Page 544 - Clinical Small Animal Internal Medicine

512 Section 6 Gastrointestinal Disease

are irritating to mucosal tissue, so it is important to manual input, typically in less than one hour. These sys-
VetBooks.ir ensure that residues of the cleaning solution have been tems may also generate a record for each endoscope of
cleaning solution exposure times and pressure test
removed before use on a patient.
Endoscopes should be stored dry, following effective
cleaning (Figure 49.5). If space is available, they can be results, and monitor the age and use of the cleaning solu-
tions. An additional advantage is that the operator is pro-
stored in specially constructed rack systems in a dedi- tected from the cleaning and sterilization fluids during
cated cabinet. Other items unrelated to endoscopy endoscope reprocessing.
should not be stored in the same cabinet to minimize the
risk of endoscope damage. If a dedicated cabinet is not
used, the cleaned and dried endoscope should be stored Endoscopic Terminology
in the original shipping/packing case to provide adequate
protection. Obviously, if transporting endoscopes in the Endoscopic evaluation of the gastrointestinal tract pro-
field or between hospital sites, they are best carried in vides an opportunity to assess the gross appearance of
their specific transport case. the gastrointestinal mucosa. Findings with gastrointesti-
Effective complete cleaning and sterilization of an nal endoscopy therefore are usually descriptions of the
endoscope can be quite time‐consuming. In practices mucosa and attempt to define the ways, if any, in which
that carry out several procedures in a day, investment in the mucosa differs from normal. Standardization of the
an automated scope cleaning and reprocessing system language used to describe endoscopy findings is useful to
can be cost‐effective, freeing up technician resources for maintain consistency in interpretations and comparison
other tasks. These systems can automatically carry out across patients. The terms recommended for the descrip-
both the low‐and high‐level cleaning steps, final rinsing tion of the mucosa, most of which are also incorporated
of the endoscope and pressure testing without further into the WSAVA recommended reporting forms for gas-
trointestinal endoscopy procedures, are summarized in
Table 49.1 and discussed in greater detail below.

Friability

Friability refers to the susceptibility of the mucosa to
superficial damage and hemorrhage on contact with
either the endoscope tip/body or biopsy instruments.

Table 49.1 Terminology used for the description
of endoscopically visualizable abnormalities of the gastrointestinal
mucosa

Parameter Definition
Normal No macroscopic lesions are observed
mucosa
Friability Occurrence and degree of bleeding on contact
of the endoscope or biopsy instrument with the
mucosal surface
Granularity Perceptible alterations in the visible texture of
the mucosa
Erosion(s) The presence of superficial linear to patchy
mucosal defects, usually with bleeding present
Hyperemia Subjective perception of the redness (pale to
markedly reddened) of the mucosa
Lymphatic The presence and degree of white foci
dilation * (punctate to diffuse) within the mucosa
Mass present Detection of abnormal tissue protruding into
the intestinal lumen
Figure 49.5 Clean and dry flexible endoscopes stored in a
dedicated storage cabinet. An effective and sturdy retention Source: Modified from Slovak et al. (2015). Reproduced with
system should be used to minimize the risk of endoscopes being permission of Elsevier.
dropped and damaged. * Lymphatic dilation is assessed and scored only in the small intestine.