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ALAT DIAGNOSA KLINIK VETERINER

TUGAS JURNAL ENDOSKOPI ALAT DIAGNOSA KLINIK

Oleh :
PUTU DIAN PURNAMA PUTRA 1709511068
AGATA ANA LAUREN N. 1709511077
AZIZ RIZAL CAHYANTO 1709511078
RIZMA YOLANDA TIMOR 1709511084

FAKULTAS KEDOKTERAN HEWAN


UNIVERSITAS UDAYANA
2020
STUDI KLINIS PADA ENDOSKOPI GASTRO-INTESTINAL ATAS PADA ANJING

Ajeet K. Singh 1 , V. Malik 2 † dan RP Pandey 3

UP Pandit Deen Dayal Upadhayay Pashu-Chikitsa Vigyan Vishwavidyalaya Evam Go-


Anusandhan Sansthan (DUVASU), Mathura-281 001 (UP)

1 PG Cendekia, 3 Profesor dan Kepala, Departemen Bedah dan Radiologi Hewan, Sekolah
Tinggi Ilmu Kedokteran Hewan dan Peternakan, Mathura, 2 Profesor Rekanan, Departemen
Bedah Hewan dan Radiologi, COVAS,SVPUA & T, Meerut;
Diterima: Juni 2018

† Penulis yang sesuai; E-mail: vickeyvet@gmail.com


Evaluasi endoskopi kerongkongan, lambung dan duodenum dilakukan pada 12 anjing dari
kedua jenis kelamin, milik berbeda trah dan kelompok umur disajikan dengan sejarah
pengurangan dalam asupan makanan, regurgitasi atau muntah kronis dan tidak menanggapi
pengobatan simtomatik. Diagnosis dibuat atas dasar gejala klinis, hemato biokimia,
radiografi, ultrasonografi, endoskopi dan evaluasi histopatologis dan pengobatan yang sesuai
adalah selesai Tanda-tanda klinis menonjol yang diamati adalah muntah kronis, regurgitasi
dan anoreksia. Berbagai kondisi didiagnosis pada endoskopi termasuk obstruksi benda asing
lambung (2), esofagitis (3), megaoesophagus (3), esofageal divertikulum (1 ), massa esofagus
ekstramural dan lambung ulkus (1), gastritis hemoragik (2) dan lambung adenokarsinoma
(1). Radiografi (polos dan kontras), Temuan ultrasonografi melengkapi endoskopi
pemeriksaan. Endoskopi ditemukan invasif minimal dan alat diagnostik yang efisien untuk
memvisualisasikan lokasi tepatnya lesi dan manuver bedah yang difasilitasi untuk dilakukan
pada anjing.
Kata kunci: Anjing, Endoskopi, Upper GIT

Gangguan astrointestinal yang menye-babkan regurgitasi, disfagia, muntah, reduksi dalam


asupan makanan dan penurunan berat badan paling sering ditemui pada anjing. Seperti tanda-
tanda klinis ini mungkin terkait dengan berbagai kelainan yang bisa melibatkan setiap sistem
organ dalam tubuh, dini dan diagnosis akurat dari penyebab yang mendasarinya adalah wajib
untuk mengadopsi perawatan yang ditargetkan. Fleksibel endoskopi telah merevolusi
pendekatan kami untuk diagnosis karena memungkinkan visualisasi langsung lumen saluran
pencernaan (GIT), dan diagnosis spesifik dengan biopsi mukosa. Endoskopi telah terbukti
efektif dalam pengambilan asing tubuh tanpa intervensi bedah (Hall et al ., 2015).

Lesi, seperti neoplasia, dangkal gastroenteritis, ulserasi, erosi, lambung hipertrofi mukosa,
lambung dan polip duodenum dapat dideteksi biopsi endoskopi. Fallin et al . (1996) telah
melaporkan obstruksi mekanik, motilitas gangguan, gastropati pilorik, benda asing dan
neoplasma GIT atas dengan endoskopi. Objektif dari penelitian ini adalah untuk mengevaluasi
secara klinis endoskopi fleksibel untuk diagnosis dan perawatan kasih sayang GIT atas pada
anjing.

Material dan metode

Dua belas anjing tanpa memandang usia, jenis kelamin, dan jenis menderita gangguan GIT
atas, tidak menanggapi pengobatan simptomatik yang dilaporkan ke Departemen Bedah
Hewan dan Radiologi dimasukkan dalam penelitian ini. Diagnosis lesi atau gangguan GIT
bagian atas dibuat oleh pemeriksaan klinis-fisiologis, laboratorium temuan, radiografi,
ultrasonografi dan endoskopi. Lesi dicatat, didokumentasikan dan berkorelasi dengan temuan
klinis untuk mencapai diagnosis yang akurat. Sesuai kebutuhan dan entitas klinis, penyelidikan
hemato-biokimia dilakukan untuk menyingkirkan hati sistemik /
penyakit ginjal atau komplikasi apa pun selama atau setelah anestesi umum. Evaluasi radiografi
(polos / kontras / keduanya) dari GIT atas dilakukan pada hewan untuk kondisi tertentu yang
memerlukannya kebutuhan. Evaluasi ultrasonografi dari leher / perut dilakukan dengan USG
mesin (Mylab40VET) menggunakan probe microconvex (transduser) dengan frekuensi 2,5-7,5
MHz. Setelah memotong / mencukur bidang yang diminati, USG coupling gel diaplikasikan
secara bebas untuk lebih baik kontak transduser-kulit. Pemindaian dilakukan dalam dua arah,
(sagital dan melintang) setelahnya dengan benar menahan anjing di lateral atau di dorsal
berbaring di atas meja ultrasound dan dengan lembut diikat oleh asisten yang memegangi kaki
depan dan kaki belakang.

