Video Endoscopy

A Client Guide About The Basic Uses, Indications, and Facts about this Useful Diagnostic Procedure in Veterinary Medicine

 What is Video Endoscopy?

          Video endoscopy is a flexible device with an attached camera to allow veterinarians to view the gastrointestinal tract of a patient without an invasive exploratory. It also has the capability of introducing small devices for collecting tissue biopsies and removing certain types of swallowed foreign bodies before they cause serious problems.

 How is video endoscopy performed?

           Video endoscopy requires general gas anesthesia, the animal is placed in left lateral recumbency, and the flexible camera is slowly introduced down the esophagus for an upper gastrointestinal study or passed retrograde for a colonoscopy for large bowel symptoms. The veterinarian can observe the lining of esophagus, stomach, small intestine or large intestine on a video screen, and the flexible scope has the capability of moving in four different directions to guide the camera carefully to avoid trauma to the surrounding tissues. Biopsies can be collected, and the animal is then recovered.

How long is my pet hospitalized for this procedure and what preparation is needed?

•  Upper gastrointestinal study: the patient needs to be fasted (no food, water is ok) for at least 18-24 hours before the procedure to allow an accurate viewing of all stomach walls. Food in the stomach creates a barrier that can hide clinically important findings like ulcers and tumors. Also, the food attaches to the outer surface of the camera making good visualization more difficult. This procedure can often be done as an outpatient similar to dentals, the pet can be dropped off before 10am in the morning, and go home that evening based on the veterinarian’s discretion.

•  Lower gastrointestinal study: the pet needs to be fasted for at least 24-48 hours, and the pet needs to be admitted to the hospital the night before to receive a treatment called GoLytely that will help clear out remaining material from the small and large colon. Often an enema will be administered 1-2 hours prior to the procedure as well. Again, the patient may go home the same evening as the procedure is performed, and only need to stay the one night before.

What clinical signs may indicate this procedure for my pet?

• Upper gastrointestinal study: history of swallowing a foreign body, chronic vomiting of food and green tinged fluid, vomiting blood or “coffee grind” material (digested blood),  loose or dark stool, decreased appetite, or weight loss

•  Lower gastrointestinal study: straining to defecate, frank red blood on stool, narrow stool, weight loss, red/swollen rectum, rectal prolapse

What are the advantages of endoscopy?

• Endoscopy is the most sensitive technique to evaluate disorders of the mucosa (the lining) of the intestinal tract.

•  Noninvasive diagnostic tool compared to surgery. 

•  It allows direct visualization of the entire stomach and portion of the intestines

•  Rare false negatives

•  Can be curative when removing foreign bodies.

•  Determine feasibility of surgical resection of masses BEFORE surgery.

•  Collect biopsies to guide some processes that don’t NEED surgery (lymphangiectasia, inflammatory bowel disease, gastritis, enteritis, or metastasized diffuse cancers where chemotherapy is a better choice).

•  Guide treatment for additional indicated testing when toxins may be suspected.

What are the limitations of endoscopy where other procedures such as barium contrast radiographs or exploratories may be better indicated?

• Megaesophagus: a motility disorder of the esophagus that causes dilation and regurgitation, best diagnosed with a contrast barium swallow

• Gastric dilatation volvulus (G D V): an ER situation best diagnosed with a quick survey film to confirm painful bloating and twisting of the stomach, and subsequent surgery to reposition and perform a preventative gastropexy

•  Jejunal foreign bodies/masses: the flexible endoscope can only go into the proximal duodenum in an upper GI study, and in a lower GI study only proceed through the colon and sometimes the distal ileum. The middle portion of the small intestine called the jejunum is best evaluated with a contrast barium study to check for obstruction and surgical biopsies/enterotomy to followup if needed.

• In a patient with an abnormal gas pattern suspicious of an obstruction on a survey film, but not a good anesthesia candidate, a barium contrast study may be a safer choice to diagnose obstruction.

• In a patient where elevated liver enzymes or findings in abdominal ultrasound indicate biopsies of other abdominal organs such as spleen, liver, kidney, an exploratory is a more direct approach to the situation and full thickness intestinal/stomach biopsies can be obtained at the same time.

• Some linear foreign bodies can be removed endoscopically, but if a large portion of small intestine is involved, surgery is a safer option; or a very large foreign body difficult to grasp with the endoscopic forceps (i.e. corn on the cob, large bones).

•  An intussusception (the telescoping of one portion of the intestine into another portion) is best diagnosed with ultrasound and corrected surgically.

What types of diagnosis can be made with endoscopy and biopsies?

•  Esophageal problems:

1. Foreign Bodies

2. Esophagitis

3. Hiatial Hernias

4. Esophageal Strictures

5. Benign Esophageal Leiomyomas

6. Esophageal Squamous Cell Carcinomas

7. Spirocerca

8. Extraluminal Obstruction

•  Stomach (Gastric) Problems:

1. Gastric antral mucosal hypertrophy

2. Foreign bodies

3. Benign Masses (Gastric leiomyomas, Gastrinoma, Adenomas)

4. Malignant Masses (Carcinoma, Adenocarcinoma, Lymphosarcoma)

5. Pithiosis

6. Helicobacter

7. Gastric Ulcers

8. Gastritis

• Small Intestine (Duodenum)

1. Ulcers

2. Inflammatory bowel disease
       Plasmacytic-lymphocytic enteritis
       Eosinophilic enteritis
       Lymphocytic enteritis

3. Benign Masses (Leiomyoma, Adeonomatous Polyps)

4. Malignant Mass (Leiomyosarcoma, Lymphosarcoma, Adenocarcinomas)

5. Infectious Enteritis (bacterial, fungal, viral)

6. Hemorrhagic Gastroenteritis (H G E)

7. Enteritis Non-infectious

8. Lymphangectasia

9. Foreign bodies

10. Parasites (diagnose on fecal first!)

• Large bowel/Colon

1. Ulcers/Erosions

2. Inflammation

3. Plasmacytic-lymphocytic colitis

4. Eosinophilic colitis

5. Cecal inversion

6. Polyps (Adenomas)

7. Malignant Tumors (Adenocarcinomas, Lymphomas)

8. Infectious (Campylobacter?)- toilet bowl drinker?

9. Intussception

10. Boxer Colitis

11. Strictures (rare)

12. Parasites (diagnose on fecal first!)

13. Histoplasmosis: fungal infection

 

 Additional Little Reminders:

• A bigger ulcer does not always cause more bleeding than a smaller one.

• Not all animals with stomach disease show vomiting, many only show signs of decreased appetite and weight loss; especially cats with lymphoma.

• Do not give Sucralfate, Pepto Bismol, Kaopectate or barium the morning of endoscopy, they all coat the lining of the stomach and can hide ulcers.

• A benign tumor and a malignant tumor can not be differentiated by appearance, a biopsy is the only conclusive way to diagnose and predict prognosis. Some benign tumors can appear very aggressive, and some carcinomas can look mistakenly subtle.

Endoscopy Pictures

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