Today's Veterinary Practice

SEP-OCT 2016

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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tvpjournal.com | September/October 2016 | T O day' S Ve T erinary Prac T ice end OS c OP y e SS en T ia LS Peer r eviewed 81 Collecting Biopsy Samples 1. To collect biopsy samples, advance the closed biopsy instrument through the operating channel into the lumen of the intestine, open it, and then retract it to the tip of the endoscope. 2. a ngle the endoscope toward the mucosa and advance the biopsy instrument into the wall as close to a perpendicular angle as possible. 3. c lose the biopsy instrument and allow the distal bending section to relax before swiftly retracting the instrument. r emoving some air from the lumen can help improve purchase of the biopsy instrument on the mucosa. 4. i f the ileocolic valve cannot be intubated, blind biopsies of the ileum may be performed. To accomplish this, pass closed biopsy forceps through the ileocolic junction, open and then advance the forceps until resistance is encountered. c lose the biopsy instrument; then retract. 5. Once the ileum has been biopsied, slowly withdraw the endoscope. a dditional biopsy samples should be taken from the cecum; the ascending, transverse, and descending colon; and the rectum. Focus biopsy samples on abnormal areas but also obtain samples from all sections of the large intestine, regardless of appearance. a minimum of 2 to 3 samples from each region should be obtained—more if the samples are not good quality. Examining the Rectum Once the biopsy samples are collected, the aboral- most portion of the rectum may be evaluated in some larger dogs. To accomplish this: 1. Withdraw the endoscope so that the distal tip is 10 to 20 cm from the anus; then deflect the endoscope upward to achieve an approximate 90-degree angle in the distal bending section. 2. Seat the distal tip against the colonic mucosa and advance the insertion tube as additional upward deflection is applied. This enables the distal bending section to "roll over" itself to achieve full retroflexion. 3. Withdraw the insertion tube until the terminal rectum can be evaluated (Figure 6) and rotate the scope clockwise and counterclockwise so that the mucosa hidden behind the insertion tube can be evaluated. 4. Once finished, advance the scope into the proximal rectum/descending colon and perform the reverse maneuver to straighten the scope tip before withdrawal. IN SUMMARY Lower G i endoscopy is a minimally invasive diagnostic technique that permits the clinician to evaluate the rectum, colon, cecum, and ileum for a wide variety of lesions. d epending on the area of interest and the goals of endoscopy, either a rigid or flexible endoscope may be used. r egardless of the type of endoscope used, it is critical to prepare the patient adequately, and use appropriate equipment and technique to maximize diagnostic and therapeutic value as well as ensure patient safety. G i = gastrointestinal; ne = nasoesophageal aL ex Ga LL a G her Alex Gallagher, DVM, MS, Diplomate ACVIM, is a clinical assistant professor of small animal medicine at University of Florida College of Veterinary Medicine, where he also received his DVM. He completed a rotating internship at Virginia– Maryland College of Veterinary Medicine; an internal medicine internship at Affiliated Veterinary Specialists in Maitland, Florida; and a residency in internal medicine at Virginia–Maryland College of Veterinary Medicine. Patrick s . Moy L e Patrick S. Moyle, DVM, is a second-year resident in small animal internal medicine at University of Florida College of Veterinary Medicine. He received his DVM from Auburn University and completed an internship at Wheat Ridge Animal Hospital in Wheat Ridge, Colorado. Figure 6. Retroflex colonoscopic view of the rectocolic junction. The insertion tube (black) should be rotated clockwise and counterclockwise to ensure the mucosa behind the endoscope is visualized.

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