Endoskopi video fleksibel dengan panjang kerja 140 cm, diameter luar 7,9 mm dengan saluran
diameter 2,8 mm ( Karl Storz veterinary video endoskop tele pack dokter hewan X LED RP
100) digunakan untuk evaluasi endoskopi. Semua binatang berpuasa untuk setidaknya 12 jam
sebelum pemeriksaan endoskopi. Glikopirrolat (0,01 mg / kg bb) + xylazine (0,5 mg / kg bb.t)
+ butorphanol (0,2 mg / kg bb.t) kombinasi digunakan sebagai obat preanestetik. Induksi
anestesi dilakukan dengan propofol (2-4 mg / kg b.wt) diberikan hingga efek untuk intubasi
binatang. Sebuah pesawat pembedahan adalah anestesi dipertahankan sepanjang prosedur
dengan isoflurane (1,5-2,5%) dalam oksigen menggunakan parsial sistem
rebreathing. Spekulum oral digunakan untuk mencegah pasien menggigit endoskop. Itu hewan
yang dianestesi dan diintubasi ditempatkan di recumbency lateral kiri. Setelah memelihara
binatang itu kepala dan leher terulur dan lidah ditarik keluar endoskop dipegang dengan tangan
kiri, bermanuver dengan tangan kanan dan endoskop diarahkan melalui orofaring dan
dibimbing punggung ke trakea dan laring sehingga tengkorak Sfingter esofagus pertama kali
terlihat. Dengan Tekanan kuat endoskop kemudian berkembang melalui sfingter esofagus
kranial untuk masuk kerongkongan serviks. Saat memajukan endoskopi melalui GIT,
kerongkongan itu kemudian dibungkus dengan udara sampai cukup buncit untuk
memvisualisasikan lumen. Saat esofagus melebar, lipatan mukosa longitudinal proksimal
kerongkongan dapat dikurangi ukurannya, yang membantu untuk mengamati lumen seluruh
serviks kerongkongan. Setelah kerongkongan sudah memadai buncit, ruang lingkup dimajukan
dalam lambat gerakan terus menerus. Tampilan luminal penuh adalah dikelola oleh
penyesuaian kecil dari atas ke bawah kenop defleksi dalam kombinasi dengan torsi kecil
gerakan. Setelah melihat lumen esofagus sfingter esofagus distal diteruskan ke pindahkan
endoskop dari kerongkongan toraks ke dalam perut. Ujung endoskop adalah dibelokkan 30%
ke kiri dengan sedikit ke atas defleksi sebagai ujung maju melalui celah seperti pembukaan
sfingter gastro-esofagus. Lebih rendah sfingter esofagus (LOS) biasanya ditutup. SEBUAH
hilangnya resistensi tiba-tiba terasa sebagai endoskop memasuki perut.

Setelah masuk ke perut, rugal terlipat divisualisasikan untuk warna dan ketebalan sebelumnya
udara tidak enak karena distensi melenyapkan udara pola rugal mukosa dan memutihkan
warna. Setelah rugae awalnya diperiksa, udara insuflasi dilanjutkan sampai lipatan rugal
dimulai untuk memisahkan memungkinkan untuk orientasi spasial dan
identifikasi sebagian besar kelainan kotor. Itu endoskop dikembangkan hingga sayatan
angularis, dengan evaluasi simultan dari fundus dan tubuh lambung dengan cara memutar
ujung probe fiberoptik. Untuk visualisasi cardia dan fundus, endoskop itu retroflexed sehingga
dimungkinkan untuk melihat bagian ruang lingkup masuk melalui kardia serta sekitarnya
daerah. Setelah pemeriksaan mukosa lambung dengan cermat, intubasi pilorik dicoba. Setelah
bertunangan dengan kanal pilorus, ujungnya didorong,
ke dalam duodenum proksimal. Saat memasuki duodenum, ada 'red-out' saat ujung lewat bulat
kelenturan proksimal. Akhirnya kekurangan dana dan manuver visualisasi yang diizinkan turun
duodenum sejauh duodenum distal lentur. Pemeriksaan endoskopi esofagus, perut dan
duodenum dilakukan seluruh prosedur dan pengamatan pada penampilan endoskopi dan
perubahan mukosa kerongkongan, lambung dan usus dua belas jari, kehadiran benda asing atau
ruang yang menempati lesi atau lainnya kelainan jika ada, dicatat.

Sampel biopsi dikumpulkan secara endoskopi, dengan menggunakan forsep biopsi dengan
rahang bundar dan diawetkan dalam larutan garam formal 10% untuk studi
histopatologis. Sampel yang dikumpulkan menjadi sasaran pemeriksaan histopatologis setelah
pewarnaan Haematoxylin dan Eosin untuk mencapai diagnosis konfirmasi.

