Comparison of the diagnostic yield of 3 and 5 mm laparoscopic liver biopsy forceps in cats.

OBJECTIVE: To determine whether 3 and 5 mm laparoscopic cup biopsy forceps provide samples of equivalent diagnostic quality in cats. STUDY DESIGN: Experimental study. ANIMALS: Twelve colony cats undergoing a concurrent nutrition study. METHODS: Two biopsy forceps (3 and 5 mm) and three biopsy techniques (twist, pull, and twist + pull) were used to collect 68 laparoscopic liver samples. Biopsies were performed consecutively with the 3 and 5 mm biopsy sites adjacent to each other. Data analyzed included the number of portal triads and hepatic lobules, tissue crush and fragmentation, overall sample area (mm2 ), sample weight, and agreement regarding morphologic diagnosis. RESULTS: The 5 mm forceps provided more hepatic lobules, portal triads, and a larger tissue weight and histologic area (mm2 ) (p < .01). The twist and pull techniques provide more hepatic lobules and portal triads compared to the twist + pull technique while the twist + pull technique resulted in greater tissue crush compared to the twist technique (p = .0097). There was good agreement for morphological diagnosis between the 3 and 5 mm samples using the twist + pull technique but not for the twist or pull techniques. CONCLUSION: Liver samples can be safely collected with 3 or 5 mm laparoscopic biopsy forceps and provide sufficient tissue for histopathology analysis in cats, with minimal artifact. The diagnostic accuracy of 3 mm samples remains unknown. CLINICAL SIGNIFICANCE: Although 3 mm laparoscopic cup biopsy forceps provided samples of sufficient diagnostic quality for histopathologic interpretation in cats, further studies are required to assess their diagnostic accuracy.

Comparing 3 mm and 5 mm laparoscopic liver biopsy samples in dogs.

OBJECTIVE: To determine whether 3 mm cup biopsy forceps (CBF) provide equivalent diagnostic samples to 5 mm CBF for histopathologic diagnosis, bacterial culture, and copper quantification. STUDY DESIGN: Clinical prospective study. ANIMALS: Ten client-owned dogs, presenting for laparoscopic liver biopsy (LLB). METHODS: Dogs underwent LLB, and paired samples were collected using 3 and 5 mm CBF. Portal triad and hepatic lobule counts, crush and fragmentation artifacts, copper concentration, bacterial culture results, and agreement on histopathologic diagnosis were compared. RESULTS: Both CBF sizes allowed for easy sample collection and resulted in minimal hemorrhage. An average of 12.13 (confidence limit (CL): 9.4-14.9) and 17.84 (CL: 15.1-20.6) portal triads were obtained using a 3 and 5 mm CBF, respectively (p = .0003). A portal triad count of 11 or more was achieved in 73.3% of the 3 mm and 93.3% of the 5 mm samples. Gwets AC1 coefficient showed a high level of agreement (0.8) for overall histopathologic diagnosis (p < .0001). The 3 mm CBF crush scores were higher (median of the differences: -1; range: -1 to 1) (p = .035). There was no difference in fragmentation scores (p = .935). CONCLUSION: The 3 mm CBF yielded smaller samples in terms of size and portal triad count compared with the 5 mm CBF. However, the portal triad count was sufficient in a majority of samples and histologic agreement with the 5 mm CBF was excellent. CLINICAL SIGNIFICANCE: In dogs, a 3 mm CBF yields adequate samples for histopathologic interpretation, copper quantification, and bacterial culture.

Near-infrared fluorescence cholangiography in dogs: A pilot study.

OBJECTIVE: To determine the effect of indocyanine green (ICG) dose and timing of administration on near-infrared fluorescence (NIRF) imaging of the normal canine biliary tree. STUDY DESIGN: Preclinical prospective study. ANIMALS: Eight purpose-bred beagles. METHODS: The dogs were randomized to receive two of four intravenous ICG dose (low [L]:0.05 mg/kg or high [H]:0.25 mg/kg)/time (0 and 3 h prior to NIRF) combinations. NIRF images were collected every 10 min for 120 min. Target (cystic duct)-to-background (liver) ratios were calculated for all timepoints and compared. RESULTS: ICG cholangiography was successful in all dogs. The contrast ratio was above 1 in the L0 group by 20 min and reached its peak at 100 min. In the H0 group, the ratio was above 1 by 60 min and reached its peak at 90 min. Contrast ratios above 2 (fluorescence twice as bright in the cystic duct compared to the liver) were maintained from 180 to 300 min for L3 and H3 and was achieved after 80 min for L0. CONCLUSION: Low dose ICG provided better ratios early after injection compared to the high dose which remained highly concentrated in the liver tissue after injection. Both doses provided excellent visualization of the biliary tree at 3 h post injection, low dose ICG provided better ratios from 3 to 5 h post injection. Based on these results, 0.05 mg/kg of ICG administered at anesthetic premedication, or as early as 3 h prior to laparoscopic surgery should yield optimal fluorescence images. CLINICAL SIGNIFICANCE: This study provides guidelines for NIRF cholangiography in clinically normal dogs.

Clinical findings and outcomes of 153 dogs surgically treated for intestinal intussusceptions.

OBJECTIVE: To describe perioperative characteristics and outcomes of dogs surgically treated for intestinal intussusception. STUDY DESIGN: Multi-institutional, retrospective study. ANIMALS: One hundred fifty-three client-owned dogs with intestinal intussusception. METHODS: Dogs were included when they had undergone surgical treatment of a confirmed intestinal intussusception. Medical records were reviewed for demographics and clinical data, including surgical complications (graded 1-4). Follow-up was obtained via telephone interview with owners and referring veterinarians. RESULTS: Dogs had a median age of 10 months (range, 2-156), and the most common location for intussusception was ileocolic (66/153 [43%]). Most cases had no identifiable cause (104/155 [67%]). Intestinal resection and anastomosis (IRA) was performed in 129 of 153 (84%) dogs; enteroplication was performed in 28 of 153 (18%) dogs, including 13 with and 15 without IRA. Intraoperative complications occurred in 10 of 153 (7%) dogs, all involving intestinal damage during attempted manual reduction. The median duration of follow-up after discharge was 334 days (interquartile range, 15-990; range, 1-3302). Postoperative complications occurred in 53 of 153 (35%) dogs, including 22 of 153 (14%) with severe (grade 3 or 4) events. Diarrhea, regurgitation, and septic peritonitis were the most common postoperative complications; intussusception recurred in four of 153 (3%) dogs, all within 72 hours postoperatively. Fourteen-day postoperative mortality rate was 6%. CONCLUSION: Surgical treatment of intestinal intussusception was curative in most dogs, even when an underlying cause was not identified. Surgical complications were common, including a 14% risk of life-threatening short-term complications. CLINICAL SIGNIFICANCE: Surgical treatment of intestinal intussusception offers an excellent prognosis, but the potential life-threatening complications should be considered.