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Endoscopy & cats—the places we can go (Proceedings)

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Aug 01, 2011

Endoscopy is a wonderful diagnostic tool that allows exploration and biopsies of areas without invasive surgery. Given the option, many clients may prefer endoscopy instead of surgery. What types of cases are suited to endoscopy? How do you prepare a cat for endoscopy? This lecture will cover those questions and more as we explore the places we can go with endoscopy. Case studies will be used to highlight certain points.

Types of scopes I use commonly in cats:

Rigid:

     • 2.7 mm Multi-purpose endoscope, 18 cm working length

Flexible:

     • Gastroscope with 2.5 mm working channel; 8.5 mm shaft diameter; 150 cm working length
     • Videoscope with 2.8 mm working channel; 8.5 mm shaft diameter; 140 cm working length
     • Specialty Fibroscope with 1.2 mm working channel, shaft diameter 2.9 mm;
     • 100 cm working length
     • Bronchoscope with 2.2 mm working channel; 5 mm shaft diameter; 580 mm working length

Scopes to start with: Rigid scope, one long flexible GI scope

Areas that can be scoped

          - Nose
          - Ears
          - Mouth
          - Pharyngeal area
          - Laryngeal area
          - Airways – Trachea, Bronchial tree
          - Upper GI – Esophagus, Stomach, Duodenum, Upper portion of jejunum
          - Lower GI - Colon up to Ileocecal colic junction
          - Vagina, Urethra and Bladder (Female cats)
          - Joints

Given all the different sizes of endoscopes available, almost any opening in the feline patient can be entered. The one exception is the urethra of the male cat.

Percutaneous approach is also a consideration (kidneys, ureters, bladder, etc.)

Preparation for Endoscopy

Since most endoscopic procedures require general anesthesia or heavy sedation, a preanesthetic evaluation (blood work, urinalysis) is recommended. Radiographs of the chest and abdomen may also be indicated depending on the pet's clinical signs. Some radiographic studies, such as skull radiographs, are better performed under anesthesia. For areas that are very vascular (nasal cavity), consider performing coagulation tests prior to the procedure.

No barium should be given to the patient within 24 hours of the procedure, AND barium must have cleared the areas of interest. Barium will cause significant damage to the endoscope and contact between the endoscope and barium must be avoided.

What can be accomplished with endoscopy?

          - Close-up visualization of an area of interest in a non-invasive manner
          - Biopsy area of interest for histopathology, cytology, and/or cultures
          - Evaluation/Removal of foreign object(s)
          - Feeding tube placement
          - Perform diagnostic tests and therapeutic procedures in any part of the body that can be
          - accessed endoscopically (Interventional Endoscopy), often performed in conjunction with
          - some other imaging modality (fluoroscopy, ultrasound). Ex: urethral stenting, balloon
          - dilatation for nasopharyngeal stenosis and esophageal strictures; tracheal stenting,
          - lithotripsy for renal, ureteral or cystic calculi