Hasil dan Diskusi

Di antara 12 kasus, empat menunjukkan gejala regurgitasi dan delapan anjing memiliki riwayat
muntah kronis yang refrakter terhadap pengobatan. Selain muntah dan anoreksia, penurunan
berat badan, kelesuan dan diare juga ditemui sebagai tanda-tanda klinis campuran pada hewan-
hewan ini. Muntahan anjing mengandung bahan makanan yang tidak tercerna pada anjing yang
menderita megaoesophagus, seperti yang juga dilaporkan sebelumnya oleh Jain dan Tayal
(2008). Dari 12 anjing, 10 memiliki riwayat perawatan sebelumnya. Laju pernapasan, denyut
nadi, dan suhu dubur berada dalam kisaran fisiologis normal pada semua anjing sebelum
evaluasi endoskopi.

Nilai yang dicatat untuk parameter hematobiochemical yang berbeda adalah sebagai berikut:

- hemoglobin : 7,4 dan 14,4 g / dL (rata-rata ± SE: 11,32 ± 0,56)


- jumlah leukosit total 10,5-38,9 (10³ / ìL) (rata-rata ± SE: 20,65 ± 2,46)
- neutrofil 62-90% (rata-rata ± SE: 79.91 ± 2.65)
- limfosit 01-35% (rata-rata ± SE: 15.16 ± 2.67)
- eosinofil 0-7% (rata-rata ± SE: 1.33 ± 0.55)
- monosit 0-9 (rata-rata ± SE: 3,54 ± 0,81)
- volume sel yang dikemas (PCV) 18-47% (rata-rata ± SE: 33,38 ± 2,06)
- nitrogen urea darah (BUN) 10-52 (mg / dL) (rata-rata ± SE: 27,66 ± 3,77 )
- kreatinin serum 0,6-1,9 (mg / dL) (rata-rata ± SE: 1,04 ± 0,01)
- ALT 28-87 (IU / L) (rata-rata ± SE: 42,58 ± 4,45) dan AST 23-49 (IU / L) (rata-rata ±
SE: 33.25 ± 2.41).
Rata-rata konsentrasi hemoglobin ditemukan normal, sedangkan jumlah leukosit lebih besar
dengan derajat neutrofilia ringan sebelum evaluasi endoskopi. Nilai rata-rata nitrogen urea
darah dan kreatinin serum lebih tinggi sebelum evaluasi endoskopi, yang dapat dikaitkan
dengan gangguan produksi urin yang dihasilkan dari kehilangan cairan akibat muntah kronis.
Nilai rata-rata ALT dan AST berada dalam kisaran normal dalam semua kasus.

Sebelum prosedur endoskopi, baik radiografi polos (6) dan kontras barium seri (4) dilakukan
dalam 10 kasus klinis. Radiografi kontras membantu dalam diagnosis satu kasus divertikulum
esofagus, satu kasus massa ekstramural dan satu kasus megaoesophagus (Jain dan Tayal, 2008).
Pada satu anjing dengan gastritis hemoragik, radiografi kontras GIT mengungkapkan adanya
barium sulfat di perut di area antrum pilorik bahkan setelah dua jam pemberian, menunjukkan
keterlambatan pengosongan lambung. Pemeriksaan ultrasono-grafik memberikan informasi
pelengkap tentang entitas klinis dalam lima kasus penelitian ini, seperti juga dilaporkan oleh
Gaschen et al. (2007) dan Penninck (2008). Semua hewan dipuasakan selama 12 jam sebelum
endoskopi. Hewan-hewan yang menunjukkan pengosongan lambung yang tertunda diberikan
periode puasa yang diperpanjang sebelum endoskopi.

Visualisasi organ masing-masing dengan posisi yang disebutkan dimungkinkan pada semua
hewan yang mengalami endoskopi. Esofagus normal berwarna merah muda pucat dan berkilau
pada 5/12 kasus. Pembuluh submukosa halus mudah divisualisasikan. Sfingter esofagus bagian
bawah (LOS) biasanya ditutup, seperti juga disebutkan sebelumnya oleh Clarke et al. (2007).
Di situs itu, ada perubahan mendadak dari mukosa esofagus skuamosa pucat ke mukosa
lambung kelenjar merah muda yang membentuk penampilan roset yang tidak teratur (Guilford,
2005). Ketika memasuki lambung, gastric rugae diperiksa warna dan ketebalannya sebelum
menghirup udara karena distensi akan melenyapkan pola mukosa rugal dan memutihkan warna
(Ritcher, 1992). Dalam satu kasus, mukosa duodenum tampak normal dan butiran halus karena
adanya vili duodenum. Patch payer juga diamati di perbatasan antimesenterik duodenum. (Hall,
2015).

Tiga kasus esofagitis didiagnosis secara endoskopi. Dalam dua kasus, muncul perdarahan pada
kerongkongan, ulserasi dan erosi. Dalam satu kasus, esofagus distal menunjukkan area kecil
erosi (Gbr. 1). Esofagitis digambarkan oleh erosi eritematik, lapisan mukosa tidak teratur dan
struktur mukosa yang meradang mungkin menyebabkan penyempitan lumen esofagus,
menyebabkan rasa sakit saat menelan dan emesis. Dalam dua kasus ada peradangan akut pada
kerongkongan, sedangkan pada kasus ketiga mungkin gangguan pencernaan dan refluks asam
yang menyebabkan eritema dan granularitas mukosa. Guilford dan Strombeck (1996) juga
melaporkan bahwa pengasaman yang berkepanjangan dari mukosa esofagus, dan berkurang
atau tidak adanya pembersihan esofageal (sering dikaitkan dengan anestesi) dapat
berkontribusi pada patogenesis peradangan.

