Lower GI endoscopy and biopsy technique

WSAVA guideline

Key findings

• Landmarks (COLON section): visualized — ileo-colic valve; ceco-colic valve (dog); cecum (cat); if the ileo-colic area was not seen, record how far the scope advanced.
• Ileal biopsy standard: usually obtainable by passing the endoscope into the ileum OR blindly passing forceps through the ileo-colic valve; gives information not always in duodenal or colonic biopsies; serious consideration whenever gastroduodenoscopy or colonoscopy seems indicated (Conclusion a). Ileal tissue templates not yet published by the Group [verify].
• Ileal sampling advantage: thinner ileal mucosa (both species) samples more readily into the muscularis mucosae than duodenal.
• Colonic lesion criteria (Table 4): surface epithelial injury, crypt hyperplasia, crypt dilation and distortion, mucosal fibrosis and atrophy + LP lymphocytes/plasma cells, LP eosinophils, LP neutrophils, LP macrophages — graded 0–3 at 40×.
• Normal canine colon anchors: 7.7±3.7 IEL/100 colonocytes (basal crypt); ~5.5±4.3 plasma cells and 3.8±3.7 eosinophils per 10,000 μm² between basal crypts; goblet cells 25.6±7.3/100 colonocytes — goblet-cell hyperplasia excluded from the final template (mucus-discharge artifact).
• Orientation rule: submucosal-side down / villi up matters only for duodenal and ileal samples — not gastric or colonic (Table 5); ileal/colonic minimum biopsy counts not quantified in the paper [verify].
• Lower-form header extras: records method of preparing colon; complications add "Colonic preparation inadequate" to None/Perforation/Excessive bleeding/Anesthetic complications/Excessive time/Other; failure fields — unable to complete examination, obtain adequate biopsies, visualization obscured — each with "why?".- Sampling/documentation: Biopsy, Brush cytology, Washing, Aspiration (no foreign-body box on the lower form); Video + Photographs; Code line Normal = 0, Mild = 1, Moderate = 2, Severe = 3.
• COLON descriptors: hyperemia/vascularity, discoloration, friability/hemorrhage, erosion/ulcer, intussusception, stricture, artifact; header boxes Normal/FB/Parasite(s)/Mass/Polyp.
• ILEUM section: explicit NOT EXAMINED box; tried to pass scope through ileocolic valve — Successful/Unsuccessful; tried to biopsy ileum — Successful/Unsuccessful; "Biopsies taken by: Direct visualization / Blindly passing forceps through ileocolic valve"; descriptors include lacteal dilatation and texture. CECUM: NOT EXAMINED box; intubation attempted (dogs) — Successful/Unsuccessful.

Recommendations

• Give serious consideration to ileal biopsies whenever gastroduodenoscopy or colonoscopy is indicated

  Consensus — Conclusion (a)

• Either direct ileal intubation or blind forceps passage through the ileo-colic valve is acceptable

  Group statement

• Routinely use the standard Lower GI report form (or equivalent) to document and ensure completeness

  Consensus — Conclusion (c); CGS/ESCG endorsed

• Record the method of colon preparation and flag inadequate preparation; document landmarks, extent, and scope-advance distance if ileo-colic area not seen

  Form standard

• Ultrasonograph the abdomen before endoscopy to detect lesions beyond endoscopic reach

  Interpretive recommendation

• Mount biopsies per Table 5 — orientation critical for ileum (villi up), unimportant for colon

  Technique standard (Table 5)

• Insist path reports state sample number + quality; use WSAVA grading (Table 4, 0–3) for colon

  Consensus — Conclusions (d), (e)

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