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WRD – Assisted Gastrointestinal Biopsies

Cats with chronic enteropathy present a difficult diagnostic challenge. The two most common differential diagnoses, chronic inflammatory enteropathy and alimentary lymphoma, can only be reliably differentiated by biopsy. Endoscopic biopsies are limited to only two segments of the intestine and obtain superficial samples limited to the intestinal lining. MISCA’s solution is the wound retraction device (WRD) which allows access to the entire intestinal tract through a 2 cm incision. The WRD allows full thickness biopsies of all three segments of the small intestinal tract in addition to samples of the stomach, lymph nodes, liver, pancreas, and colon if needed. Cats often eat the same day, and do not require overnight hospitalization.

WRD

  1. Full thickness biopsies are obtained.
  2. All segments of small intestine can be accessed (duodenum, jejunum, and ileum).
  3. Other organs can be accessed, including mesenteric lymph nodes, liver, pancreas and colon.
  4. The incision is 2-3 cm in length, and patients are typically discharged the same day.
  5. With administration of Nocita, a local pain blocking medication that lasts for 3 days, there is less need for pain medications.
  1. The pinch biopsies that are obtained by endoscopy only sample the inner intestinal lining; the deeper submucosa and muscularis may not be adequately sampled with endoscopic biopsies.
  2. The jejunum CANNOT be accessed endoscopically at all.
  3. Other abdominal organs such as lymph nodes, liver, pancreas, and colon CANNOT be assessed or biopsied endoscopically.
  4. In order to access the ileum by colonoscopy, the colon must be cleaned out in advance. This requires a 24-hour hospitalization in which IV fluids are administered while a cathartic solution (Go-Lytely) is delivered through a nasogastric tube overnight before the procedure.

minimally-invasive-surgery-cats3WRD-assisted gastrointestinal biopsies are appropriate for cats with a chronic enteropathy that have had an abdominal ultrasound indicating some degree of intestinal wall thickening. Cats should NOT be on oral or injectable steroids prior to the procedure as this may deem the biopsies to be nondiagnostic.

Your cat must be referred by your primary veterinarian.  Your cat will have a consultation with our internal medicine specialist who will determine if the procedure is appropriate, if any further testing is necessary and what samples should be obtained.  A fasting blood panel to assess small intestinal absorptive function may be recommended. The results can be useful in demonstrating intestinal dysfunction to direct therapy postoperatively.

The WRD procedure is performed by our soft tissue surgeon.  Cats are typically discharged the same day, several hours after the procedure is completed.  Many cats return to eating later that evening.  A recheck will be scheduled within 2 weeks after the procedure to assess healing and discuss the results of the biopsies and testing.  A complete clinical summary will be provided to you and your veterinarian explaining treatment options and/or referral to an oncologist if recommended.

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