Megaoesophagus adalah penyebab penting regurgitasi pada populasi anjing (Bexfield et al.,
2006). Dalam penelitian ini, megaoesophagus didiagnosis (dengan radiografi dan dikonfirmasi
oleh endoskopi) pada dua anjing jantan German Shepherd yang terkena regurgitasi persisten
sejak lahir dan penurunan berat badan bertahap (Gbr. 2). Mega esofagus kongenital terjadi
karena perkembangan saraf yang tidak lengkap di esofagus (Bexfield et al., 2006). Radiografi
survei / kontras adalah alat yang lebih andal untuk diagnosis megaoesophagus daripada
endoskopi. Penampilan endoskopi mega esophagus dalam penelitian ini adalah esofagus
lembek yang melebar yang membentang dari daerah servikal kranial ke kardia, dengan jumlah
yang bervariasi dari buih, cairan dan sisa makanan yang difermentasi dalam lumen.
Pengamatan serupa juga telah dilaporkan oleh Hall (2008) dalam kasus megaoesophagus.

Divertikulum esofagus didiagnosis dalam satu kasus Labrador retriever yang menderita
regurgitasi yang terjadi sebagian besar setelah makan. Kondisi ini didiagnosis dengan
radiografi kontras dan dikonfirmasi dengan endoskopi. Regurgitasi postprandial umum terjadi
pada anjing yang menderita divertikulum esofagus (Shaw dan Ihle, 1997). Konsekuensi dari
divertikula adalah gangguan pada motilitas esofagus normal dan akumulasi makanan dan
cairan di dalam divertikulum. Pemeriksaan endoskopi menunjukkan kantong besar di bagian
tengah kerongkongan, sementara sepertiga ekor kerongkongan tampak buncit.

Massa esofagus ekstramural didiagnosis pada satu anjing. Massa radio-opak terlihat di
dada yang berdekatan dengan pangkal jantung dan retensi barium sulfat terlihat di
kerongkongan sepanjang toraks bahkan setelah 2 jam pemberiannya. Ini didiagnosis sebagai
massa eksternal yang menghalangi lumen esofagus pada esofagoskopi (Gbr. 3). Tanda-tanda
klinis termasuk regurgitasi, anoreksia, salivasi, penurunan berat badan dan disfagia diamati
dalam kasus neoplasia esofageal yang dicatat dalam studi. Diagnosis neoplasia esofageal
umumnya bergantung pada tanda-tanda yang teramati dengan radiografi, esofagram (dengan
atau tanpa fluoroskopi) dan endoskopi. Dalam penelitian ini, pada radiografi ventrodorsal,
massa ekstramural berdiameter 2,9 cm ditemukan di bidang paru kiri dekat dengan garis tengah
toraks. Pada kontras radiografi (barium esofagram), distal esofagus tampak mengecil. Dalam
kasis ini, selama endoskopi massa besar dan halus yang benar-benar menghalangi lumen
esofagus dari luar divisualisasikan bersama dengan ulkus yang tertekan di mukosa serviks
esofagus.

Gbr 3: Gambar endoskopi menunjukkan massa besar


yang sepenuhnya menghalangi lumen esofagus dari luar.

Evaluasi endoskopi sangat membantu dalam mengidentifikasi keberadaan benda asing


di perut (Gbr. 4). Benda asing di perut ini dapat menyebabkan muntah, dan tanda-tanda klinis
dapat lebih parah karena migrasi benda asing ke bagian posterior GIT. Endoskopi menjadi alat
yang paling cocok untuk visualisasi dan pengambilan benda asing dalam penelitian ini. Dalam
kedua kasus, mukosa lambung yang sehat memiliki warna pink cerah yang normal. Schaer
(2006) juga menyatakan bahwa gangguan lambung yang umum pada anjing adalah gastritis
dan benda asing, di mana muntah adalah gejala umumnya.

Gbr 4: Gambar endoskopi menunjukkan bola


berdiameter sekitar 3 cm terperangkap di antrum pilorus.

Gambaran endoskopi mukosa lambung dalam kebanyakan kasus penelitian berkisar


dari penebalan ringan, eritema dan erosi hingga penebalan ekstrem dan gangguan lambung.
Dalam satu kasus terjadi penebalan dinding lambung dengan infiltrasi difus sel neoplastic yang
disebabkan oleh adenokarsinoma lambung (Gbr 5). Swann dan Holt (2002) melaporkan bahwa
tanda-tanda klinis paling umum dari karsinoma lambung adalah muntah, anoreksia, penurunan
berat badan yang progresif, hematemesis, melena, anemia, kelesuan, ptyalisme, polydipsia,
distensi perut dan ketidaknyamanan perut, seperti yang dicatat dalam penelitian ini. Karsinoma
lambung dapat memiliki berbagai bentuk, tetapi sebagian besar berbentuk adenokarsinoma
tubular. Sulit untuk mendiagnosisnya dengan radiografi, tetapi ultrasonografi dapat
memperlihatkan lipatan rugal yang menebal. Diagnosis dikonfirmasi dengan pemeriksaan
gastroskopi setelah memvisualisasikan granularity penebalan mukosa, kerapuhan, erosi dan
perdarahan, yang mungkin disebabkan oleh respon inflamasi yang mengakibatkan
pembentukan fagosit di dalam mukosa dan infiltrasi oleh neutrofil, yang memperkuat respons
inflamasi dengan melepaskan kemotoksin dan selanjutnya merusak mukosa lambung,
melebarkan arteriol sub mukosa dan meningkatkan aliran darah pada mukosa.

