Following induction of anesthesia - it is essential to intubate patient.
Tie endotracheal tube to mandible NOT maxilla, to aid passage of endoscope.
Lay patient in left lateral recumbancy.
Place mouth gag to protect endoscope.
Insert endoscope along hard palate and into proximal esophagus .
Slowly pass endoscope along the esophagus.
Step 2 - Enter stomach
Once cardia is reached gently apply force on endoscope to enter stomach.
'Red out' will occur during intubation of stomach. (Vision is lost).
Once you feel the endoscope pass the cardia, STOP, gently inflate stomach with air.
Do NOT examine the stomach but inflate with only the minimum amount of air to permit passage of the endoscope to the pylorus. Excessive air will close the pylorus, making duodenal intubation impossible.
Step 3 - Identify pylorus
Pass endoscope along antrum to visualize the pylorus .
Bile may be observed entering the stomach as may antral peristaltic contraction.
Step 1 - Entering the duodenum
Intubation of the duodenum of the cat is the hardest endoscopic procedure to carry out.
Gently move the endoscope tip towards the pylorus, 'red out' will occur again.
Maintain gentle pressure, do NOT force the endoscope, until resistance is reduced indicating passage into the duodenum. Often the 'red out' will become a 'yellow out' indicating the presence of bile and entry into the duodenum.
At this point inflate with air until mucosa is visualized .
Advance endoscope along the duodenum examining the mucosa as you proceed.
Note the mucosa has a velvet appearance which is different to the stomach.
Collect biopsy samples from different levels of the duodenum.
With 1.5 m insertion tubes the jejunum may be examined, but NOT the ileum.
Step 2 - Biopsy collection
Do not overinflate the bowel as this will make mucosa stretch tightly reducing ability to collect samples.
Try and advance biopsy forceps perpendicular to the mucosa.
Tent mucosa before closing biopsy forceps and retrieving sample.
Deeper samples can be collected by sampling repeatedly at the same site.
Perforation will occur if this is done too frequently.
Capillary bleeding from biopsy sites is normal.
Step 1 - Remove endoscope
Gently withdraw endoscope into stomach.
Examine the stomach at this time Gastroscopy and take biopsies.
Withdraw endoscope from patient. Support end of scope as it is withdrawn to prevent damage.
Routine post anesthetic observation.
Check mucus membrane color, heart and respiratory rates in case of hemorrhage.
Check there is no evidence of gastric dilation.
Do not overinflate bowel. Apply only enough air to allow adequate visualization.
Arterial bleeding from biopsy sites.
Bowel perforation from applying too much force especially during intubation of duodenum.
Iatrogenic damage to mucosa caused by advancing endoscope along bowel.