10-year-old cat on prednisolone -is laparotomy biopsy worth the risk for IBD vs. lymphoma diagnosis?
My 10-year-old British Longhair (male, ~large build,7.2kg) has been dealing with chronic GI issues and I'm looking for perspective from others who've been in a similar situation or from vet-savvy folks.
His history:
He's had chronic vomiting and GI sensitivity for a while. About 3-4 months ago he was put on 2.5mg prednisolone daily for small intestinal inflammation. We also switched his food to Royal Canin Gastrointestinal Fibre Response, and for about four weeks he had zero vomiting — which felt like a miracle.
What the workup showed:
He's had three abdominal ultrasounds. The most recent one showed focal wall thickening/inflammation in the mid-jejunum. There was significant improvement from the first to second ultrasound, but the 3rd one showed little change. The location is too deep to reach via endoscopy, which is why the specialist (internal medicine vet) is recommending a full laparotomy biopsy to differentiate between IBD and low-grade intestinal lymphoma (LGAL).
My concern:
He's already on long-term steroids, which affects wound healing. When he had dental surgery a while back, his healing was noticeably slow. I'm scared that a laparotomy — which is a significant abdominal surgery — could be very hard on him at his age and current health status, and that recovery itself could rob him of quality of life.
I understand the distinction between IBD and LGAL matters for treatment (chlorambucil would be added for lymphoma), but right now he's actually doing relatively well on the current protocol.
My questions:
For those who've faced this: was the biopsy worth it?
How significant is the surgical risk in a steroid-compromised older cat?
Is there any value in continuing the current treatment empirically and monitoring, rather than pursuing surgical confirmation?
Did anyone get a second opinion that changed the recommended path?
I love him deeply and just want to make the right call. Any insight appreciated... I really don't know what to do and I have the surgery scheduled for next Monday. Thank you everyone in advance!!