Page 3310 - Cote clinical veterinary advisor dogs and cats 4th

Consent to Perform Endoscopy, Upper GI (Gastroduodenoscopy)

VetBooks.ir Patient name:_________________________________
Pet owner’s name:_____________________________ Med rec #____________
Best contact during/after procedure (e.g., cell phone number):____________________

INTRODUCTION FORESEEABLE RISKS TO THE PROCEDURE
We want to make sure that you understand the planned medical Complications associated with this procedure are rare but can
procedure to be performed on your pet. You should know why the include gastrointestinal perforation (in less than 0.5% of dogs and
procedure has been suggested, what the potential benefits are for less than 2% of cats), excessive bleeding at a biopsy site, and
your pet, and the most common/important risks of the procedure. torsion of the stomach after anesthesia. Gastrointestinal perforation
Alternatives to this procedure, when applicable, will be discussed is life-threatening and would require immediate surgical intervention.
with you. It is also important that you recognize that medicine is You should also know that endoscopy only allows for evaluation
not an exact science, and that the outcome cannot be guaranteed. of a small portion of the intestine, and only allows for sampling of
We encourage you to ask us as many questions as required for the innermost layer of the gastrointestinal tract. It is possible that
you to make a well-informed decision. endoscopy might not identify a specific cause of your pet’s illness.
You should also know that it is not always possible to remove foreign
BENEFITS/OPTIMAL OUTCOME OF THE PROCEDURE bodies stuck inside the gastrointestinal tract via endoscopy, even
Upper GI endoscopy is a minimally invasive procedure that can despite repeated attempts. In such cases, surgery would likely be
serve more than one purpose. In some cases, this procedure may required.
allow us to inspect the upper gastrointestinal tract (esophagus,
stomach, and a small part of the intestines) and obtain tissue samples Other anticipated risks specific to your pet:___________________
that may help us determine the cause for a pet’s clinical signs.
In other cases, if a pet is unable to consume enough calories to _________________________________________________________
maintain his or her weight, a feeding tube can be placed during
this procedure to help provide adequate nutrition. Another use
for upper GI endoscopy is to remove foreign material from the ALTERNATIVES TO THE PROCEDURE
gastrointestinal tract, such as a rawhide or chew toy that has The alternative to this procedure would be to perform surgery in
become stuck. Unless this procedure is performed to remove a order to obtain the tissue samples.
foreign body, endoscopy is not a treatment for disease, but a tool The most important advantage of obtaining surgical biopsies is
that aims to find a diagnosis for a treatable disease. that it would allow evaluation of the entire length of the intestines,
and sampling of all layers of the gastrointestinal tract. Additionally,
EXPLANATION OF THE PROCEDURE evaluation and biopsy of the other abdominal organs (e.g., the liver
During this procedure a small camera (endoscope) is inserted by and pancreas) would also be possible with surgery. However, surgery
mouth and used to visually inspect the esophagus (the connection is more invasive than endoscopy, and surgery does not allow visual
from the mouth to the stomach), stomach, and a short section of inspection of the inside of the esophagus, stomach, or intestines.
the small intestine. This part of the procedure allows us to identify Regardless of the method used to obtain tissue samples, without
foreign material, ulcers, and some tumors. A biopsy instrument is the additional information provided by analysis and inspection of
used to obtain small samples (approximately the size of a grain the tissue, we would need to develop a treatment plan without a
of rice) of the innermost layers of the stomach and small intes- confirmed diagnosis, which might lead to a suboptimal outcome.
tine. These samples are sent to a laboratory for analysis under
a microscope. AUTHORIZATION
Additional procedures planned for your pet at the same time By signing this form below, you agree that:
as the upper GI endoscopy: • You understand how/why the procedure is likely to help your
pet
____________________________________________________________ • You understand what will be done to your pet during the
procedure
USE OF SEDATIVES OR ANESTHESIA • You understand the known risks that accompany the proce-
This procedure requires general anesthesia. General anesthesia dure, and also understand that unforeseen complications may
causes your pet to become unconscious. Although anesthesia occur
is performed routinely with good outcomes, it does bring risks, • You understand that the procedure may not produce the results
including a very small risk of death. These risks are increased for we hope to achieve
animals with severe disease. To reduce these risks, your pet will • You understand the alternatives to this procedure for your
be supplied with extra oxygen, and will be monitored closely during pet
both anesthesia and during recovery from anesthesia. The decision • You agree that you have been given time to ask questions regard-
to perform this procedure is based on having assessed that the ing the procedure, that these have been answered satisfactorily,
anticipated benefit is greater than the anesthetic risk. and that you are free to decline the procedure.

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved.