{"id":461,"date":"2015-03-01T13:43:42","date_gmt":"2015-03-01T13:43:42","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=461"},"modified":"2022-02-16T17:20:53","modified_gmt":"2022-02-16T17:20:53","slug":"endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/","title":{"rendered":"Upper Gastrointestinal Endoscopy Techniques, Part 2"},"content":{"rendered":"<p align=\"LEFT\"><strong>Upper gastrointestinal endoscopy (UGIE) is a minimally invasive procedure that can:<\/strong><\/p>\n<ul>\n<li>Aid in the diagnostic evaluation of clinical signs referable to the esophagus, stomach, and proximal small intestine (<strong>Figure 1<\/strong>)<\/li>\n<li>Obtain biopsy samples as part of the diagnostic evaluation of a pet with chronic gastrointestinal (GI) signs.<\/li>\n<\/ul>\n<div id=\"attachment_8074\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/EE-fig-1.png\"><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-8074\" class=\"size-full wp-image-8074\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/EE-fig-1.png\" alt=\"FIGURE 1. Gastrointestinal anatomy with important landmarks. Illustration by Lisa Wirth, VMD\" width=\"300\" height=\"230\" \/><\/a><p id=\"caption-attachment-8074\" class=\"wp-caption-text\">FIGURE 1. Gastrointestinal anatomy with important landmarks. <em>Illustration by Lisa Wirth, VMD<\/em><\/p><\/div>\n<hr \/>\n<p>The column <strong>Endoscopy Essentials <\/strong>will discuss endoscopic evaluation of a specific body system, reviewing indications, disease abnormalities, and proper endoscopic technique<strong>. <\/strong>The first part of this article\u2014<a href=\"https:\/\/todaysveterinarypractice.com\/endoscopy-essentials-part-1-overview-of-upper-gastrointestinal-endoscopy-2\/\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Part 1: Overview of Upper Gastrointestinal Endoscopy<\/strong><\/a> (November\/December 2014 issue)\u2014reviewed indications for UGIE techniques, appearance of healthy GI tissue, and abnormalities of the upper GI tract.<\/p>\n<hr \/>\n<p>This article will discuss patient and equipment preparation and provide step-by-step instructions on how to perform:<\/p>\n<ul>\n<li>Esophagoscopy<\/li>\n<li>Gastroscopy<\/li>\n<li>Enteroscopy.<\/li>\n<\/ul>\n<h2>Patient Preparation<\/h2>\n<p><strong>Prior to Procedure <\/strong><\/p>\n<p>Withhold food for 24 hours prior to elective UGIE to improve visualization of the mucosa and reduce risk for aspiration. If a UGIE must be performed on a more emergent basis and the presence of food or debris is compromising the field of view, the endoscopist should instill flush through the endoscope channel. If this is not sufficient, gastric lavage can be attempted using a large bore gastric tube and warm water. In these cases, the best defense against the development of aspiration pneumonia is to ensure that the endotracheal tube cuff is fully inflated and that the endotracheal tube is only removed once the patient is fully awake and able to protect its airway. Patients should undergo a 24-hour washout period if sucralfate has been administered or a barium contrast study performed.<\/p>\n<h3><strong>Anesthesia &amp; Monitoring<\/strong><\/h3>\n<p>General anesthesia is required, and a qualified individual should be dedicated to monitoring the patient throughout the procedure.<\/p>\n<ol>\n<li>Position the patient in left lateral recumbency to facilitate entrance into the pylorus and duodenum.<\/li>\n<li>Ensure the endotracheal tube cuff is well inflated to help reduce risk of aspiration.<\/li>\n<li>Place a mouth gag to facilitate passage of the insertion tube and protect the endoscope (in case the patient unexpectedly recovers jaw tone during the procedure).<\/li>\n<li>Be mindful that anticholinergic drugs (eg, atropine) and pure mu opioids (eg, morphine, fentanyl) can increase pyloric tone, making entrance into the duodenum more difficult.<\/li>\n<\/ol>\n<h2>Equipment Considerations<\/h2>\n<h3><strong>Gastroscope Selection<\/strong><\/h3>\n<ol>\n<li>Select the <em>largest diameter<\/em> and <em>longest length<\/em> gastroscope that the patient can accommodate:\n<ul>\n<li>Most dogs: 100 to 140 cm length, with 9.8 mm diameter<\/li>\n<li>Small dogs and cats: 100 to 140 cm length, with 7.8 mm diameter<\/li>\n<\/ul>\n<\/li>\n<li>Instrument channel diameter is of high importance; I recommend a 2.8 mm or larger channel that can accommodate larger biopsy forceps.<\/li>\n<\/ol>\n<h3><strong>Gastroscope Preparation<\/strong><\/h3>\n<p>Ensure that the scope selected has functional 4-way tip deflection and that insufflation, irrigation, and suction functions are working appropriately. These functions can be tested by depressing the:<\/p>\n<ol>\n<li>Insufflation\/irrigation valve partially, with the distal tip of the insertion tube in a bowl of water; insufflation should yield bubbles<\/li>\n<li>Suction valve; then watching as water is drawn into the suction canister<\/li>\n<li>Insufflation\/irrigation valve completely, with the scope\u2019s tip directed at your hand; a fine spray of water for irrigation should be visualized or felt against the skin.<\/li>\n<\/ol>\n<h3><strong>During the Procedure <\/strong><\/h3>\n<p>During the procedure, keep the following close by:<\/p>\n<ul>\n<li>Bowl of water in case the tip of the scope becomes occluded and\/or the lens becomes soiled<\/li>\n<li>Clean gauze in order to remove material from the lens as needed.<\/li>\n<\/ul>\n<div class=\"orange-box\">\n<h3 align=\"LEFT\">Beware: Gastric Overinflation<\/h3>\n<p align=\"LEFT\">The anesthetist should monitor for evidence of <strong>gastric overinflation, <\/strong>which can reduce venous return and\/or lead to a vasovagal response. Signs include:<\/p>\n<ul>\n<li>Overt gastric distension<\/li>\n<li>Increased or decreased heart rate<\/li>\n<li>Changes in respiratory pattern<\/li>\n<li>Hypotension.<\/li>\n<\/ul>\n<p align=\"LEFT\">If gastric overinflation is suspected, <strong>the endoscopist should immediately suction air from the stomach.<\/strong><\/p>\n<\/div>\n<h2>General Technique Guidelines<\/h2>\n<ol>\n<li>Frequently insufflate air to maintain an open lumen, but be mindful of overinsufflation.<\/li>\n<li>With rare exception, only advance the insertion tube when there is clear visualization. Never apply significant pressure in a forward direction without visualization.<\/li>\n<li>If the lens becomes soiled, clean it by:\n<ul>\n<li>Irrigation<\/li>\n<li>Gently passing the lens of the scope along the mucosa<\/li>\n<li>Withdrawing the scope and suctioning water through the insertion tube, followed by gently wiping the lens with clean gauze.<\/li>\n<\/ul>\n<\/li>\n<li>If GI motility is deterring progress, pause, and once the wave of motility passes, resume forward motion.<\/li>\n<li>When experiencing a <em>red out<\/em> (when the operator\u2019s field of view consists only of pinkish\/red mucosa), or when unsure of location, back up until you are reoriented in the center of a lumen.<\/li>\n<li>Use of the deflection control knobs\u2014located on the handpiece\u2014or rotation of the endoscopist\u2019s wrists can alter scope direction\/orientation.<\/li>\n<li>Slow and steady movements are preferable to quick movements.<\/li>\n<\/ol>\n<table border=\"1\" width=\"580\" cellspacing=\"0\" cellpadding=\"10\">\n<tbody class=\"arial\">\n<tr>\n<td colspan=\"2\" valign=\"top\" bgcolor=\"#ffffff\"><strong>Indications for Upper Gastrointestinal Endoscopy<\/strong><\/td>\n<\/tr>\n<tr class=\"NAVCMint2\" bgcolor=\"#7fcecd\">\n<td valign=\"top\"><strong>TYPE OF ENDOSCOPY<\/strong><\/td>\n<td valign=\"top\"><strong>INDICATIONS<\/strong><\/td>\n<\/tr>\n<tr>\n<td class=\"NAVCMint2\" valign=\"top\">Esophagoscopy<\/td>\n<td valign=\"top\" bgcolor=\"#cccaca\">\n<ul>\n<li>Diagnose processes that disrupt the esophageal mucosa or obstruct its lumen<\/li>\n<li>Confirm the presence of, or provide additional evidence for, other esophageal diseases<\/li>\n<li>Perform therapeutic procedures<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"NAVCMint2\" valign=\"top\">Gastroscopy<\/td>\n<td valign=\"top\" bgcolor=\"#cccaca\">\n<ul>\n<li>Diagnose, and evaluate signs associated with, acute GI disease<\/li>\n<li>As part of complete UGIE to evaluate chronic GI disease<\/li>\n<li>Perform therapeutic procedures<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"NAVCMint2\" valign=\"top\">Enteroscopy<\/td>\n<td valign=\"top\" bgcolor=\"#cccaca\">\n<ul>\n<li>As final part of complete UGIE to evaluate chronic GI disease<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>Esophagoscopy<\/h2>\n<ol>\n<li>Before beginning, make sure the patient\u2019s head and neck are extended and the insertion tube is lubricated.