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To Scope or Not

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Amy Allen, DVM, DACVIM VetScope 2019-11-13

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To Scope or Not
Amy Allen, DVM, DACVIM
Mobile Endoscopy
415-272-8982

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Lecture notes
• Email me for digital copy
– Amyntrip@SBCGlobal.net

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Shout outs
-Just for fun
-See a “Shout Out”
-Call out type of animal
-First or closest one gets a prize

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Is endoscopy the right answer?
-Non-invasive
– Home and eating within 4 hours of procedure
– No healing, No pain, No risk of infection, No risk of strictures, No need for antibiotics
– Try to act as if it is your body and then choose
-Faster
– Usually (depends on procedure)
– Consider hospital time and healing time in your calculation

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Yes, it is – often!
– Less expensive vs. surgery
– Visualize structures not seen in surgery
– Mucosa, esophagus, underlying causes
– Not sure? Call me 24/7.
– “If in doubt, scope it out!”

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Foreign bodies may represent pica

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Post-surgical stricture

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Scope for the jackpot

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Shout out

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Symptom Approach
–Hard swallowing
– Oro/Nasopharynx, Tonsils, Esophagus,
Nose, GI disease (nausea),...
– Scope for post nasal discharge, foreign
body, polyp, tumor, fungal, ...
– Sneezing/Nasal discharge
– Scope for foreign body, tumor, fungal,
chronic rhinitis
– Suspect a nasal foxtail but can’t find it?
– Scope! Before your patient presents for secondary fungal or chronic rhinitis in a year.

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Visualize caudal nares

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Visualize Nasopharynx

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After ballooning

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After search for hard swallowing

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Rhinoscopy Tamalpais Pet

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With cats, what they usually do is they eat the grass and then they vomit up into the nasopharynx. Then we have to go over the soft palate over the back of the nose to pull out that grass or whatever foreign bodies they vomited up into nasopharynx.

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Shout out

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Symptom Approach
– Bleeding (with normal bleeding times and BP)
– Hematemesis
– Scope for foreign body, cancer, ulcer – Hematochezia
– Hematochezia
– Scope to locate source (colon, cecum, ileum)
– Scope for tumor – assess number, location, size and biopsy for histopathology before sx
– Hematuria
– Scope to locate source, biopsy if tumor

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Hematochezia

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Shout out

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Symptom Approach
• Cough
– Scope for laryngeal function exam, oro/nasopharynx, assess extent of disease (e.g. collapse, secondary changes), search for foreign body, masses, or to follow up on treatment
– Scope before antibiotic or steroid trials if possible. Best to know what you are treating and which if any antibiotics are needed.

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May not need Pred or Abx!

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Post Nasal Discharge

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Intermittent Cough

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Localize

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Bronchoscopy Broadway
Removing grass awn
Animal Internal Medicine
Bronchoscopy Broadway
End of grass awn

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Secondary changes

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Shout out!

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Symptom Approach
– UTI’s or Incontinence
– Chronic or recurrent
– Scope for ectopic ureters, foreign body, strictures, anatomical abnormalities or mass
– Megaesophagus/Regurgitation
– Scope to confirm disease and check for esophagitis, esophageal foreign body or tumor and place PEG tube early to prevent aspiration

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Vaginal Vault

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Shout out!

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Symptom Approach
– Chronic Otitis
– Scope for foreign body, tumor, polyps
– Assess tympanic membrane
– Clean out
– Vomiting/Diarrhea
– Scope for foreign body, IBD/LSA (before steroids ideally), Infectious causes, Lymphangectasia (yes, we can see it!)

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Animal Internal Medicine
Endoscopy of an Ear
Bulging eardrum
purulent discharge and blood after biopsying and moving eardrum
mass

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Lymphangectasia

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Rule out infectious

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Foreign Bodies – seen and unseen

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8 months later
- This cat was treated for “IBD” for 8 months.