Gbr 5: Gambar endoskopi menunjukkan penebalan


karena infiltrasi difus dari dinding lambung oleh sel-sel neoplastik.

Sampel biopsi dikumpulkan secara endoskopi menggunakan forcep biopsi dari mukosa
lambung pada anjing Lhasa apso dan duodenum pada anjing Labrador dengan gastritis
hemoragik parah. Daerah perdarahan kecil biasanya terlihat segera setelah biopsi mukosa
diperoleh. Pada duodenoscopy, mukosa tampak bergranular normal dan halus karena fili
duodenum. Papilla duodenum juga terlihat (Gbr. 6). Sampel biopsi dikumpulkan dari mukosa
duodenum pada anjing Labrador yang menunjukkan cedera epitel ringan pada ujung fili.
Deskuamasi epitel fili, bersamaan dengan perubahan voular, distensi crypt dan infiltrasi sel
mononuklear juga diamati.
Gbr 6: Duodenoscopy yang menunjukkan depresi pucat,
mewakili jaringan limfoid (bercak Peyer).

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/334274215

Clinical studies on upper gastro-intestinal endoscopy in dogs


Article · December 2018

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Gastro-intestinal endoscopy in dogs 11

Indian J. Vet. Surg. 39(2): 130-135, December 2018

ijvs
Clinical studies on upper gastro-intestinal endoscopy in dogs
Ajeet K. Singh1, V. Malik21 and R.P. Pandey3
U.P. Pandit Deen Dayal Upadhayay Pashu-Chikitsa Vigyan Vishwavidyalaya Evam Go-Anusandhan
Sansthan (DUVASU), Mathura-281 001 (UP)
PG Scholar, 3Professor and Head, Department of Veterinary Surgery and Radiology, College of Veterinary Science and
1

Animal Husbandry, Mathura, 2Associate Professor, Department of Veterinary Surgery and Radiology, COVAS, SVPUA&T,
Meerut;
Received: June, 2018

Endoscopic evaluation of oesophagus, stomach and duodenum was conducted in 12 dogs of either sex, belonging to different
breeds and age groups presented with the history of reduction in food intake, regurgitation or chronic vomiting and not
responding to symptomatic treatment. Diagnosis was made on the basis of clinical symptoms, haemato-biochemical,
radiographic, ultrasonographic, endoscopic and histopathologic evaluation and appropriate treatment was done. Prominent
clinical signs observed were chronic vomiting, regurgitation and anorexia. Different conditions diagnosed on endoscopy
included gastric foreign body obstruction (2), oesophagitis (3), megaoesophagus (3), oesophageal diverticulum (1),
extramural oesophageal mass and gastric ulcer (1), haemorrhagic gastritis (2) and gastric adenocarcinoma (1). Radiographic
(plain and contrast), ultrasonographic finding complemented the endoscopic examination. Endoscopy was found to be
minimally invasive and efficient diagnostic tool to visualize precise location of the lesion and facilitated surgical manoeuvres
to be undertaken in dogs.

Key words: Dogs, Endoscopy, Upper GIT

G astrointestinal disturbances leading to regurgitation, dysphagia, vomiting, reduction in food


intake and weight loss are most frequently encountered in dogs. As these clinical signs may
be associated with a variety of disorders that can involve any organ system in the body, early
and accurate diagnosis of the underlying cause is mandatory to adopt a targeted treatment.
Flexible endoscopy has revolutionized our approach to diagnosis as it permits direct visualization
of the lumen of the gastrointestinal tract (GIT), and specific diagnosis by mucosal biopsy.
Endoscopy has been proved effective in retrieval of foreign body without surgical intervention
(Hall et al., 2015).

Lesions, such as neoplasia, superficial gastroenteritis, ulcerations, erosions, gastric mucosal


hypertrophy, gastric and duodenal polyps can be detected endoscopic biopsy. Fallin et al. (1996)
have reported mechanical obstruction, motility disorder, pyloric gastropathy, foreign body and
neoplasm of upper GIT by endoscopy. The objective of the present study was to clinically evaluate
the flexible endoscopy for diagnosis and treatment of upper GIT affections in dogs.

Materials and Methods


Twelve dogs irrespective of age, sex and breed suffering from upper GIT disturbances, not
responding to any symptomatic treatment reported to the Department of Veterinary Surgery and
Radiology were included in the study. Diagnosis of lesions or disorders of upper GIT was made by
clinico-physiological examination, laboratory findings, radiography, ultrasonography and endoscopy.
The lesions were recorded, documented and correlated with clinical findings to reach an accurate

1 Corresponding author; E-mail: vickeyvet@gmail.com

Indian J. Vet. Surg. 39(2) 2018


Gastro-intestinal endoscopy in dogs 12

diagnosis. As per the requirement and clinical entity, haemato-biochemical investigations were
carried out to rule out any systemic hepatic/ renal diseases or any complication during or after
general anaesthesia. Radiographic evaluation (plain/contrast/both) of upper GIT was performed in
animals for specific conditions necessitating its requirement. Ultrasonographic evaluation of the
neck/abdomen was performed with an ultrasound machine (Mylab40VET) using microconvex probe
(transducer) with frequency of 2.5-7.5 MHz. After clipping/shaving the area of interest, ultrasound
coupling gel was applied liberally for better transducer-skin contact. Scanning was performed in two
directions, (sagittal and transverse) after properly restraining the dogs in lateral or in dorsal
recumbency on the ultrasound table and gently restrained by assistant(s) holding the fore limbs and
hind limbs.