<\/li>\n<li>Advance the insertion tube through the oropharynx, directing dorsal to the endotracheal tube.<\/li>\n<li>The cervical esophageal sphincter (CES) may be visualized and is easily intubated with gentle pressure. Once in the cervical esophagus, pause to insufflate the lumen, allowing it to distend for adequate visualization.<\/li>\n<li>To achieve adequate insufflation, occasional assistance is required to occlude the midesophagus at the thoracic inlet.<\/li>\n<li>A few deflection adjustments are required to traverse the length of a normal esophagus; attempt to remain in the center of the lumen for optimal visualization of the mucosa.<\/li>\n<li>The procedure is complete when the lower esophageal sphincter (LES) is visualized. Typically the LES is a closed, slit-like opening, eccentrically located; it may partially open in response to short puffs of air.<\/li>\n<\/ol>\n<div class=\"orange-box\">\n<h3><strong>What You Will See: Esophagoscopy<\/strong><\/h3>\n<ul>\n<li>Normal esophageal mucosa is pale pink, smooth, and glistening (<strong>Figure 2<\/strong>).\n<p><div id=\"attachment_4399\" style=\"width: 406px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-23.jpg\"><img decoding=\"async\" aria-describedby=\"caption-attachment-4399\" class=\"wp-image-4399 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-23.jpg\" alt=\"Microsoft PowerPoint - EE Upper GI Endoscopy Part 2 Images\" width=\"396\" height=\"300\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-23.jpg 396w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-23-300x227.jpg 300w\" sizes=\"(max-width: 396px) 100vw, 396px\" \/><\/a><p id=\"caption-attachment-4399\" class=\"wp-caption-text\">Figure 2. Normal esophagus and lower esophageal sphincter in a dog.<\/p><\/div><\/li>\n<li>In cats, the caudal thoracic esophagus has circular rings, which denote the section comprised of smooth muscle.<\/li>\n<li>In dogs, the cervical esophagus has longitudinal mucosal folds that disappear when the lumen is fully insufflated.<\/li>\n<li>In both species, note the outline of the:\n<ul>\n<li>Trachea in the ventral wall of the esophagus<\/li>\n<li>Aorta in the midthoracic esophagus.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<h2>Gastroscopy<\/h2>\n<h3>Standardized Approach<\/h3>\n<p>The novice endoscopist should establish a standardized approach to UGIE.<\/p>\n<ol>\n<li>To enter the stomach, align the tip of the insertion tube with the center of the LES.<\/li>\n<li>Insufflate and gently advance the scope until the gastric rugal folds are visualized (<strong>Figure 3<\/strong>).\n<p><div id=\"attachment_4400\" style=\"width: 305px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-33.jpg\"><img decoding=\"async\" aria-describedby=\"caption-attachment-4400\" class=\"wp-image-4400 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-33.jpg\" alt=\"Microsoft PowerPoint - EE Upper GI Endoscopy Overview Images\" width=\"295\" height=\"300\" \/><\/a><p id=\"caption-attachment-4400\" class=\"wp-caption-text\">FIGURE 3. Canine gastric body partially insufflated; note the normal rugal folds traversing the gastric body.<\/p><\/div><\/li>\n<li>Once in the stomach, pause to insufflate, allowing the rugal folds to separate and flatten for improved visualization.<\/li>\n<li>Within seconds, the gastric body and greater curvature are in view.<\/li>\n<li>Use the rugal folds as a guide, advance the gastroscope parallel to the folds, further into the gastric body and, ultimately, to the antrum.<\/li>\n<li>As you approach the area of the lesser curvature, fewer rugal folds will be noted.