Gastrointestinal Endoscopy Endoscopy Traditionally performed only on a

Gastrointestinal Endoscopy

Endoscopy • Traditionally performed only on a referral basis • Many private practices are starting to invest in equipment • Technicians assist with patient prep, during the procedure, take care of equipment

Required functions • 4 way deflection • Air/water/suction capabilities • Optics/visualization – Video endoscopes • Tube length • Large biopsy channel

Endoscope anatomy • Insertion tube – 100 cm or longer – Contains insufflation and water channel – Second suction/biopsy channel – Distal tip moves in all 4 directions

Endoscope anatomy • Handpiece – Eyepiece – Deflection knobs – Air/water valve – Suction valve – Separate channel for instrument insertion

Endoscopy anatomy • Umbilical cord – Conveys light from external source into fiberoptics of insertion tube

Video endoscopy • Attach specialized camera to eyepiece • Video endoscope

Forceps Biopsy ◦ Outer diameter is slightly smaller than biopsy channel diameter ◦ 50 cm longer than channel Retrieval forceps ◦ Single loop snare ◦ 3 or 4 prong grasper ◦ Basket retrieval Cytology brushes Aspiration catheters Balloon dilators

Endoscopy • Esophagogastroduodenoscopy (EGD) – Performed in patients with chronic vomiting, suspect FB, suspect GI ulcers, strictures and for collecting biopsy specimens • Colonoscopy – Often used when tumors are suspected, chronic diarrhea

Endoscopy • EGD’s and colonoscopies are performed primarily with a flexible endoscope vs. rigid endoscope

Endoscopy • Patient Prep – Area to be examined must be emptied hours before the procedure

Endoscopy • EGD – Esophagus, stomach, duodenum – Patient comes to clinic 24 hours prior to procedure – Withhold food for 12 to 24 hours – Withhold water for 4 hours – If GI motility is compromised, you may need to repeat later

Endoscopy • Colonoscopy – Patient arrives at clinic 2 days before the procedure – Fast for 24 to 36 hours – Administer osmotic cathartic the day before via a stomach tube • Go. LYTELY – Administer again (twice) the afternoon before the procedure 2 hours apart, the last dose 2 -4 hours before the procedure starts. – Warm water enema 1 hour prior to procedure

Endoscopy • After anesthesia induction – Colonoscopy – EGD • Watch for over-filling of the stomach with air as this will cause difficulty in respiration

Endoscopy • Technicians often are in charge of moving the endoscope in and out of the body for the veterinarian, and controlling knobs and valves • Micromovements are crucial • Allows the vet to focus on the procedure

Endoscopy • Obtaining biopsy samples – Have biopsy instruments ready at all times – Check forceps for working condition prior to procedure – Be sure you know the forceps work prior to the procedure – Communication

• Handling biopsy. Endoscopy samples – Specimens are small • thickness – Tease sample out of forceps gently with a 25 G needle – Shake sample into preservative vial directly or onto tissue paper and then into vial

Endoscopy • Cleaning the endoscope – Very important as the endoscope can become inoperable if improperly maintained – Consult the manufacturer’s manual

Endoscopy • Cleaning the endoscope – Initial cleaning is very important. – Flush water then air through the air/water channel – Wipe insertion tube with a soft cloth – Suction detergent/flush water through insertion tube – Brush channels of the endoscope – Clean and lubricate valves

Endoscopy • Cold sterilization – Allow appropriate contact time – Rinse – Hang to dry

Endoscopy • Storage – Hanging position – Well ventilated cabinet – Do not store in the padded case

Other uses • • • PEG tube placement Cystoscopy Rhinoscopy Bronchoscopy Equine – EIPH – Laryngeal paralysis – “roarers” • Arthroscopic procedures

Endoscopy • Purchasing an endoscope – Last 5 -10 years – Buy quality unit – Human pediatric scope can be used, but may need an adult scope for larger dogs