Flexible video endoscope with a working length of 140 cm, outer diameter of 7.9 mm with a channel
diameter of 2.8 mm (Karl Storz veterinary videoendoscope tele pack vet X LED RP 100) was used for
endoscopic evaluation. All the animals were fasted for at least 12 hr before endoscopic examination.
Glycopyrrolate (0.01 mg/kg b.wt) + xylazine (0.5 mg/kg b.wt) + butorphanol (0.2 mg/kg b.wt)
combination was used as preanesthetic medication. Induction of anaesthesia was done with
propofol (2-4 mg/kg b.wt) given till effect to intubate the animals. A surgical plane of anaesthesia
was maintained throughout the procedure with isoflurane (1.5-2.5%) in oxygen using a partial
rebreathing system. An oral speculum was used to prevent the patient from biting the endoscope.
The anaesthetized and intubated animal was placed in left lateral recumbency. After keeping the
animal’s head and neck extended and tongue pulled out, the endoscope was held with the left hand,
manoeuvred with the right hand and the endoscope was directed through the oropharynx and
guided dorsal to the trachea and larynx so that the cranial oesophageal sphincter came into view
first. With firm pressure the endoscope was then progressed through the cranial oesophageal
sphincter to enter the cervical oesophagus. When advancing the endoscope through the GIT, the
oesophagus was then insufflated with air until sufficiently distended to visualize the lumen. As the
oesophagus dilated, the longitudinal mucosal folds of the proximal oesophagus could be reduced in
size, which helped to observe the lumen of the entire cervical oesophagus. Once the oesophagus was
adequately distended, the scope was advanced down in a slow continuous motion. Full luminal view
was managed by minor adjustments of the up-down deflection knob in combination with small
torque movements. After viewing the oesophageal lumen the distal oesophageal sphincter was
passed to move the endoscope from the thoracic oesophagus into the stomach. The tip of the
endoscope was deflected 30% to the left with slight upward deflection as the tip advanced through
the slit like opening of gastro-oesophageal sphincter. The lower oesophageal sphincter (LOS) was
usually closed. A sudden loss of resistance was felt as the endoscope entered the stomach.

Upon entry into the stomach, the rugal folds were visualized for colour and thickness before
insufflating air because distension obliterates the mucosal rugal pattern and blanches the colour.
Once the rugae were initially examined, air insufflation was continued till the rugal folds began to
separate allowing for the spatial orientation and identification of most gross abnormalities. The
endoscope was advanced till the incisures angularis, with simultaneous evaluation of the fundus
and the body of the stomach by twisting the tip of the fiberoptic probe. For visualization of cardia
and fundus, the endoscope was retroflexed so that it was possible to see the portion of the scope
entering through the cardia as well as surrounding area. After careful examination of gastric
mucosa, pyloric intubation was attempted. Once engaged with the pyloric canal, the tip was
pushed through, into the proximal duodenum. On entering the duodenum, there was a ‘red-out’
as the tip passed round the proximal flexure. Eventually insufflation and manoeuvring allowed
visualization of the descending duodenum as far as the distal duodenal flexure. Endoscopic
examination of oesophagus, stomach and duodenum was performed throughout the procedure

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Gastro-intestinal endoscopy in dogs 13

and observations on the endoscopic appearance and mucosal changes of oesophagus, stomach
and duodenum, presence of foreign bodies or space occupying lesions or other abnormalities if
any, were recorded.

Biopsy samples were collected endoscopically, by using biopsy forceps with round cupped jaws and
preserved in 10% formal saline for histopathological studies. The collected samples were subjected
to histopathological examination after Haematoxylin and Eosin staining to reach confirmatory
diagnosis.

Results and Discussion

Among 12 cases, four exhibited symptoms of regurgitation and eight dogs had the history of chronic
vomiting refractory to treatment. Besides vomiting and anorexia, weight loss, lethargy and diarrhoea
were also encountered as mixed clinical signs in these animals. The vomitus contained undigested
food materials in dogs suffering from megaoesophagus, as also reported earlier by Jain and Tayal
(2008). Out of the 12 dogs, 10 had the history of previous treatment. The respiratory rate, pulse rate
and rectal temperature were within normal physiological range in all the dogs before endoscopic
evaluation.

The values recorded for different haematobiochemical parameters were as follows: haemoglobin 7.4
and 14.4 g/dL (mean±SE:

11.32±0.56), total leukocyte count 10.5-38.9 (103/ìL) (mean±SE: 20.65±2.46), neutrophils 62-90%
(mean±SE: 79.91±2.65), lymphocytes 01-35 % (mean±SE: 15.16±2.67), eosinophils 0-7% (mean±SE:
1.33±0.55) and monocytes 0-9 (mean±SE: 3.54±0.81), packed cell volume (PCV) 18-47 % (mean±SE:
33.38±2.06), blood urea nitrogen (BUN) 10-52 (mg/ dL) (mean±SE: 27.66±3.77), serum creatinine 0.6-
1.9 (mg/dL) (mean±SE: 1.04±0.01), ALT 28-87 (IU/L) (mean±SE: 42.58±4.45) and AST 23-49 (IU/L)
(mean±SE: 33.25±2.41). Mean haemoglobin concentration was found to be normal, whereas total
leukocyte count was greater with mild degree of neutrophilia prior to endoscopic evaluation. Mean
values of blood urea nitrogen and serum creatinine were higher prior to endoscopic evaluation,
132 Singh et al.
which could be attributed to impaired urine output resulted from fluid loss consequent to chronic
vomiting. The mean values of ALT and AST were in normal range in all cases.

