Diagnostic Endoscopy

Upper GI endoscopy, often referred to as ‘endoscopy’, ‘gastroscopy’ or ‘oesophago-gastro-duodenoscopy’, is a procedure that allows the veterinary surgeon to directly examine the lining of the upper part of the GI tract. The upper GI tract consists of the oesophagus, the stomach, the duodenum and the first part of the jejunum.

A flexible tube with a camera and a light source, about the thickness of your little finger, is placed into your pet’s mouth and then into the oesophagus, stomach and duodenum. 

Upper GI endoscopy is performed to evaluate the signs and attempt to identify/exclude the causes of persistent regurgitation, acute and chronic vomiting, difficulty swallowing (dysphagia), blood in the vomit (haematemesis), diarrhoea and weight loss. It is an excellent minimally invasive alternative to traditional surgery for investigating the cause of bleeding from the upper GI tract. Endoscopy tends to be more accurate than abdominal imaging (e.g. radiography and ultrasonography) for detecting inflammation (redness), bleeding, ulcers, tumours and blunted intestinal villi (finger-like projections that increase the surface area of the intestine for the absorption of food).

Minimally invasive diagnostics:

Endoscopy can be used to obtain biopsy samples using specialised instruments known as biopsy forceps. Biopsy samples are routinely obtained during endoscopic examinations as many conditions can only be diagnosed in a laboratory by analysing tissue specimens. Biopsy samples from suspicious areas can be useful for distinguishing between cancerous and non-cancerous conditions.

Lower GI endoscopy, often referred to as ‘ileoscopy and colonoscopy’, is a procedure that allows the veterinary surgeon to directly examine the lining of the lower part of the GI tract. The lower GI tract consists of the last part of the small intestine (distal jejunum/ileum) and the colon, including the caecocolic pouch (similar to the appendix in humans) and the rectum.

A flexible tube with a camera and a light source, about the thickness of your little finger, is placed into your pet’s rectum to examine the last part of the colon (rectum and descending colon), the middle colon (transverse colon), the first part of the colon (ascending colon) and the ileocolic sphincter (the valve that separates the last part of the small intestine from the colon).

Colonoscopy and ileoscopy are performed to evaluate the signs and attempt to identify/exclude the causes of persistent diarrhoea, weight loss, low vitamin B12 levels, excessive mucus, straining to defaecate and blood in the faeces (haematochezia). It is an excellent minimally invasive alternative to traditional surgery and tends to be more accurate than abdominal imaging (radiography and ultrasonography) for detecting inflammation (redness), bleeding, ulcers, polyps and tumours.

Minimally invasive diagnostics:

Endoscopy can be used to obtain biopsy samples using specialised instruments known as biopsy forceps. Biopsy samples are routinely obtained during endoscopic examinations as many conditions can only be diagnosed in a laboratory by analysing tissue specimens. Biopsy samples from suspicious areas can be useful for distinguishing between cancerous and non-cancerous conditions.

Rhinoscopy is a minimally invasive procedure that allows the veterinary surgeon to directly examine the back of the nose (nasopharynx) and the nasal cavities. In some patients, the endoscope can also be manipulated to allow evaluation of the frontal sinuses. This procedure is called sinusoscopy.

A rhinoscope is a small endoscope with a camera and a light source. Rhinoscopes are described as either flexible (long tubes made of small fibreoptic bundles encased within a soft flexible material) or rigid (long tubes made of glass rods encased within a stainless steel tube). A flexible or rigid rhinoscope can be inserted into each nostril to view the nasal passages and sinuses. A flexible endoscope can also be inserted into the mouth and up over the soft palate in a retroflexed position (bent back on itself) to examine the nasopharynx. 

Rhinoscopy may be recommended for diagnostic and/or interventional (treatment) purposes.

Minimally invasive diagnostics:

Rhinoscopy can be used to confirm the cause of persistent and uncontrolled sneezing, reverse sneezing, chronic nasal discharge (unilateral or bilateral), snoring (stertor) and unexplained nose bleeds (epistaxis). Rhinoscopy can also be used to obtain biopsy samples using specialised instruments known as biopsy forceps. These samples can be submitted to a laboratory for bacterial culture and sensitivity testing. Biopsy samples may also be useful for distinguishing between cancerous and inflammatory conditions.

