The Pros and Cons of Gastrointestinal Endoscopy

Indications for a patient referral to AVS for GI endoscopy include regurgitation, chronic vomiting, hematemesis (without coagulation problems) melena, chronic small and large bowel diarrhea, removal of esophageal/gastric foreign objects, feeding tube placement and dilation of esophageal/colonic strictures. Generally endoscopy is a very safe procedure with the major risk being possible complications associated with anesthesia. It is not a replacement for but used in conjunction with a complete history and physical examination as well as other diagnostics such as blood work, fecal examination, radiography and ultrasound.

PROS

  1. Minimally invasive
    Animals undergoing endoscopy require anesthesia and some preparation – fasting (12-36 hrs), warm water only enemas, and possibly oral osmotic solutions
  2. Low morbidity and mortality
  3. Sensitive for diagnosing mucosal diseases
    Esophageal, gastric, duodenal, distal ileal (possibly), colonic mucosa only
  4. Allows for descriptive and photographic documentation of lesions

CONS

  1. Cannot assess functional disease, luminal diameter, wall thickness
  2. Cannot identify disease in most of the small intestine
  3. Cannot detect disease in the deep submucosa, muscularis or serosa
  4. Not appropriate if bowel perforation is suspected
  5. Not ideal if pet not adequately prepared or barium/sucralfate present
  6. Cannot assess or biopsy lymph nodes
  7. Biopsy samples are very small, need multiple

COMPLICATIONS – rare with an experienced endoscopist

  1. GI perforation possible
  2. Laceration of major blood vessels or major organs adj to GI tract
  3. Decreased venous return or hypoxia if stomach over inflated
  4. Bradycardia due to vasovagal reflex from over distention/traction
  5. GDV from inadequate removal of air as endoscope is removed
  6. Mucosal bleeding usually minor unless ulcerations, neoplasia
  7. Bacteremia post-endoscopy, noted in humans, likely in animals