<\/li>\n<\/ol>\n<h3><strong>Complete Evaluation<\/strong><\/h3>\n<p>When performing a UGIE, the operator must decide whether to do a complete gastric evaluation now or reserve it until enteroscopy is complete. Many endoscopists recommend advancing through the pylorus quickly because\u2014once the stomach is fully insufflated\u2014pyloric tone increases, making entrance more difficult.<\/p>\n<p>Regardless of when it is performed, complete evaluation should include identification of the following landmarks, using these steps:<\/p>\n<ol>\n<li><strong>Gastric body:<\/strong> Use 4-way tip deflection to achieve panoramic views of the gastric mucosa.<\/li>\n<li><strong>Angularis incisura, Antrum, &amp; Cardia:<\/strong> Once the scope has been advanced through the gastric body, deflect the tip upwards (counterclockwise rotation of the inner knob) to view the angularis incisura (<strong>Figure 4<\/strong>)\u2014the fold of the lesser curvature that separates the body from the antrum. This view also provides visualization of the body\/antrum and cardia.\n<p><div id=\"attachment_4401\" style=\"width: 305px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-42.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4401\" class=\"wp-image-4401 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-42.jpg\" alt=\"Microsoft PowerPoint - EE Upper GI Endoscopy Overview Images\" width=\"295\" height=\"300\" \/><\/a><p id=\"caption-attachment-4401\" class=\"wp-caption-text\">FIGURE 4. Normal canine angularis incisura; the antrum is below the angularis, while the body is above it.<\/p><\/div><\/li>\n<li><strong>Cardia:<\/strong> Further deflection in an upward direction, also called <em>retroflexion<\/em> or <em>J-maneuver<\/em>, allows evaluation of the cardia, as well as\u00a0visualization of the gastroscope entering the stomach (<strong>Figure 5<\/strong>).\n<p><div id=\"attachment_4402\" style=\"width: 306px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-51.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4402\" class=\"wp-image-4402 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-51.jpg\" alt=\"Microsoft PowerPoint - EE Upper GI Endoscopy Overview Images\" width=\"296\" height=\"300\" \/><\/a><p id=\"caption-attachment-4402\" class=\"wp-caption-text\">FIGURE 5. Normal canine cardia; the gastroscope is entering the stomach through the lower esophageal sphincter.<\/p><\/div><\/li>\n<li><strong>Fundus:<\/strong> To evaluate the fundus, rotate the wrist in a clockwise and counterclockwise fashion to achieve a 360\u00b0 view. When the scope is in the retroflexposition, withdraw the scope, rather than advancing it, to bring the tip of the scope closer to an area of interest.<\/li>\n<li><strong>Pylorus:<\/strong> Advancement to the pylorus (<strong>Figure 6<\/strong>) can be challenging in large dogs because the insufflated stomach allows the scope to loop upon itself within the cavernous space. In these patients, withdraw air and start over if there is difficulty in reaching the pylorus.\n<p><div id=\"attachment_4403\" style=\"width: 301px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-61.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4403\" class=\"wp-image-4403 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-61.jpg\" alt=\"Microsoft PowerPoint - EE Upper GI Endoscopy Overview Images\" width=\"291\" height=\"300\" \/><\/a><p id=\"caption-attachment-4403\" class=\"wp-caption-text\">FIGURE 6. Normal canine pylorus.<\/p><\/div><\/li>\n<\/ol>\n<div class=\"orange-box\">\n<h3><strong>What You Will See: Gastroscopy<\/strong><\/h3>\n<ul>\n<li>Normal mucosa appears smooth and glistening, with a pink to red color. Canine mucosa is more vibrant compared to the paler pink coloration of feline mucosa.<\/li>\n<li>The antrum tends to be devoid of prominent rugal folds; if present, a pathologic process should be suspected, such as mucosal hypertrophy, inflammation, or cancer.<\/li>\n<li>Depending on the degree of insufflation, note that the:\n<ul>\n<li>Rugal folds can take on a markedly different appearance, ranging from very prominent folds with minimal insuffl ation to almost nonexistent folds at full insufflation<\/li>\n<li>Color of the mucosa can change: as the stomach becomes overdistended, the mucosa may take on a blanched or white appearance.