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Interventional Endoscopy

Balloon Dilation of Strictures

A stricture is an abnormal narrowing that occurs within a tubular lumen such as the esophagus. Strictures can be congenital or acquired due to damage to the mucosa that scars down as it heals. This occurs most commonly in the esophagus, but can occur in other areas such as the colon, nasal cavity, or urethra. Esophageal strictures may occur due to reflux of acid from GI disease or anesthesia, secondary to certain oral medications becoming stuck in the esophagus, or as a result of esophageal foreign bodies.

To treat a stricture, a special balloon catheter can be guided to the stricture site endoscopically. The balloon is then inflated to breakdown the scar tissue. While some patients may require only one treatment, a majority of patients will require 2-3 treatments as there is a tendency for rescarring to occur. In a small number of cases more than three dilations may be needed.

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Ballooning of an esophageal stricture in a dog.

Foreign Body Retrieval

Has your dog or cat ever eaten something he wasn’t supposed to? You’re not alone. We commonly see patients that have ingested foreign material, anything from clothes to loose change to balls. After ingestion, these objects can get stuck in the esophagus, stomach, or small intestine. Most objects that make it into the colon will pass out on their own. For foreign bodies that are in the esophagus or stomach, it is often possible to retrieve them using endoscopy and specialized instruments. This is minimally invasive and avoids the need for surgery which can result in greater expense and longer hospitalization. Besides the GI tract, foreign bodies can sometimes end up in the airways like the nasal cavity or trachea. These can also usually be removed with endoscopy.

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Nasal foreign body in the dog seen on rhinoscopy. Bone foreign body in the esophagus of a dog. Coin foriegn bodies in the stomach of a dog. Lateral radiograph of a cat with hair bands in the stomch that were removed endoscopically. Endoscopic removal of coins using a grasping forcep. Twenty-three hairbands were removed from this cat’s stomach using endoscopic scissors and grasping forceps.

Bladder Polyp or Stone Removal

A bladder polyp is a benign growth attached by a narrow stalk to the inside of the bladder wall. These can result in signs of lower urinary tract disease by causing local inflammation, bleeding, or infection. If identified during cystoscopy, polyps can be removed using a wire snare negating the need for invasive surgery. Polyps can occur singly or as multiple polyps, and can extend into the urethra. Polyps that are too large to be removed through the urethra may require surgery for removal.

Bladder stones occur commonly in dogs with most being either struvite or calcium oxalate. While the former can potentially be dissolved with medical therapy, calcium oxalate stones require removal if they are causing lower urinary tract signs or chronic infections. Depending on the size of the stone, it may be possible to remove the stone using an endoscope and a stone retrieval basket. If the stones are small enough, they can be removed without the aid of an endoscope using a procedure called voiding urohydropropulsion.

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A wire basket is deployed to capture bladder stones and remove them through the urethra avoiding the need for surgery.

Feeding tube placement

Feeding tubes can be essential for providing adequate nutrition to patients that are anorexic. In addition, they can be used for patients that are unable to adequately eat due to oral or esophageal diseases. There are several different types of feeding tubes that can be used. Selection of what type of tube to use is in part determined by the patient’s disease process, how long they will need a feeding tube, and any contraindications for using a specific type of tube. A gastrostomy tube is a tube that is placed into the stomach across the abdominal wall. This can be done without the need for surgery using endoscopy and is referred to as a PEG tube (Percutaneous Endoscopic Gastrostomy tube).

PEG tubes offer the advantages of bypassing the esophagus, being of a larger size then other types of feeding tubes, and having the ability to check residual volume in the stomach prior to feedings. PEG tubes can be used indefinitely, but may require replacement over time. Some patients have had them in for years. Most patients tolerate PEG tubes quite well.

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PEG tube placement in the stomach of a dog.