Flexible endoscopy

• A minimally invasive method of visualizing and examining the mucosal surface of the gastrointestinal, respiratory and urinary tracts.
  
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Advantages

• Minimally invasive technique.
• Well-tolerated by the patient.
• Requires only light anesthesia.
• Good visualization of the mucosa.
• Able to collect biopsy samples  for histological examination.
• Follow up procedures well-tolerated and permit progress to be monitored.
• Minor surgical corrections possible.
• Foreign body retrieval possible.

Disadvantages

• Not possible to examine the entire gastrointestinal tract.
• Lesions deeper than the mucosa will be missed.
• Limited ability to carry out surgical corrections.
• Equipment is expensive.
• Requires high level of technical skill.

• Difficult to carry out.
• Considerable patient preparation is required.
• Must ensure the gastrointestinal tract is empty.
• Induction of general anesthesia.

Risk assessment

• Variable depending on which procedure is being carried out and skill of operator. May include:
  • Ruptured viscus.
  • Hemorrhage.

Veterinarian expertise

• Most require high level of operator experience.

Anesthetist expertise

• General anesthesia is required Anesthetic induction: overview.
• Some patients may be at greater risk than others.

Nursing expertise

• Require to have high level of understanding regarding the equipment and procedures to assist veterinary surgeon and for cleaning and maintaining equipment.

Minimum equipment

• Depends on body system being examined:
  • Esophagoscopy Esophagoscopy.
  • Gastroscopy Gastroscopy.
  • Enteroscopy Enteroscopy.
  • Colonoscopy Colonoscopy.
  • Bronchoscopy Bronchoscopy.
  • Cystoscopy Cystoscopy: transurethral cystoscopy/vaginoscopy.
• Rigid endoscopes useful for examining esophagus, removing foreign bodies  and for proctoscopy.
• Fiber-optic endoscopes used for all other purposes.
• Light source with air and water facilities.
• Biopsy forceps.
• Cytology brushes.
• Cleaning equipment.

Ideal equipment

• video endoscopes provide the best image for examining tissues.

Minimum consumables

• Source of clean water.
• Endoscope disinfectant.
• Cleaning brushes.
• Containers and formol saline for samples.

• Use suitable medication appropriate for patient being examined.

• Nil by mouth for 24 hours and no water 2 hours prior to gastroscopy.

• Light general anesthesia.

• Large intestinal tract examination requires starvation, bowel cleansing Bowel cleansing solution solution and enemas Enema.
• Respiratory and urinary tract requires no special preparation.

Step 1 - Standard

• Depends on body system being examined:
  • Esophagoscopy Esophagoscopy.
  • Gastroscopy Gastroscopy.
  • Enteroscopy Enteroscopy.
  • Colonoscopy Colonoscopy.
  • Bronchoscopy Bronchoscopy.
  • Cystoscopy Cystoscopy: transurethral cystoscopy/vaginoscopy.

Step 2 - Specific

• Examine the mucosa carefully while advancing the endoscope.
• Collect biopsy samples from abnormal lesions.
• Collect biopsy samples from normal tissue for comparison.
• Following examination ensure stomach is deflated prior to endoscope removal.
• Remove endoscope carefully.

Monitoring

• Standard post-anesthesia observation.

General Care

• Label and submit samples for examination.
• Clean the equipment Endoscope: cleaning.

Potential complications

• Hemorrhage from biopsy sites.
• Perforation of viscus.
• Gastric dilation.
• Iatrogenic damage from passage of endoscope.

• Procedure unlikely to affect patient adversely.

• Poor operator competence, unable to examine tissues thoroughly.
• See complications.
• Poor preparation of the patient.
• Incorrect examination.

Refereed papers

• Recent references from PubMed and VetMedResource.

Other sources of information

• Thomas D, Simpson J W & Hall E J (eds) (1996)BSAVA Manual of Canine and Feline Gastroenterology.1st edn.
• Tams T R (1990)Small Animal Endoscopy.Mosby Books, St Louis.