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<h2>Enteroscopy<\/h2>\n<h3><strong>Pyloric Canal Approach <\/strong><\/h3>\n<p>Entering the pyloric canal and descending duodenum can be challenging for the novice endoscopist. Perhaps the most important recommendation is to:<\/p>\n<ol>\n<li>Maintain the pyloric orifice in the center of view at all times, while slowly advancing the tip, making only small adjustments in the deflection control knobs.<\/li>\n<li>Alternatively, lock the control knobs and rely on wrist rotation to guide the tip into the orifipyloric canal\u2014which is very tight and narrow\u2014 visualization is diminished as the tip of the scope comes into contact with the mucosa, resulting in an image of blurred pink mucosa.<\/li>\n<li>While traversing the pyloric canal, insuffl ate short puffs of air to maintain an open lumen, which appears as a shadow among the blurred pink background of the mucosa.<\/li>\n<li>If progress is not being made, back up to a point with visualization and realign the pyloric orifice to the center of the field of view.<\/li>\n<li>If multiple unsuccessful attempts are made, try a blinded technique, which can be successful but may also induce trauma to the proximal duodenum: With the tip of the insertion tube centered over the pyloric orifice, pass a biopsy instrument through the working channel into the pylorus; then use the instrument as a guide to advance the tip of the endoscope through the orifice.<\/li>\n<\/ol>\n<h3><strong>Approach to Proximal Duodenum <\/strong><\/h3>\n<ol>\n<li>Once in the canal, attempt to direct the tip downward and to the right, in order for it to fall into the proximal duodenum.<\/li>\n<li>Then deflect the tip upward, and sometimes to the left, to orient the scope in the center of the lumen of the descending duodenum.<\/li>\n<li>If mastering the exact direction of deflection is challenging, make slight deflections of the control knobs, looking to advance toward a shadow (representing the lumen) in the blurred mucosa.<\/li>\n<\/ol>\n<h3><strong>Approach to Caudal Duodenum <\/strong><\/h3>\n<p>The transition between the descending to ascending duodenum and ascending duodenum to jejunum\u00a0is marked by a flexure. The bend leading into the ascending duodenum is a rather acute left turn. The lumen of the duodenum is narrow, rendering clear visualization around each flexure difficult. Therefore, using a mucosal slide technique is appropriate to navigate these areas.<\/p>\n<ol>\n<li>Continue to advance the scope until the handpiece is at the patient\u2019s mouth. In most cases the tip can be advanced into the caudal duodenum, but in some small dogs and cats it may be advanced into the proximal jejunum.<\/li>\n<li>Deflect the tip in the direction of the lumen and slowly slide the insertion tube along the mucosa.<\/li>\n<li>As long as the scope advances without significant resistance, continue the quest to find a lumen. Keep in mind that the duodenal mucosa is sensitive and this technique may result in superfi cial erosions and hemorrhage.<\/li>\n<\/ol>\n<h3><strong>Evaluation of the Duodenum <\/strong><\/h3>\n<p>Once in the duodenum, distend the lumen with air for mucosal evaluation.<\/p>\n<blockquote>\n<h3 align=\"LEFT\">Learn More<\/h3>\n<p align=\"LEFT\">See <a href=\"https:\/\/todaysveterinarypractice.com\/endoscopy-essentials-part-1-overview-of-upper-gastrointestinal-endoscopy-2\/\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Part 1: Overview of Upper Gastrointestinal Endoscopy<\/strong> <\/a>(November\/December 2014 issue) for indepth discussion regarding esophageal, gastric, and duodenal abnormalities.<\/p>\n<\/blockquote>\n<h2>Histopathologic Diagnosis<\/h2>\n<p>While thorough mucosal evaluation is a valuable feature of endoscopy, a histopathologic diagnosis cannot be made from gross observation. Biopsies should always be obtained, even if the mucosa appears to be normal.