Endoscopy for Foreign Object Removal in Dogs
As human medicine advances, veterinary medicine benefits. One particular area of great benefit is in the removal of ingested foreign objects in dogs. As anyone that has had a young dog can attest, they are quite curious and will sometimes eat the strangest things. Clothing, including underwear and socks, string, fish hooks, toys, plastic etc. These objects don’t always pass through the intestines. Obstructions can occur and without surgery, 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.
An endoscope can be used to remove some ingested items for the stomach. An endoscope 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 fibers allow light to pass into the stomach and allow the veterinarian to see what is inside the stomach. In addition to fiber optic cables, there are channels that allow water to flush and clean the tip and air to dilate the stomach to allow better visualization. Another channel allows the passage of various tools used to grasp or snare foreign objects.
Most endoscopes are 110 cm long and 7.5-10mm in diameter. This size works well for almost any size dog.
Advantages of Endoscopy in Dogs
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 in Dogs
There are few complications associated with endoscopy. The biggest disadvantage is that only the stomach and a small part of the intestine can be visualized. Foreign objects stuck in the intestines are not amenable to endoscopy. Another disadvantage is that dogs/cats can have more than one foreign object. You and the veterinarian may be misled if a large foreign object is removed from the stomach. There still may be 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. Despite trying endoscopy, the dog may also 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 Foreign Body
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. This involved ingesting a liquid dye and then 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 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 to Remove Foreign Objects Using Endoscopy
In order to use an endoscope, the dog must be under anesthesia. After being anesthetized, the dog is placed on his/her 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 the inside of the stomach. This expands the stomach and allows for easier visualization. By using the control knobs, the tip of the endoscope is moved around to look at all areas of the stomach. Once the foreign object is found, the tools used to grasp the foreign object 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 be quite slick and slimy due to a 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 easy. Some objects are very strongly stuck 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.