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tvpjournal.com | November/December 2015 | ToDay's VeTeriNary PracTice eNDoscoPy esseNTiaLs Peer reviewed 81 Techniques for Sharp Objects. if foreign bodies are sharp or have become embedded in the esophageal mucosa, the object must frst be dislodged before grasping and removing it, which can be particularly challenging. 1. Techniques that may facilitate removal include full air distension of the esophagus, balloon dilation of the esophagus proximal to the object, and short interchangeable push and pull movements. 2. if the object is stuck within the esophagus and in reach of a rigid grasping forceps, attempt removal with a gentle twisting motion. Do not use this technique with fshhooks. 3. Dislodge fshhooks from the esophageal mucosa by grasping the stem and defecting the tip of the endoscope away from the wall (Figure 5). ensure that the fshhook's point is directed caudally, whenever possible, during extraction. Surgical Techniques Thoracotomy. To avoid perforation, the endoscopic retrieval procedure should be aborted and a thoracotomy performed if: • The object is well embedded • Little to no progress is made using the previously described techniques • The object cannot be pushed into the stomach for removal via laparotomy. Gastrotomy. if the object is distal in the esophagus, it may be possible to perform a laparotomy to remove the object via a gastrotomy. if perforation is suspected, obtain follow-up thoracic radiographs. After Removal once the object is removed: 1. ensure that no additional foreign objects are present. 2. evaluate the mucosal surface thoroughly for damage (Figure 6). chronic mucosal injury may weaken the esophageal wall, increasing the risk for iatrogenic tearing during foreign body extraction. 3. consider treatment of esophagitis (see Treatment of Esophagitis & Severe Esophageal Injuries ) when the mucosa appears erythematous, eroded, or ulcerated. 4. offer soft food to the patient for 18 to 24 hours after the procedure. 5. Note that exuberant post-procedure healing may lead to esophageal stricture. GASTRIC FOREIGN BODY RETRIEVAL Prior to Procedure 1. Perform routine preanesthetic blood analysis and complete physical examination to evaluate systemic health, and tailor the anesthetic plan, when possible. 2. ideally, fast the patient for 6 to 8 hours prior to gastroscopy, which reduces the risk of aspiration and allows better visualization of the foreign body. if the foreign body must be removed on an emergent basis: • Pass a stomach tube to lavage the stomach and remove gastric contents, which may improve visibility and aid in foreign body identification (Figure 7) • alternatively, rotate the patient to right lateral or ventral recumbency during the procedure, which can also aid in locating the foreign body or making it more accessible. Treatment of Esophagitis & Severe Esophageal Injuries Typical treatment options for esophagitis include: • Carafate slurry • Proton pump inhibitors • H-2 receptor antagonists. Treatment options for severe esophageal injury secondary to esophageal foreign body removal include: • Antimicrobials: For deep ulceration or perforation • Metoclopramide: To increase lower esophageal sphincter (LES) pressure • Corticosteroids: If there is no evidence of infection, a short tapering course of prednisone may reduce the fibroblastic response, decreasing risk for stricture formation. With severe esophageal injury, consider placement of a gastric tube to allow esophageal rest while providing adequate nutrition. For more information on medical therapy for the GI tract, turn to page 46 and read Symptomatic Management of Primary Acute Gastroenteritis. Figure 7. Endoscopic image of 3 coins lodged in the stomach of a dog.