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T O day' S Ve T erinary Prac T ice | September/October 2016 | tvpjournal.com end OS c OP y e SS en T ia LS Peer r eviewed 78 volume colonic lavage solution (eg, polyethylene glycol solution with electrolytes [P e G 3350- e ]) in 2 doses of 40 to 60 mL/kg in dogs or 30 mL/ kg in cats over 2 H, repeated 2 to 4 H later. 5. a lternatively, the entire volume can be delivered as a constant rate infusion via ne tube over 6 to 8 H. r arely, the most enthusiastic dogs may be encouraged to consume the P e G 3350- e flavored with broth, ice cream, or small amounts of canned dog food. 6. Make sure to clamp or kink off the tube during extubation to prevent inadvertent and potentially fatal aspiration of colonic lavage solution. Enema i n addition to the lavage solution, all patients should receive multiple warm water enemas. 1. a dminister an enema 30 to 60 minutes after each successful administration of P e G 3350- e and repeat 1 to 2 H before the procedure. 2. i nsert a well-lubricated red rubber catheter into the rectum and advance it to the level of the last rib. 3. i nstill 20 to 30 mL/kg warm water. 4. i n cats, administer the enema slowly because rapid administration may cause vomiting and potential aspiration of colonic lavage solution. ANESTHESIA & MONITORING For complete lower G i endoscopy, general anesthesia is recommended. i f a focal lesion of interest exists in the distal descending colon or rectum, sedation may be used for rigid colonoscopy. However, if significant insufflation is used (flexible endoscopy), evaluation of the transverse or ascending colon or ileum is desired, or deep biopsies are performed, general anesthesia is recommended to improve patient comfort and cooperation. EQUIPMENT CONSIDERATIONS d epending on the goals of lower G i endoscopy and the area of interest, rigid or flexible endoscopes may be used. Rigid Colonoscopy r igid endoscopy can be used to evaluate the descending colon and rectum, and is primarily performed with human sigmoidoscopes or proctoscopes (Figure 2). These scopes are available in pediatric (9–15 mm) and adult (19–23 mm) diameters, and their lengths range from 10 to 35 cm. a s a rule, the largest scope that permits successful evaluation of the area of interest should be chosen. i f instruments are used, they need to be longer than the endoscope's speculum. c ompared with flexible endoscopy, magnification and detailed examination of the mucosal surface are poor; however, proctoscopes and sigmoidoscopes are relatively inexpensive and allow for large biopsy samples. Flexible Colonoscopy Flexible endoscopy can be used to evaluate the rectum, colon, cecum, and distal ileum. While flexible endoscopy allows a more thorough evaluation of the mucosa than rigid endoscopy, biopsy samples are generally limited by the size of the operating channel. Some clinicians feel that rigid endoscopy allows a better examination of the rectum but, with proper technique and adequate insufflation, the rectum is well visualized even in patients in which retroflex protocscopy cannot be performed. Figure 2. Welch Allyn 19-mm × 15-cm standard sigmoidoscope with obturator and insufflation bulb (welchallyn.com). Figure 3. Fujinon e C-530-LS 11.5-mm × 160- cm videoscope with 3.8-mm operating channel and forward water jet function for irrigation (fujifilm.com).