Today's Veterinary Practice

SEP-OCT 2016

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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 79 a gastroscope or a colonoscope may be used (Figure 3), and the largest-diameter endoscope that permits evaluation of the areas of interest is recom - mended. Subsequently, selection of a flexible endo- scope depends on patient size. With advancements in video endoscopy, flexible endoscopes for colonos - copy can have an insertion tube as small as 5.9 mm in diameter. This generally permits intubation of the ileocolic junction and evaluation of the distal ileum even in small dogs and cats. a n operating channel of at least 2.8 mm is recommended for adequate biopsy sample size and may not be available on smaller diameter scopes. Gastroscopes or colonoscopes generally have a working length between 100 cm and 170 cm. For large- or giant-breed dogs, an endoscope with a working length of at least 140 cm may be needed to evaluate the ascending colon, cecum, or ileum. Additional Instrumentation • i f the preparation is inadequate, colonic lavage pumps may be used to promote visualization of the colonic mucosa (Figure 4). • For rigid colonoscopy, mare uterine biopsy forceps may be used to obtain large biopsy samples of intraluminal masses. a lternatively, rigid biopsy instruments can be used to biopsy more discrete mucosal lesions. • For flexible endoscopy, a wide array of biopsy forceps is available, and selection depends primarily on the operating channel of the endoscope and operator preference. • i f a rectal polyp or a pedunculated mass is identified, a snare may be used to remove it at its stalk. Note: This technique is not recommended for the novice endoscopist; insufficient training may result in substantial hemorrhage and/or colonic perforation. • Balloon dilators in a variety of sizes can be used to sequentially balloon-open rectal strictures. GENERAL GUIDELINES r egardless of whether rigid or flexible endoscopy is used, clinicians should follow several important guidelines to avoid potential complications. • Frequent insufflation is imperative to maintain a visual field during G i endoscopy, but avoid overinsufflation because it can lead to patient discomfort or increased risk for G i rupture. • The anesthetist or an assistant should monitor the abdomen frequently for evidence of distension. • Only advance the insertion tube when a clear luminal view is present (except when using blind "slide-by" technique, see Step 5, page 80). i f the lumen cannot be visualized, do not advance the scope until the lumen is centered again. • i f visualization becomes impaired from feces or mucus, use irrigation to clean the distal tip. i f this is unsuccessful, clean the distal tip by touching it to a clear area of mucosa. Rigid Colonoscopy Navigating the Anatomy 1. r igid colonoscopy can be performed with the animal in any recumbency, but right lateral recumbency is preferred to minimize the angle of the rectocolic junction. 2. Before inserting the endoscope into the rectum, make sure the obturator and end of the endoscope are well lubricated. 3. r emove the obturator once it is advanced into the rectum; then rotate the viewing lens into place. c losure of the lens allows insufflation and visualization of the colonic mucosa. 4. a dvance the endoscope, with continual insufflation, ensuring that a clear luminal view is maintained. Collecting Biopsy Samples 1. i f biopsy specimens need to be obtained, advance the endoscope to within a centimeter of the desired area. 2. Open the viewing lens and advance the rigid biopsy forceps through the speculum to the mucosa. 3. Open the jaws of the biopsy forceps, advance into the desired tissue, close, and remove the sample. Figure 4. e rbe ei P2 irrigation pump (erbe-med.com).

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