Endoscopic examination
- Insert endoscope along hard palate and into proximal esophagus .
- Stop and gently inflate esophagus with air.
- Once mucosa is visualized stop inflating with air.
Do not overinflate.
- Slowly pass endoscope along the esophagus examining the mucosa as you proceed.
- Examine the entire length of the esophagus.
Step 2 - Biopsy collection
Esophagus is tough and difficult to biopsy.
- Do not overinflate esophagus as this will make mucosa stretch tightly reducing ability to collect samples.
- Try and advance biopsy forceps perpendicular to the mucosa.
- Tent mucosa before closing biopsy forceps and retrieving sample.
- Deeper samples can be collected by sampling repeatedly at the same site.
- Perforation will occur if this is done too frequently.
- Capillary bleeding from biopsy sites is normal.
Step 1 - Remove endoscope
- Gently withdraw endoscope.
- Support end of scope as it is withdrawn to prevent damage.
- Routine post-anesthetic observation.
- Check mucous membrane color, heart and respiratory rates in case of hemorrhage.
- Check there is no evidence of gastric dilation.
- Do not overinflate esophagus.
- Apply only enough air to allow adequate visualization.
- Arterial bleeding from biopsy sites.
- Esophageal perforation from applying too much force.
- Iatrogenic damage to mucosa caused by advancing endoscope along esophagus.
- Recent references from PubMed and VetMedResource.
Other sources of information
- Simpson J W (1996)Gastrointestinal Endoscopy.In:Manual of Canine and Feline Gastroenterology.Eds D Thomas, J W Simpson & E J Hall. BSAVA, Cheltenham. pp 20.
- Tams T R (1998)Small Animal Endoscopy.2nd edn. St Louis: C V Mosby.