Otoendoscopy (video-otoscopy) is a procedure that allows the veterinary surgeon to directly examine the ears. An otoscope is a small rigid endoscope with a camera and a light source. The otoscope is passed into the ear canal with the patient either conscious as a ‘dry’ procedure or, more commonly, under general anaesthesia with the assistance of fluid irrigation to examine the ear canal and ear drum (tympanic membrane).

Otoendoscopy is performed to evaluate the signs and attempt to identify/exclude the causes of persistent ear infections, polyps, ear drum rupture, head tilt, wobbly gait, nystagmus (abnormal side-to-side eye movement) and Horner’s syndrome (droopy eyelid, small pupil, dry eye). It is an excellent minimally invasive alternative to traditional surgery for investigating and treating many ear conditions. Otoendoscopy tends to be more accurate than traditional imaging techniques (e.g. radiography) for diagnosing external, middle and inner ear disease. It is often used in conjunction with computed tomography (CT).

Minimally invasive diagnostics:

Otoendoscopy can be used to obtain biopsy samples or fine-needle aspirates using specialised instruments known as biopsy forceps, aspiration needles and aspiration catheters. Samples are routinely obtained during endoscopic examinations and can be submitted to a laboratory for analysis. Otoendoscopy can also be used to help exclude underlying conditions leading to chronic ear disease as it permits for therapeutic flushing to allow a highly magnified and illuminated visual assessment of the ear compared with handheld otoscopes.

Urethrocystoscopy is a procedure that allows the veterinary surgeon to directly examine the urethra, bladder and openings of the ureters. A urethrocystoscope is an endoscope with a camera and a light source. Urethrocystoscopes are described as either flexible or rigid. A rigid endoscope is often used in female dogs and cats, as well as male cats who have a perineal urethrostomy. A flexible endoscope is used in male dogs due to the longer and more tortuous path of the urethra. The urethra of male cats is usually too small for effective urethrocystoscopy. The urethrocystoscope is inserted into the vulva or penis and directed towards the urethral opening, into the urethra and then into the bladder.

Urethrocystoscopy is performed to evaluate the signs and attempt to identify/exclude the causes of persistent blood in the urine, straining to urinate, repeated urinary tract infections and incontinence. Urethrocystoscopy tends to be more accurate than abdominal imaging (e.g. radiography, computed tomography (CT) and ultrasonography) for detecting both structural and functional urinary tract disease.

Minimally invasive diagnostics:

Urethrocystoscopy can be used to obtain biopsy samples or fine-needle aspirates using specialised instruments known as biopsy forceps, aspiration needles and aspiration catheters. Samples are routinely obtained during endoscopic examinations and can be submitted to a laboratory for culture and sensitivity testing, cytology and histopathology. Biopsy samples or fine-needle aspirates from suspicious areas can be useful for distinguishing between cancerous and non-cancerous conditions. In addition, identifying the location where the ureters (the tubes that carry urine from the kidneys) enter the bladder can help identify the cause of urinary incontinence (e.g. an ectopic ureter is one that opens into the urethra rather than the bladder).

Laparoscopy is a procedure that allows the veterinary surgeon to directly examine the abdominal cavity and organs, as well as to undertake minimally invasive surgical interventions (keyhole surgery). A laparoscope is a small rigid endoscope with a camera and a light source. As in human surgery, in order to perform laparoscopy, a working space needs to be created within the abdomen. This is achieved by inserting a needle into the abdominal cavity and inflating it with carbon dioxide. Once the abdomen has been inflated, a cannula (small plastic or metal tube) can be inserted through a small (0.5–1 cm) incision in the skin and muscle of the abdominal wall and directed into the abdominal cavity. The laparoscope is placed through this cannula. Once the laparoscope is in place, the remaining cannulae for the surgical instruments can be placed. A typical laparoscopic procedure may require the placement of between one and four cannulae.

Laparoscopy may be recommended for diagnostic and/or interventional (treatment) purposes.

Minimally invasive diagnostics:

Laparoscopy can be used to obtain biopsy samples from the liver, spleen, pancreas, lymph nodes, kidneys and gall bladder. Samples are obtained using specialised instruments known as biopsy forceps, aspiration needles and aspiration catheters. Biopsy samples are routinely obtained during endoscopic examinations and can be submitted to a laboratory for analysis. Biopsy samples from suspicious areas can be useful for distinguishing between cancerous and non-cancerous conditions. Laparoscopy provides a highly magnified and illuminated field of vision, allowing much larger and more diagnostic samples to be collected compared with ultrasound-guided methods, and is considered less painful compared with exploratory surgery.