Using Endoscopy to Remove Objects From the Stomach in Cats
As human medicine advances, veterinary medicine benefits. One particular area that has benefited greatly concerns the removal of ingested foreign objects. As anyone who has had a young dog or cat can attest, pets are quite curious and will sometimes eat the strangest things, such as clothing, including underwear and socks, string, fish hooks, toys and plastic. Unfortunately, these objects don’t always pass through the intestines. Obstructions can occur and without treatment can lead to serious illness and even death.
In the past, a surgical incision was required to remove all foreign objects. With medical advancement, surgery is no longer the only option. Your veterinarian can now remove some ingested items from the stomach by using an endoscope, which is a long flexible tube with a bendable tip. Fiber optic cables pass through the tube from the eyepiece on one end to the bendable tip. These cables allow light to pass into the stomach and allow the veterinarian to see what is inside. In addition to fiber optic cables, there are channels that allow water to flush and clean the tip and air to dilate the stomach for better visualization. Another channel allows the passage of various tools used to grasp or snare foreign objects.
Most endoscopes are 110 cm long and 7.5 to 10mm in diameter. This size works well for almost any size dog or cat.
Advantages of Endoscopy
The advantage of an endoscope is the removal of a potentially life-threatening obstruction without surgery. There is no pain and no surgical incision.
Disadvantages of Endoscopy
There are few complications associated with endoscopy. The biggest disadvantage is that only the stomach and a small part of the upper intestine can be visualized. Foreign objects stuck lower in the intestines cannot be reached by an endoscope. Another disadvantage is that dogs/cats sometimes have ingested more than one foreign object, and your veterinarian may be misled if a large foreign object is removed from the stomach, and there is still another obstruction elsewhere. This cannot be visualized with an endoscope and surgery may be required.
Another potential disadvantage is that endoscopes are not able to remove all foreign objects. Even after an endoscopic procedure, your pet may still need surgery. The only significant disadvantage is the additional anesthesia time.
Despite the disadvantages, endoscopy should be attempted, when available, to remove a gastric foreign object before going to surgery.
Diagnosis of a Gastric Foreign Body in Cats
In order to use the endoscope properly, a gastric foreign body must first be diagnosed. Typically abdominal radiographs (X-rays) will show an abnormality in the stomach. If a foreign body is suspected but not obvious on plain x-rays, a barium study may be done, which involves ingesting a liquid dye before taking X-rays. The dye will outline any abnormality within the stomach.
Once a gastric foreign body is diagnosed, endoscopy can be performed. If there is both a gastric and intestinal foreign object, endoscopy may not be the appropriate treatment. It is difficult or impossible to remove some intestinal obstructions with an endoscope.
Treatment of a Gastric Foreign Body Using an Endoscope
In order to use an endoscope, your pet is anesthetized and placed on his side. The tip of the endoscope is gently guided through the mouth, down the esophagus (the tube connecting the mouth to the stomach) and then into the stomach. Once in the stomach the endoscope is used to add air to expand the stomach to allow for easier visualization. By using the control knobs, the tip of the endoscope can be moved around to look at all areas of the stomach. Once the foreign object is found, the grasping tools are inserted through the endoscope.
Now the difficult part begins. Finding a part of the foreign object that can be grasped by a small snare or grabbing tool can be difficult. The object may have a slick covering of saliva. Smooth or round objects such as balls or rocks are very difficult to extract with an endoscope. When the endoscope tool has grasped a part of the object, gentle steady pulling frequently dislodges the object and it can be carefully pulled out of the stomach and out of the body. Unfortunately, not all endoscopic procedures go this well. Some objects are very strongly wedged in the pylorus (outlet of stomach to intestines), or a significant amount of the object is in the intestines as well as in the stomach.
A general guideline for most veterinarians is that if the object cannot be retrieved within 45 minutes, surgery is necessary.
After an endoscopic procedure, there is no surgical incision to care for and there is typically no pain associated with the procedure.
Make sure your dog or cat is able to eat and drink without vomiting. If any vomiting or lack of appetite occur, contact your veterinarian.
The best way to prevent an endoscopic procedure is to prevent ingestion of foreign objects. Do not let your dog or cat play with small items that could easily be swallowed. This includes strings, yarn and thread for cats.