<\/p>\n<p>CES = cervical esophageal sphincter; GI = gastrointestinal; LES = lower esophageal sphincter; UGIE = upper gastrointestinal endoscopy<\/p>\n<div class=\"orange-box\">\n<h3><strong>What You Will See: Enteroscopy<\/strong><\/h3>\n<ul>\n<li>The mucosa varies from pink\/red to yellow\/white (<strong>Figure 7<\/strong>). In general, dogs tend to have more vibrant coloration compared to the pale pink\/ creamy color of feline mucosa.<\/li>\n<\/ul>\n<div id=\"attachment_4404\" style=\"width: 389px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-71.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4404\" class=\"wp-image-4404 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-71.jpg\" alt=\"Microsoft PowerPoint - EE Upper GI Endoscopy Overview Images\" width=\"379\" height=\"300\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-71.jpg 379w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-71-300x237.jpg 300w\" sizes=\"(max-width: 379px) 100vw, 379px\" \/><\/a><p id=\"caption-attachment-4404\" class=\"wp-caption-text\">FIGURE 7. Normal canine duodenum.<\/p><\/div>\n<ul>\n<li>The duodenal mucosa is textured with a rough, grainy, or even shaggy appearance; this texture represents villi.<\/li>\n<li>In the dog, you may note Peyer\u2019s Patches, which appear as discrete, white, circular indentations or craters (<strong>Figure 8<\/strong>).<\/li>\n<\/ul>\n<div id=\"attachment_4405\" style=\"width: 307px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-81.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4405\" class=\"wp-image-4405 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-81.jpg\" alt=\"Figure 8\" width=\"297\" height=\"300\" \/><\/a><p id=\"caption-attachment-4405\" class=\"wp-caption-text\">FIGURE 8. Peyer\u2019s Patches in the lateral wall of the canine duodenum.<\/p><\/div>\n<ul>\n<li>Located in the proximal duodenum of the dog are 2 papillae (major and minor) that appear as small circular buttons that may be flat or raised; feline patients have only the major duodenal papilla, which can be challenging to identify (<strong>Figure 9<\/strong>).<\/li>\n<\/ul>\n<div id=\"attachment_4406\" style=\"width: 305px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-9.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4406\" class=\"wp-image-4406 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-9.jpg\" alt=\"Microsoft PowerPoint - EE Upper GI Endoscopy Part 2 Images\" width=\"295\" height=\"300\" \/><\/a><p id=\"caption-attachment-4406\" class=\"wp-caption-text\">FIGURE 9. Normal feline duodenal papilla.<\/p><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Follow these step-by-step instructions on how to perform esophagoscopy, gastroscopy, and enteroscopy.<\/p>\n","protected":false},"author":1,"featured_media":620,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":3549,"footnotes":""},"categories":[357],"tags":[13],"class_list":["post-461","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-march-april-2015","tag-peer-reviewed","column-features","clinical_topics-gastroenterology","clinical_topics-radiology-imaging"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Upper Gastrointestinal Endoscopy Techniques, Part 2 | Today&#039;s Veterinary Practice<\/title>\n<meta name=\"description\" content=\"Follow these step-by-step instructions on how to perform esophagoscopy, gastroscopy, and enteroscopy.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Upper Gastrointestinal Endoscopy Techniques, Part 2\" \/>\n<meta property=\"og:description\" content=\"Follow these step-by-step instructions on how to perform esophagoscopy, gastroscopy, and enteroscopy.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/\" \/>\n<meta property=\"og:site_name\" content=\"Today&#039;s Veterinary Practice\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/todaysveterinarypractice\" \/>\n<meta property=\"article:published_time\" content=\"2015-03-01T13:43:42+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2022-02-16T17:20:53+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-1-stomach-drawing-LP.