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ToDay's VeTeriNary PracTice | November/December 2015 | tvpjournal.com eNDoscoPy esseNTiaLs Peer reviewed 80 Endoscopic Retrieval 1. apply principles of general endoscopic technique (see Upper Gastrointestinal Endoscopy Series—Part 2: Upper Gastrointestinal Endoscopy Techniques, March/april 2015, available at tvpjournal.com), including: • Placing the patient in left lateral recumbency • ensuring the endotracheal tube cuff is well inflated. 2. Distend the esophageal lumen with air to obtain good visualization, and designate an assistant to monitor the degree of gastric distension. acute respiratory decompensation can result from insuffation into a perforated esophagus or severe overdistension. 3. once the object is encountered, thoroughly inspect it and ask these questions: • is the object embedded in the esophageal mucosa? • are there ridges or grooves that can be grasped easily? • is the position amenable to extraction? • are there sharp edges that could damage the mucosa during extraction? 4. select a retrieval instrument based on the appearance of the foreign body and grasp the object frmly, seating the retrieval instrument onto the object as much as possible. 5. Withdraw the instrument to the tip of the endoscope; then remove the object and scope together, slowly and with minimal force. 6. if the object needs to be adjusted to facilitate grasping it, avoid using the endoscope, which can damage its tip. instead, use an overtube to push or manipulate the object. 7. During removal, if the: • object has a sharp end, when possible position the sharp end either caudally or within the retrieval instrument (parallel to the lumen) to prevent damage as the object is retrieved • sharp end cannot be retrieved as described, encase the object in an overtube before removal • object gets caught at the Ues, endotracheal cuff deflation may facilitate extraction. Additional Retrieval Techniques The majority of esophageal foreign bodies can be removed quickly and without complication. However, when objects cannot be retrieved easily, the following techniques can be considered. Foley Catheter Technique. if object confguration renders grasping it impossible, removal using a Foley catheter can be attempted: 1. advance the Foley catheter past the foreign body, employing a guidewire if needed 2. infate the cuff, and gently and slowly withdraw the catheter. Figure 5. Endoscopic image of a fshhook esophageal foreign body in a dog. Figure 6. Endoscopic image of a rawhide esophageal foreign body in a dog being removed with a snare retrieval instrument (A); note the esophageal pressure necrosis and mucosal erosion following extraction ( B). a b