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Star from duodenum

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“IBD or LSA”

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Which foreign bodies are easy?
- Coins, bones, grass, needles, thumb tacks, plastic pieces, linear foreign bodies (yes, really), most esophageal foreign bodies, hairballs, hair bands, socks/cloth, tampons, small balls
- Those that take a little more time but still scopable – Large balls (even full sized tennis balls), grass impaction, extra large hairballs, embedded fishhooks, whole chickens, wedged intestinal foreign bodies

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Esophageal foreign bodies – child’s play?

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Esophageal Foreign Body

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Removing Esophageal FB

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FB out!

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Esophageal foreign bodies can be subtle

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But really, they can be
- This dog came in every day for 10 days with symptoms of non-localizable pain

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“It all started with a treat.”

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Cloth – easy to grab

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Even blankets

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Coins

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Strings

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Rocks Easy / More difficult

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Needles, Tacks, Fishhooks

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Getting Creative

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Baby Bottle Liner Technique

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Shout Out

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Myths
– “It is too big to scope out”
– If it went down, it should come up.
– String foreign body
– As long as I can get near the end of
string, I can get it out.
– Sharp things – glass, razor blades, needles, etc...
– Not a problem. Foreign body hood protector and removing in correct position

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Large hairballs

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Rubber ducky’s become ducky statues

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Whole ball

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Even the jumbo tennis balls

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Linear foreign bodies

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Sharp Foreign Bodies

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Piece of glass

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Fishhooks

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Too big?

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A chance to cure without harm

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Animal Internal Medicine
Owner: McAbee. William Animal: Scout Date: 30-Nov-2017 11:39:07 RAbdomen Lateral
North Peninsula Veterinary

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Too Small

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Shout Out

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– “Once it is in the intestines/jejunum, it needs surgery”
– Duodenum is not a problem, can reach mid jejunum in a cat or small dog. (150 cm scope)
– Too Many/too much
– Requires patience but remember no
recovery time.
– “It has been in there too long!”
– Only a problem if necrosis or perforation

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Thanks for not cutting me!

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Cats and plastic

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More plastic foreign bodies

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Not too many – takes patience though

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Hair bands are common

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Dogs too

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Guarantees
The most common reason I hear for not performing endoscopy is that the owner wants a guarantee we will get the answer or remove the foreign body.

We cannot guarantee anything in medicine but we can guarantee that endoscopy is safer and in the right hands, a highly successful option.

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Shout out

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Should I wait until tomorrow?
- While some foreign bodies will move on and save the owner the expense of endoscopy, I never like to sleep on a gastric foreign body because they might become an intestinal foreign body and can cause a surprising amount of damage in a short time.
- Consider if there might be a toxin in the foreign body – eg zinc in coins or any metallic foreign body

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Waiting...
- Never wait – even hours on an esophageal foreign body. The damage can be extensive quickly leading to perforation or future strictures.
- Bones can cause ulcers and perforations quickly.
- Metallic foreign bodies.

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Esophageal FB

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Ouch!

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Double ouch!!

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Bones can be like knives

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Near perforation from bone

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Zinc toxicosis

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Shout out

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Other Endoscopy Options
- Percutaneous Endoscopic Gastrostomy Tubes
- Jejunal Percutaneous Endoscopic Gastrostomy Tubes
- Place and ensure correct placement of NE or NG tubes
- Minimally invasive endoscopy assisted gastropexies
- Stent Placements (ureters, trachea, bronchi, colons, urethra,...)
- Balloon dilations (esophageal feeding tube option)

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PEG tube in cat

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Shout out

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Esophageal stricture

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Balloon Dilation

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Lesion distal to stricture

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Esophagus after 4th dilation

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Gastropexy

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How I Protect my Scopes

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Shout out

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Ella the Siamang

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Thankssss for lisssening

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Amy Allen, DVM,
Diplomate ACVIM
415-272-8982

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