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"800\" \/>\n\t<meta property=\"og:image:height\" content=\"540\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"12 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/radiology-imaging\\\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/radiology-imaging\\\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Upper Gastrointestinal Endoscopy Techniques, Part 2\",\"datePublished\":\"2015-03-01T13:43:42+00:00\",\"dateModified\":\"2022-02-16T17:20:53+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/radiology-imaging\\\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\\\/\"},\"wordCount\":2321,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/radiology-imaging\\\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2015\\\/03\\\/Figure-1-stomach-drawing-LP.jpg\",\"keywords\":[\"Peer Reviewed\"],\"articleSection\":[\"March\\\/April 2015\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/radiology-imaging\\\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\\\/#respond\"]}]},{\"@type\":[\"WebPage\",\"MedicalWebPage\"],\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/radiology-imaging\\\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\\\/\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/radiology-imaging\\\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\\\/\",\"name\":\"Upper Gastrointestinal Endoscopy Techniques, Part 2 | Today&#039;s Veterinary Practice\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/radiology-imaging\\\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/radiology-imaging\\\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2015\\\/03\\\/Figure-1-stomach-drawing-LP.jpg\",\"datePublished\":\"2015-03-01T13:43:42+00:00\",\"dateModified\":\"2022-02-16T17:20:53+00:00\",\"description\":\"Follow these step-by-step instructions on how to perform esophagoscopy, gastroscopy, and enteroscopy.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/radiology-imaging\\\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/radiology-imaging\\\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/radiology-imaging\\\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\\\/#primaryimage\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2015\\\/03\\\/Figure-1-stomach-drawing-LP.jpg\",\"contentUrl\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2015\\\/03\\\/Figure-1-stomach-drawing-LP.jpg\",\"width\":800,\"height\":540},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/radiology-imaging\\\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Upper Gastrointestinal Endoscopy Techniques, Part 2\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#website\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/\",\"name\":\"Today's Veterinary Practice\",\"description\":\"Peer-Reviewed Veterinary Journal\",\"publisher\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#organization\",\"name\":\"Today's Veterinary Practice\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2022\\\/01\\\/tvp-logo.png\",\"contentUrl\":\"https:\\\/\\\/todaysveterinarypractice.com\\\/wp-content\\\/uploads\\\/sites\\\/4\\\/2022\\\/01\\\/tvp-logo.png\",\"width\":179,\"height\":89,\"caption\":\"Today's Veterinary Practice\"},\"image\":{\"@id\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/todaysveterinarypractice\",\"https:\\\/\\\/www.youtube.com\\\/thenavc\"],\"email\":\"info@navc.com\"},{\"@type\":\"Person\",\"@id\":\"\",\"url\":\"https:\\\/\\\/navc.sitepreview.app\\\/todaysveterinarypractice.com\\\/author\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Upper Gastrointestinal Endoscopy Techniques, Part 2 | Today&#039;s Veterinary Practice","description":"Follow these step-by-step instructions on how to perform esophagoscopy, gastroscopy, and enteroscopy.","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"Upper Gastrointestinal Endoscopy Techniques, Part 2","og_description":"Follow these step-by-step instructions on how to perform esophagoscopy, gastroscopy, and enteroscopy.","og_url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/","og_site_name":"Today&#039;s Veterinary