Prior to the endoscopic procedure, both plain radiography (6) and contrast barium series (4) were
performed in 10 clinical cases. Contrast radiography was helpful in diagnosis of one case of
oesophageal diverticulum, one case of extramural mass and one case of megaoesophagus (Jain
and Tayal, 2008). In one dog with haemorrhagic gastritis, contrast radiography of GIT revealed the
presence of barium sulphate in the stomach in the area of pyloric antrum even after two hours of
administration, suggesting delayed gastric emptying. Ultrasono-graphic examination provided
complementary information about the clinical entity in five cases of the present study, as also
reported by Gaschen et al. (2007) and Penninck (2008). All the animals were fasted for 12 hr prior
to endoscopy. The animals showing delayed gastric emptying were provided extended fasting
period before endoscopy.

Visualization of the respective organ with the position mentioned was possible in all the animals
subjected to endoscopy. Normal oesophagus was pale pink and glistening in 5/12 cases. Fine
submucosal vessels were easily visualized. The lower oesophageal sphincter (LOS) was usually
closed, as also mentioned earlier by Clarke et al. (2007). At that site, there was an abrupt change
from the pale squamous oesophageal mucosa to pink glandular gastric mucosa forming an

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Gastro-intestinal endoscopy in dogs 14

irregular rosette appearance (Guilford, 2005). As the stomach was entered, the gastric rugae
were examined for colour and thickness before insufflating air because distension would
obliterate the mucosal rugal pattern and blench the colour (Ritcher, 1992). In one case duodenal
mucosa appeared normal and fine granular due to the presence of duodenal villi. Payer’s patches
were also observed in the antimesenteric border of duodenum. They appeared multiple in
numbers as large oval depressions in the mucosa up to several centimeters in length (Hall, 2015).

Three cases of oesophagitis were diagnosed endoscopically. In two cases, oesophagus appeared

Indian J. Vet. Surg. 39(2) 2018


haemorrhagic, ulcerated and eroded and in one case, the distal oesophagus showed small areas of
erosions (Fig. 1). Oesophagitis was depicted by erythematic erosions, irregular mucosal lining and
structures. The inflammed mucosa might have caused narrowing of oesophageal lumen, leading to
painful swallowing and emesis. In two cases there was an acute inflammation of the oesophagus,
while in the third case it might be indigestion and acid reflux causing erythema and mucosal
granularity. Guilford and Strombeck (1996) also reported that prolonged acidification of the
oesophageal mucosa, and reduced or absent oesophageal clearance (often associated with
anaesthesia) might contribute to the pathogenesis of inflammation.

Megaoesophagus is an important cause of regurgitation in canine population (Bexfield et al., 2006).


In the present study, megaoesophagus was diagnosed (by radiography and confirmed by endoscopy)
in two male German shepherds affected with persistent regurgitation since birth and gradual weight
loss (Fig. 2). Congenital mega oesophagus occurs due to incomplete development of nerves in the
oesophagus (Bexfield et al., 2006). Survey/contrast radiography is more reliable tool for diagnosis of
megaoesophagus than endoscopy. The endoscopic appearance of mega oesophagus in this study
was a markedly dilated, flaccid oesophagus extending from the cranial cervical region to the cardia,
with variable amounts of froth, fluid and fermenting food residue in the lumen. Similar observations
have also been reported by Hall (2008) in case of megaoesophagus.

Oesophageal diverticulum was diagnosed in one case of Labrador retriever suffering from
regurgitation episodes occurring mostly after eating. The condition was diagnosed on contrast
radiography and confirmed by endoscopy. Postprandial regurgitation is common in dogs suffering
from oesophageal diverticulum (Shaw and Ihle, 1997). The consequences of diverticula are
disturbances in normal oesophageal motility and accumulation of food and fluid within the
diverticulum. Endoscopic examination revealed a large pocket at the midsection of the oesophagus,
while the caudal third of the oesophagus appeared distended.

Extramural oesophageal mass was diagnosed in one dog. A radio-opaque mass was seen in the
thorax adjacent to the base of heart and retention of barium sulphate was seen in the thoracic
oesophagus even after 2 hr of its administration. This was diagnosed as an external mass obstructing
the oesophageal lumen completely on oesophagoscopy (Fig. 3). Variable clinical signs including
regurgitation, anorexia, salivation, weight loss and dysphagia were observed in a case of
oesophageal neoplasia recorded in the preset study (North and Banks, 2009; Trumpatori and White,
2011). The diagnosis of oesophageal neoplasia generally relies on recognition of the associated signs
with plain radiography, an oesophagram (with or without fluoroscopy) and endoscopy. In the
present study, on the ventrodorsal radiograph, an extramural mass of 2.9 cm diameter was found in
the left lung field close to the mid-line of the thorax, as also reported by Oh et al. (2016). On contrast
radiography (barium oesophagram), the distal oesophagus seemed to be narrowed with reduced
ability to pass contrast material through the oesophageal lumen suggesting the presence of a mass

Indian J. Vet. Surg. 39(2) 2018


Gastro-intestinal endoscopy in dogs 15

extramurally. These findings are similar to the reports of North and Banks (2009) and Dennis et al.
(2010). In this case, during endoscopy, a large and smooth mass completely obstructing the lumen of
oesophagus from outside was visualized along with punched ulcer in the cervical oesophageal
mucosa.

