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tvpjournal.com | November/December 2015 | ToDay's VeTeriNary PracTice eNDoscoPy esseNTiaLs Peer reviewed 79 objects that are very diffcult or impossible to remove from the stomach endoscopically include corn cobs, large rocks, large balls, polyurethane glue, and heavy objects. WHAT INSTRUMENTATION IS NEEDED Retrieval Instruments a variety of foreign body retrieval instruments are available (Figure 4). at minimum, those needed for foreign body retrieval include: • Long-arm 2-prong grasping forceps • s nare loop. Table 2 provides a complete list of commonly used foreign body retrieval instruments. Note that retrieval forceps may be limited by the size of the working channel; large instruments require a 2.8- mm working channel. Do not use biopsy forceps because the foreign body may damage or blunt the instrument. Disposable instruments are available, but they are less sturdy and durable. Mucosal Protection When a foreign body is sharp, or concern exists that mucosa could be damaged during extraction, an overtube or hood can be used (Table 2). overtubes are designed to pass over the endoscope; they should be 2 mm larger than the endoscope and 50 to 60 cm in length. Foreign body hoods are rubber latex shields that ft over the distal aspect of most gastroscopes. ESOPHAGEAL FOREIGN BODY RETRIEVAL Prior to Procedure esophageal foreign bodies should be removed promptly because complications are more likely when the foreign body has prolonged contact with the esophageal mucosa. However, take time to pursue the following steps prior to retrieving foreign bodies: 1. Perform routine preanesthetic blood analysis and complete physical examination to evaluate systemic health, and tailor the anesthetic plan, when possible. 2. review radiographs with particular attention to the location and quantity of objects; foreign objects are often seen at areas of anatomic narrowing, including the: • Upper esophageal sphincter (Ues) • Thoracic inlet • Heart base • Distal esophagus proximal to the gastroesophageal junction. 3. Discuss risks and possible complications with the client. Figure 4. Foreign body retrieval instruments (clockwise from top left): raptor forceps, snare loop, basket grasping forceps, 4-prong grasping forceps, Roth net retriever (usendoscopy.com), and rat tooth forceps. Table 2. Commonly Used Foreign Body Retrieval Instruments INSTRUMENT USE Forceps Grasping forceps (2, 3, or 4 prong) Based on shape and orientation of object; number of prongs determined on case-by-case basis Alligator forceps For general purpose removal Rat tooth & raptor forceps For removal of weighted materials Rigid grasping forceps When foreign bodies— located in the cranial cervical esophagus—can be visualized with laryngoscope Rigid forceps (laparoscopic instrument) Passed alongside fexible endoscopes to grasp object with rigid instrument under direct endoscopic guidance Retrievers & Snares Polypectomy snares Basket retrievers For removal of smooth, round objects Net retrievers For removal of round or diffcult- to-grasp objects, especially coins Mucosal Protection Overtubes Passed over endoscope to protect mucosa by encasing sharp objects as they are withdrawn Foreign body hoods Fits over distal aspect of most gastroscopes to shield mucosa as sharp objects are withdrawn