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Definition

Epistaxis is the presence of hemorrhage exiting the nares. Mucosal trauma includes bruising, abrasions, and lacerations which can occur during passage of the endoscopy into any hollow organ.

Risk factors

 Small‐sized horses or foals

 Insufficient restraint

 Unsedated patients

 Restriction of the passageway to be scoped by luminal masses or extraluminal swelling

Pathogenesis

Similar to passage of a nasogastric tube, there is the potential risk of epistaxis or other mucosal trauma. The severity of this injury is typically much less than for nasogastric intubation, because passage of the endoscope is visually guided and directed and the endoscopes are generally narrower in diameter and more pliable than most nasogastric tubes. Sources of epistaxis would most likely include the nasal mucosa during endoscope advancement, because visualization would reduce the risk of traumatizing the nasal turbintate and ethmoid turbinates. However, further advancement of the endoscope into a more restricted space (guttural pouches, esophagus) could result in inadvertent flexing of the scope into the turbinates. Advancement of the endoscope into the urethra, ureters, uterus, or caudal intestinal tract could cause direct mucosal trauma in some cases.

Prevention

Use of intranasal phenylephrine, which causes vasoconstriction of mucosal vessels, and application of carbomethylcellulose lubricant, which reduces friction between the endoscope and the passageways, may reduce mucosal trauma and irritation in small patients or patients with restricted nasal passages.

Treatment and expected outcome

Most epistaxis and mucosal trauma complications associated with endoscopy are self‐limiting and do not need specific treatment. If severe epistaxis occurred, treatment could be applied similar to that described for epistaxis associated with nasogastric intubation (see Chapter 5: Complications of Nasogastric Intubation).