Friday, May 13, 2016

Endoscopy Use Can Be Challenging, Rewarding


"Being a veterinary internal medicine specialist most of my day consists of thinking about test results and not many hands-on procedures.

I (Perry Jameson) do perform physical examinations on each patient and abdominal ultrasounds, but the majority of the time I am looking at results and then deciding which medications to treat.

Sometimes, I will admit I do get a little jealous of the excitement of Dr. Henri Bianucci's job.

However, there is a procedure in the world of internal medicine that is beneficial for my patients as well as fun and challenging for me: endoscopy.

An endoscope is a long, tubular instrument with a camera on the end. The endoscope is a noninvasive technique that allows me to visually assess the esophagus, stomach and intestine of my patients. The only major risk is the anesthesia required.

There are also channels that run down the scope that allow me to pas instruments to perform certain procedures without surgery. Once the side effects of anesthesia wear off, they should be back to how they were prior to the endoscopy.

Last week, I had a day that reminded me just how fun, challenging and rewarding endoscopy can be.

Comet is a 4-month old male German shepherd who began regurgitating as soon as he was weaned onto solid food at around 6 weeks of age. He could keep a gruel down, but anything thicker came right back out. This was stunting his growth.

His family veterinarian had performed X-rays, which revealed his esophagus narrowed just above his heart preventing solid foods from easily passing.

His breed is prone to having a birth defect where a non-functioning vessel wraps over the esophagus and narrows the lumen. Thoracic surgery is required to cut the vessel and free the esophagus. Every test performed looked like this was Comet's problem, so he went to surgery.

Well, no abnormal vessel was found so they called me into the operating room to scope Comet. What I found surprised us all.

Comet had a stricture of his esophagus. When the esophagus heals following an injury, it often will form a stricture resulting in an opening one-forth the normal size. I have seen this in patients who had severe stomach acid reflux during anesthesia or a rib bone caught in the esophagus, but never in a puppy without history of an esophageal injury.

If surgery were performed to fix this area, it would heal back with a stricture. With the endoscope, however, we were able to pass a balloon through the narrowing. When the balloon was expanded, it dilated the area. Now Comet can keep his food down and can grow like a normal puppy should.

Soon after completing Comet's procedure, one of the ER doctors telling me a Labrador named Pewter, who had eaten a AAA battery, was on her way. The family veterinarian had induced vomiting in hopes of bringing the battery up, but this had only produced food. X-rays revealed the battery was definitely in the stomach.

Mom was presented with two options. We could try to remove the battery by endoscopy and, if successful, she would go home the same day.

Removing a foreign body by endoscopy is easier said than done however. You are working in a tight space with small instruments while watching all of this on a TV screen.

If there is any food in the stomach, it can literally be like looking for a needle in a hay stack. If part of all of the foreign body has passed into the intestine, it can be impossible and even dangerous to remove. Usually, we can get most foreign bodies out of the stomach, but every once in awhile, surgery is necessary.

So going straight to surgery is an option, but this means she would be with us for a night or two. Mom elected to let me try endoscopic removal. Fortunately, the dog's stomach was empty so I was able to find the battery.

A device with a loop was passed down the scope that I was able to loop over the battery. Once tightened around the battery, it was pulled out of the stomach, up the esophagus and out the mouth.

Edward was my final endoscopy of the day. He is a 9-year-old Yorkie who had chronic diarrhea, weight loss and low blood proteins.

This breed can develop a condition of the intestine where they ooze protein into the bowel and lose it from their body every time they defecate. If it goes on long enough, their blood proteins drop. These proteins help keep fluid in our blood vessels, and when they drop too low, the vessels leak fluid into the thoracic or abdominal cavity.

Edward had developed a pot belly secondary to this fluid accumulation and was starting to have shortness of breath from the chest fluid.

We drained the fluid to make it easier for him to breathe and then performed an endoscopy. Visually I noted an excess of fluid in his intestines, but this is a nonspecific finding. What we needed to know was what was causing the problem.

The endoscope allowed me to pass a small biopsy instrument into his intestine and obtain tissue samples. Edward was able to go home the same day. A pathologist was able to look at the samples microscopically and give me a diagnosis that enabled me to come up with a treatment plan.

Endoscopy is a valuable yet noninvasive tool for diagnosing and treating gastrointestinal disease."

By Dr. Henri Bianucci and Dr. Perry Jameson from 
Veterinary Specialty Care LLC



Click here for the original article.



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