Upper GI endoscopy and biopsy technique

WSAVA guideline

Key findings

• 5 advantages of endoscopy: (1) directed biopsy of visible mucosal lesions; (2) multiple biopsies — 10+ per site; (3) some diagnoses without biopsy (ulceration, erosion, lymphangiectasia); (4) minimal perforation/septic-peritonitis risk; (5) quicker, less stressful, cheaper (§Endoscopic Exam & Biopsy).
• Limits: duodenoscopy cannot access the entire tract; very easy to take inadequate samples (villus tips); muscularis mucosae and dense submucosal infiltrates (incl. lymphoma) cannot be reliably sampled.
• Forceps size: larger (e.g., 2.8 mm) forceps procure larger, perhaps better samples than smaller (e.g., 2.2 mm); duodenal quality equivalent dog vs cat — thin feline mucosa samples readily into the muscularis mucosae; channel size not stated [verify].
• Timing: endoscopy seldom benefits acute diarrhea (< 3 weeks); healthier patient (little/no weight loss, good BCS, normal albumin) → therapeutic trials first; severe weight loss, poor BCS, anorexia, hypoalbuminemia, US infiltrates → biopsy earlier (Conclusion a). Ultrasound first detects out-of-reach lesions (mid-jejunum).
• Biopsy numbers: cat ~6 marginal-or-adequate stomach/duodenum samples; dog ~6–7 adequate or 10–15 marginal; canine duodenal crypt lesions ~13 adequate or 28 marginal; skilled endoscopists need fewer.
• Handling (Table 5): retrieve/unfold with hypodermic needle without tearing; sponge or cellulose acetate; orient submucosal-side down, villi up (duodenal/ileal only); never let dry; 10% buffered formalin (vial → specimen down; cassette → up); free-floating samples need dissecting-microscope orientation.
• Upper-form header: date; case number; patient/client card; procedure(s); indication(s); endoscope(s); forceps/retrieval device(s).
• Complications/failures: None / Perforation / Excessive bleeding / Anesthetic complications / Excessive time / Other; plus Unable to complete examination / obtain adequate biopsies / retrieve foreign object / visualization obscured — each with "why?".
• Sampling + documentation: Biopsy, Brush cytology, Washing, Aspiration, Foreign body retrieved; Video + Photographs; every lesion row carries the Code — Normal = 0, Mild = 1, Moderate = 2, Severe = 3 — with location comments.
• Organ checklists: Esophagus — Normal/FB/Mass/Stricture/Hiatal hernia (+ GE sphincter). Stomach — Normal/FB/Mass/Polyp(s)/Parasite(s); separate site-of-lesions and site-of-biopsies lists (fundus, body, incisura, antrum, pylorus); descriptors add can't-inflate-lumen, edema, difficulty passing through pylorus. Duodenum/jejunum — records scope-tip distance + whether papilla(e) were seen; descriptors add texture and lacteal dilatation.

Recommendations

• Where biopsy is indicated, endoscopic biopsy is the preferred choice — for infiltrative, erosive or anatomic lesions

  Consensus — Conclusion (a)

• Examine carefully and completely first; routinely use standard report forms; check boxes strongly recommended

  Consensus — Conclusion (c); CGS/ESCG endorsed

• Biopsy the ileum ideally in addition whenever gastroduodenoscopy is performed

  Consensus — Conclusion (a)

• Sample counts by species/quality tier: cat ~6; dog 6–7 adequate or 10–15 marginal; crypt lesions 13/28

  Evidence-based (Group biopsy study)

• Mount per Table 5 — duodenal samples submucosal-side down, villi up; 10% buffered formalin

  Technique standard (Table 5)

• Ultrasonograph before endoscopy if clients allow; prefer therapeutic trials first in the healthier patient

  Consensus — Conclusion (a)

• Insist on sample number + quality in path reports; reassess technique if mostly inadequate/marginal

  Consensus — Conclusion (d)

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