Practice","article_publisher":"https:\/\/www.facebook.com\/todaysveterinarypractice","article_published_time":"2015-03-01T13:43:42+00:00","article_modified_time":"2022-02-16T17:20:53+00:00","og_image":[{"width":800,"height":540,"url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-1-stomach-drawing-LP.jpg","type":"image\/jpeg"}],"twitter_card":"summary_large_image","twitter_misc":{"Written by":"","Est. reading time":"12 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/#article","isPartOf":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/"},"author":{"name":"","@id":""},"headline":"Upper Gastrointestinal Endoscopy Techniques, Part 2","datePublished":"2015-03-01T13:43:42+00:00","dateModified":"2022-02-16T17:20:53+00:00","mainEntityOfPage":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/"},"wordCount":2321,"commentCount":0,"publisher":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#organization"},"image":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/#primaryimage"},"thumbnailUrl":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-1-stomach-drawing-LP.jpg","keywords":["Peer Reviewed"],"articleSection":["March\/April 2015"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/#respond"]}]},{"@type":["WebPage","MedicalWebPage"],"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/","name":"Upper Gastrointestinal Endoscopy Techniques, Part 2 | Today&#039;s Veterinary Practice","isPartOf":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/#primaryimage"},"image":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/#primaryimage"},"thumbnailUrl":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-1-stomach-drawing-LP.jpg","datePublished":"2015-03-01T13:43:42+00:00","dateModified":"2022-02-16T17:20:53+00:00","description":"Follow these step-by-step instructions on how to perform esophagoscopy, gastroscopy, and enteroscopy.","breadcrumb":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/#primaryimage","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-1-stomach-drawing-LP.jpg","contentUrl":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2015\/03\/Figure-1-stomach-drawing-LP.jpg","width":800,"height":540},{"@type":"BreadcrumbList","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/endoscopy-essentials-upper-gastrointestinal-endoscopy-techniques-part-2\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/"},{"@type":"ListItem","position":2,"name":"Upper Gastrointestinal Endoscopy Techniques, Part 2"}]},{"@type":"WebSite","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#website","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/","name":"Today's Veterinary Practice","description":"Peer-Reviewed Veterinary Journal","publisher":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#organization","name":"Today's Veterinary Practice","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#\/schema\/logo\/image\/","url":"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2022\/01\/tvp-logo.png","contentUrl":"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2022\/01\/tvp-logo.png","width":179,"height":89,"caption":"Today's Veterinary Practice"},"image":{"@id":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/todaysveterinarypractice","https:\/\/www.youtube.com\/thenavc"],"email":"info@navc.com"},{"@type":"Person","@id":"","url":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/author\/"}]}},"_links":{"self":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts\/461","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/comments?post=461"}],"version-history":[{"count":2,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts\/461\/revisions"}],"predecessor-version":[{"id":28105,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/posts\/461\/revisions\/28105"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/media\/620"}],"wp:attachment":[{"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/media?parent=461"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/categories?post=461"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-json\/wp\/v2\/tags?post=461"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}