In two cases of gastric foreign body, the fundus, greater curvature, lesser curvature and incisura
angularis appeared normal. Endoscopic evaluation was helpful in identifying the presence of
foreign bodies in the stomach (Fig. 4). These foreign bodies in the stomach cause vomiting and
after passage of time the clinical signs become more severe due to migration of the foreign
bodies to the posterior parts of GIT. Endoscopy was found to be the most suitable tool for
visualization and retrieval of foreign body in the present study. In both the cases gastric mucosa
was healthy and had the normal bright pink colour. Schaer (2006) also stated that the common
gastric disturbances in dogs are gastritis and foreign body, where vomiting is the common finding.

The endoscopic appearance of gastric mucosa in most cases of this study ranged from mild
thickening, erythema and erosion to extreme thickening and disruption of normal gastric
architecture. In three cases, the gastric lumen contained a small quantity of bile tinged yellowish
liquid. In one case poorly defined thickening of the stomach wall by diffuse infiltration of
neoplastic cells endoscopically suggested gastric adenocarcinoma (Fig. 5). Adenocarcinoma is the
most common type of gastric carcinoma (Patnaik et al., 1977). Swann and Holt (2002) reported
that the most common clinical signs associated with gastric carcinoma were vomiting, anorexia,
progressive weight loss, haematemesis, melena, anaemia, lethargy, ptyalism, polydipsia,
abdominal distension and abdominal discomfort, as also noted in this study. Canine gastric
carcinomas can assume a wide range of forms, but they mostly have the features of tubular
adenocarcinoma. In the present case it was a mucosal form and was diagnosed as intestinal type
(tubular type) canine gastric adenocarcinoma. It was difficult to diagnose it on survey radiography
but ultrasonography provided some clues showing thickened rugal folds. The confirmatory
diagnosis was made on gastroscopy after visualizing mucosal thickening granularity, friability,
erosions and frank haemorrhages, which might be due to inflammatory response resulting in
recruitment of phagocytes into the mucosa and infiltration by neutrophils, which again amplified
the inflammatory response by releasing chemotaxins and further damaging the gastric mucosa,
dilating the sub mucosal arterioles and increasing mucosal blood flow.

Biopsy samples were collected endoscopically using round cupped biopsy forceps from gastric
mucosa in a Lhasa apso and descending duodenal mucosa in a Labrador with severe haemorrhagic
gastritis. The animals subjected to endoscopy guided biopsy had slight transient oozing of blood from
the biopsy site. A small area of haemorrhage was normally evident immediately after a mucosal
biopsy was obtained; however, excessive mucosal haemorrhage from a single biopsy site indicative
of increased tissue friability (Jergens and Miles, 1994), was not observed in the present study.

Histopathological examination of the endoscopically obtained tissue sections from the gastric
adenocarcinoma in a Lhasa apso showed poorly demarcated unencapsulated irregular pleomorphic
glands involving mostly the mucosa with neoplastic cells, excessive desmoplasia with nests of
neoplastic acini. Some glands were well differentiated and were lined by polarized neoplastic cells.
Neoplastic cells were cuboidal with moderate eosinophilic cytoplasm. Nuclei round to oval with
stippled chromatin, dysplastic, mild anisokaryosis. Glandular lumen contained eosinophilic secretary
product with sloughed neoplastic cells. On duodenoscopy the mucosa appeared normal and fine
granular due to the duodenal villi. The major duodenal papillae were seen (Fig. 6). Payer’s patches

Indian J. Vet. Surg. 39(2) 2018


Gastro-intestinal endoscopy in dogs 16

were also observed in the duodenal wall as large oval depressions in the mucosa up to several
centimeters in length and they were multiple in numbers. Biopsy samples collected

134 Singh et al.

Fig. 1:Endoscopic image showing small areas of Fig. 4:Endoscopic image showing a crazy ball of about erosions on distal
oesophagus. 3 cm diameter trapped in the pyloric antrum.

Fig. 2:Endoscopic image showing severely dilated Fig. 5:Endoscopic image shows poorly defined lumen of the oesophagus
thickening (arrow) due to the diffuse infiltrations
of the stomach wall by the neoplastic cells.

Fig. 3:Endoscopic image shows a large mass completely obstructing the lumen of oesophagus from outside.

from the descending duodenal mucosa in the Labrador showed mild epithelial injury of villious
tip. Desquamation of epithelium of villious, along with vacoular change, crypt distension and
infiltration of mononuclear cells were also observed.

Indian J. Vet. Surg. 39(2) 2018


Fig. 6:Descending duodenum showing a row of pale depressions, representing lymphoid tissue (Peyer’s patches).

Indian J. Vet. Surg. 39(2) 2018


Gastro-intestinal endoscopy in dogs 17

From the observations of this study, it can be concluded that flexible endoscopy is efficient
diagnostic tool to visualize precise location of the lesion and facilitates surgical manoeuvres to be
undertaken in dogs. Endoscopy also facilitates collection of multiple superficial mucosal biopsy
samples and enables retrieval of gastric foreign bodies.

Acknowledgements
Financial help provided by ICAR under the scheme “All India Network Programme on Diagnostic
Imaging and Management of Surgical Conditions in Animals” (AINP-DIMSCA) is duly
acknowledged.

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