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Equine Gastroscopy Procedure:
 
Pass endoscope ventrally via either left or right nostril into the pharynx, take care that the endoscope does not pass via the middle meatus, potentially causing trauma to the ethmoid turbinates
To aid passage of the endoscope, the horse should be encouraged to swallow by passing approximately 2-3 millilitres of water by de-pressing the blue piston towards the lateral food channel. The endoscopist should not attempt to aid passage by manipulating the tip as this usually prevents rather than promotes the passage of the endoscope. The lining of the oesophagus should be positively identified before inserting the endoscope further. Take care that the endoscope does not retroflex and become crushed by teeth, a mouth guard is often used to protect the scope.
Inflate the oesophagus by covering the blue piston and advance the endoscope, try and keep the centre of the oesophagus in the centre of the field of view.
On entry to the stomach cover the blue piston to inflate.
As the stomach is inflated the rugul folds that are usually present are obliterated, once the stomach is inflated, both the greater curvature opposite the cardiac orifice and the right side of the stomach can be seen. It is easier to conceptualize the image through the scope if the squamous portion of the stomach is positioned in the top section and the glandular portion in the lower section of the image.
Once the correct orientation is obtained the stomach should be systematically examined. The tip of the endoscope should be elevated to visualize the saccus cecus and lowered to observe the glandular region of the stomach. To view the lesser curvature the scope may be advanced with the tip directed to the right. This is an area where severe gastric ulceration may be found.
To enter the duodenum the endoscope is directed ventrally after the cardia orifice is identified so as to visualise the pyloric antrum. The endoscope is then advanced through the pylorus into the duodenum.
A visual inspection of the stomach is often easier when retracting the endoscope
At the end of the procedure excess air can be aspirated by turning on the aspirator unit and de-pressing the red piston, the stomach will collapse and assist in patient recovery
A visual inspection of the oesophagus is often easier when withdrawing the endoscope ensure that the tip of the endoscope is straight
 
Cleaning & Disinfection:
 
A large tray or cleaning station is required for cold soaking endoscope and associated instruments and water bottle

Endoscopes should be cleaned and disinfected immediately following the endoscopy to avoid contamination solidifying in the channels of the scope, channel irrigators or flushing adapters can be used to assist this process an aspiration unit may also be used to aspirate detergent and disinfectant through scope
Remove gross contamination from patient tube on withdrawal by wiping patient tube with tissue or soft cloth soaked in enzymatic detergent
LEAK CHECK THE ENDOSCOPE BEFORE SCOPE IS PLACED IN FLUID
Refer to manual for leak checking procedure
Place the tip of the scope in enzymatic detergent and de-press the blue piston to blow water through the channel, cover the blue piston to blow bubbles, this will remove contamination from the outlet pipe and avoid air water blockages
Clean the control body and insertion tube taking care to remove contamination from lenses on the eyepiece and distal end of the scope
Cold soak any instruments that have been used, biopsy forceps should be placed in enzymatic detergent as soon as possible to avoid jaws sticking
Remove red and blue pistons and biopsy cap, there are two holes located under the red piston
Pass the cleaning brush through the hole located directly in front of you, the cleaning brush will emerge at the aspiration connector on the light guide plug, you may feel some resistance as the brush turns the corner but you should not feel any resistance whilst passing the brush through the channel, if you do, stop and contact your service provider, this process may be required several times to ensure gross contamination is removed from channel
Pass the cleaning brush through the hole located at approx 6.00 o clock, the cleaning brush will emerge at the distal tip of the scope, ensure that the bending section is straight, again you should fell no resistance as the cleaning brush is passed through the channel, if so contact your service provider for assistance, this process may be required several times to remove gross contamination from channels of scope
Pass the cleaning brush through the biopsy port and the cleaning brush will again emerge at the distal tip, repeat as necessary.
Attach the channel irrigators to the red and blue piston ports and re-attach the biopsy cap to aid flushing
Flush enzymatic detergent through the channels of the scope, fluid will be seen at the water bottle connector on the light guide probe, the aspiration connector on the light guide probe and the distal tip of the scope
Leave instrument to soak for approx 20-30 minutes or according to your soak times, manufactures times will differ.
Discard enzymatic detergent and cold soak instrument in disinfectant, again flush disinfectant through the channels of the scope via flushing adapters, ensure that disinfectant emerges at the water bottle connector, aspiration connector and distal tip
Leave to cold soak according to your manufactures recommended times
Discard disinfectant and flush with distilled water or sanitizer through the channels of the scope via flushing adapters, this will remove trace elements of disinfectant from the scope and sanitise the instrument
Wipe instrument with tissue to dry, pay particular attention to the light guide probe
Remove flushing adapters and replace air water and aspiration pistons
Re-connect endoscope to the light source and turn on pump
De-press the blue piston to evacuate excess water from channel
Cover the blue piston to pass air through channels
Endoscope should be stored hanging up and not in transportation case