Gastrointestinal endoscopy

image of Gastrointestinal endoscopy
Online Access: £ 25.00 + VAT
BSAVA Library Pass Buy a pass



The history and the physical examination of a patient indicates to the clinician the probable region of the gastrointestinal (GI) tract responsible for clinical signs. Further investigations using plain and contrast radiography, ultrasonography and functional tests may permit a tentative diagnosis to be made. However, these investigative procedures rarely permit a definitive diagnosis. Until recently clinicians have been limited in their ability to diagnose GI disease morphologically because of the need to carry out an exploratory laparotomy in order to obtain biopsy samples, where such a procedure may compromise an already seriously ill patient. The ability to pass a flexible endoscope directly into the GI tract and visualize the mucosa for gross abnormalities and collect biopsy samples without resorting to surgery have revolutionized gastroenterology. This chapter explains Flexible endoscope design; Components of the endoscope; Care and cleaning of endoscopes; Common problems encountered during endoscopy; Biopsy collection; Patient preparation for the upper GI endoscopy; Oesphagoscopy; Gastroscopy; Enteroscopy; Ileoscopy; and Colonoscopy.

Preview this chapter:
Loading full text...

Full text loading...



Image of 4.1
4.1 Rigid endoscopes can be used for examination of the oesophagus, removal of oesophageal foreign bodies and examination of the rectum.
Image of 4.2
4.2 There would be a loss of light passing along non-clad fibres due to the absence of suitable cladding around the fibre. This is why only light is transmitted down non-clad fibres, while the more expensive clad fibres are used to transmit the image.
Image of 4.3
4.3 Flexible endoscope including the insertion tube, handpiece and umbilical cord.
Image of 4.4
4.4 The handpiece of a flexible endoscope carries various important operational controls.
Image of 4.5
4.5 The tip of the insertion tube can be rotated through 90 degrees in three planes and 180 degrees in one plane.
Image of 4.6
4.6 One-handed manipulation of the headpiece. All endoscopists need to learn this technique.
Image of 4.7
4.7 There are two types of end piece available for flexible endoscopes. The end-viewing tip is more popular and is used for the majority of examinations, where the endoscopist wishes to see directly forward. The side-viewing endoscope is designed to allow good visualization of the wall of the bowel and to assist in catheterizing ducts, such as the bile duct. It is rarely used in small animal practice.
Image of 4.8
4.8 Two types of halogen cold light source designed for fibreoptic endoscopes.
Image of 4.9
4.9 Two types of suction unit that can be used with flexible endoscopes.
Image of 4.10
4.10 There are various types of biopsy forceps cups that can be used to collect samples. This figure shows biopsy forceps, with and without a central spike, which are commonly used for biopsy collection.
Image of 4.11
4.11 Basket forceps which can be used to retrieve gastric foreign bodies with the endoscope.
Image of 4.12
4.12 ‘Red out’ occurs whenever the endoscope is passed through a sphincter or comes up against the mucosal surface.
Image of 4.13
4.13 Gastric biopsy site and biopsy forceps as seen through the endoscope.
Image of 4.14
4.14 The patient is placed in left lateral recumbency with the endotracheal tube tied to the mandible and with the mouth gag in place. The flexible endoscope can now pass easily along the hard palate and into the pharynx.
Image of 4.15
4.15 Endoscopic view of the pharynx. The laryngeal opening (white arrow) and the lateral fold of the larynx (black arrow) are visible.
Image of 4.16
4.16 View along the length of a normal cranial oesophagus.
Image of 4.17
4.17 Annular rings seen in the caudal oesophagus of all cats.
Image of 4.18
4.18 The cardia high pressure zone, separating the oesophagus from the stomach.
Image of 4.19
4.19 Large cavernous oesophagus associated with megaoesophagus.
Image of 4.20
4.20 Oesophageal foreign body lodged in the caudal oesophagus.
Image of 4.21
4.21 Reflux oesophagitis with gastric secretions, lying in the oesophagus.
Image of 4.22
4.22 Oesophageal stricture showing changes to the mucosal colour due to fibrosis.
Image of 4.23
4.23 Oesophageal tumour. These are rare in dogs and cats.
Image of 4.24
4.24 Normal gastric fundus showing the rugal folds. (Diagram reproduced from with permission from Elsevier.)
Image of 4.25
4.25 The images show a view of the angular incisure on the lesser curvature of the stomach. This is a very important endoscopic landmark. (Diagram reproduced from with permission from Elsevier.)
Image of 4.26
4.26 The angular incisure becomes more prominent as the stomach becomes distended with air.
Image of 4.27
4.27 Retroflexed view of the gastric cardia with the endoscope clearly visible entering the stomach. (Diagram reproduced from with permission from Elsevier.)
Image of 4.28
4.28 Over-distension of the stomach will result in the angular incisure closing over the antrum, leading to difficulty in intubating the antral canal and pylorus. (Reproduced from with permission from Elsevier.)
Image of 4.29
4.29 The pylorus can usually be visualized with the endoscope in the antral canal. Often the pylorus is closed, but here it is open. Some bile-stained fluid can be seen in the antral canal.
Image of 4.30
4.30 Some of the mucosal changes which may be observed individually, or in combination, in animals with gastric carcinoma. (a) Large gastric ulcer at the entrance to the antrum. (b) Mass and pigmentation. (c) Proliferative mass. (d) Loss of normal architecture. (e) Colour change to the mucosa.
Image of 4.31
4.31 A flexible endoscope made with a 1.6 metre insertion tube, permitting the jejunum to be examined in dogs and cats. (Courtesy of Guide Dogs for the Blind)
Image of 4.32
4.32 Normal duodenal mucosa has a ‘velvet’ appearance due to the presence of thousands of intestinal villi. (Diagram reproduced from with permission from Elsevier.)
Image of 4.33
4.33 Biopsy of the ileum can be carried out via the colon.
Image of 4.34
4.34 View along the descending colon from the rectum.
Image of 4.35
4.35 The splenic flexure can be clearly seen, indicating the end of the descending colon and the start of the transverse colon.
Image of 4.36
4.36 In the normal dog or cat, colonic submucosal blood vessels can be easily seen. This is not an indication of inflammation.
Image of 4.37
4.37 Ulcerative colitis in the dog.
Image of 4.38
4.38 Rectal adenoma obstructing the lumen of the rectum.
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error