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1098 Endoscopy, Upper GI (Gastroduodenoscopy)

Endoscopy, Upper GI (Gastroduodenoscopy) Client Education Bonus Material
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(e.g., CBC, serum biochemistry profile,
Difficulty level: ♦♦
to the gut wall.
urinalysis, abdominal radiographs in all maximizes visibility and minimizes trauma
Synonym cases), abdominal ultrasound, fecal flotation, • Thread the scope through the lower esopha-
Upper gastrointestinal (GI) endoscopy adrenocorticotropic hormone stimulation test geal sphincter by keeping the opening to the
(i.e., ACTH stimulation test), and others stomach in the center of the screen/view
Overview and Goal as indicated by the specific features of each piece while gently advancing the scope.
Minimally invasive endoscopic method of visu- case). • After the distal end of the endoscope is in
alizing the mucosal surface of the stomach and the stomach, insufflate the stomach with air
proximal duodenum. This procedure offers the Possible Complications and to separate the walls and improve visibility.
possibility of retrieving foreign bodies (p. 1115), Common Errors to Avoid Insufflate until the rugal folds of the stomach
performing mucosal biopsies, and placing a • Narcotic analgesics (e.g., morphine and are less prominent but still present. If the
gastrostomy or jejunostomy tube (p. 1109). butorphanol) increase motility of the rugal folds are completely flattened by insuf-
pyloric antrum and may make passage of flation of air, there is risk of compromising
Indications the endoscope into the duodenum difficult. respiration or rupturing the stomach.
• Chronic or acute vomiting • If there is any possibility the stomach • If duodenoscopy is to be performed, it is best
• Gastric/esophageal foreign body (p. 351) may contain food, perform an abdominal to proceed directly to the pylorus. Prolonged
• Suspicion of gastric or duodenal ulcer (p. radiograph immediately before endoscopy insufflation or other activity in the stomach
380) to confirm the stomach is empty. stimulates pyloric tone and motility, making
• Suspicion of gastric or duodenal neoplasia • Gastric or duodenal rupture threading the scope through the pylorus more
(p. 379) ○ Usually only occurs when the wall is difficult.
• Suspicion of inflammatory bowel disease compromised by a deep ulcer or neoplasia. • Advancing the scope through the pylorus
(p. 543) Avoid advancing the scope when the is usually the most difficult part of this
• Placement of percutaneous endoscopic lumen cannot be seen. procedure. The tone and degree of patency
gastrostomy (PEG) tube for enteral feeding • Overinsufflation, usually of the stomach, of the pylorus can be quite varied.
may cause potentially severe bradycardia • If it is difficult to advance the scope to the
Contraindications due to abdominal compartment syndrome opening of the pylorus (i.e., the scope is
• Food or barium in stomach and creates the risk of gastric rupture. fed into the animal but advances no closer
• Large and/or sharp foreign body • Prior administration of barium can make to the pylorus), suction some air out of the
visualization difficult, and aspirating it stomach—it may have been overinflated.
Equipment, Anesthesia through the endoscope may be damaging This is common in large-breed dogs.
• General anesthesia (with endotracheal intuba- to the suction channel of the endoscope. • If the pylorus is open, immediately advance
tion) required • Failure to recognize the major duodenal the scope into the duodenum. If the pylorus
• Mouth gag/speculum papilla as a normal structure (major and is closed, maintain the opening to the pylorus
• Flexible fiberoptic or video endoscope minor duodenal papillae in cats) could in the middle of the screen while gently
○ Diameter of 9-10 mm and length lead to inadvertent biopsy and potential advancing the scope. If resistance is encoun-
of 1000-1250 mm are sufficient for fibrosis and obstruction of the pancreatic tered, do not force the scope. Sometimes,
gastroscopy and duodenoscopy of most and common bile ducts. insufflating some air at the opening of the
medium- to large-sized dogs and for only pylorus will stimulate it to open (short puffs
gastroscopy of cats and small dogs. Procedure of air).
○ A diameter of 5.5 mm or less is usually • Induce general anesthesia. • If the pylorus is impossible to thread, try
necessary to enter the duodenum of cats or • Position the animal in left lateral recumbency. feeding a closed pair of endoscopic biopsy
small dogs. A length of 900-1000 mm is • Place a mouth gag. forceps through the pylorus. Use the threaded
usually sufficient for cats and small dogs. • Lubricate the endoscope with water-based forceps as a guide wire to feed the scope into
• Vacuum source for endoscopic suction lubricating jelly. the duodenum.
• Endoscopic biopsy forceps • Introduce the endoscope into the mouth, and • After the distal end of the endoscope is in
• Endoscopic foreign-body retrieval forceps, feed it gently through the upper esophageal the duodenum, advance the scope down to
snares, or baskets sphincter. the limit of its length.
• Biopsy jar with 10% buffered formalin; cas- • Examine the esophageal mucosa as the scope • Identify, if possible, the major duodenal
settes for placement of biopsies in formalin is advanced down to the lower esophageal papilla where the pancreatic duct and
ideal sphincter. common bile duct empty into the duodenum.
• Insufflate the esophagus with enough air Do not biopsy this structure accidentally.
Anticipated Time to prevent the walls from collapsing on the • Examine and identify any irregularities of the
• Usually 60-90 minutes anesthesia time scope and reducing visibility. An assistant duodenal mucosa and any foreign bodies.
(30-60 minutes endoscopy time) may be required to gently occlude the upper • Obtain multiple (6-12) mucosal biopsies
• Complex foreign-body retrieval may take > esophagus by gently squeezing the cervical using biopsy forceps. Store them in 10%
60 minutes. region externally, immediately cranial to formalin. Brushings or fluid samples for
the larynx, to prevent insufflated air from cytologic analysis or culture may be obtained
Preparation: Important escaping out of the mouth. This will not be now as well.
Checkpoints necessary after the tip of the endoscope is • Slowly withdraw the endoscope from the
• Animal should have fasted for 12 hours in the stomach. duodenum, and obtain mucosal biopsies
before the procedure if possible. • It is important to keep repositioning the periodically along its length.
• Simpler, less invasive diagnostic procedures scope as it is advanced so the scope is kept in • After the tip of the endoscope is back in
are performed before diagnostic endoscopy the center of the lumen on the screen. This the stomach, examine the entire stomach,

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