The following procedures are performed to visually view the inside of the intestines to determine the presence of polyps. In most cases, biopsies will also be taken to confirm abnormalities in the intestines which may not be apparent when visually viewing the colon.
Once it has been determined that a child may have polyps, the first priority is to study the type of polyps present as well as the number and distribution of polyps within the GI tract. Because the evaluation of recovered polyps or biopsies, along with their number and distribution are critical to distinguishing between polyposis syndromes, it is critical for the doctor to recover sufficient numbers of polypectomy specimens during the colonoscopy whenever possible.
Upper endoscopy with biopsy
Upper endoscopy, also known as esophagogastroduodenoscopy, is performed to obtain a biopsy of the lining of the esophagus, stomach, or small intestine. Biopsies are important to diagnose inflammation of the stomach, small intestine (gastritis, duodenitis), celiac disease (wheat allergy), food allergy, and esophagitis, both reflux-related or also food allergy-related.
Upper endoscopy can also be used to remove polyps and varices (dilated blood vessels at the end of the esophagus) in a procedure called banding.
Esophagogastroduodenoscopy is normally performed under general anesthesia in children through age 21. It also can be done in children including immature infants in the NICU setting.
The procedure is performed by placing a long, flexible tube with a camera at the end through the mouth into the esophagus, stomach and small intestine (duodenum). A biopsy is then taken of all of these structures. During this procedure, the abdomen is inflated with carbon dioxide to give the surgeon a better view.
Esophagogastroduodenoscopy usually takes anywhere between 15 minutes and 45 minutes. Most children will experience sore throat, nausea and occasional vomiting after the procedure, with some flecks of blood due to the biopsies.
If your child experiences any of the following symptoms after the endoscopy, you should alert your physician:
- Severe abdominal pain
- Throwing up blood
- High fever
- Big change from his / her usual behavior
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Percutaneous endoscopic gastrostomy (PEG)
This procedure involves the placement of a feeding tube directly into the stomach. It is often done through the mouth by a procedure called endoscopy. Local numbing medicines and intravenous sleep medicines are used. This procedure can also be done surgically. While the patient is under general anesthesia, a small cut is made on the left side of the stomach area. A small, flexible, hollow tube with a balloon or special tip is inserted into the stomach. The stomach is then stitched closed around the tube and the cut is closed.
Gastrostomy feeding tubes are used for several reasons and may be needed temporarily or permanently. It may be recommended for:
- Babies with birth abnormalities of the mouth, esophagus or stomach
- Patients who cannot swallow properly
- Patients who cannot eat enough food by mouth to stay healthy
- Patients who often breathe in food when eating
Lower endoscopy (colonoscopy) with biopsy
A lower endoscopy, also known as a colonoscopy, is performed to obtain biopsies of the terminal ileum and colon. Colonoscopy is performed under anesthesia administered by a pediatric anesthesiologist on staff at Children's Hospital. Prior to the procedure, the child typically has to undergo a "cleanout" to allow the physician a better view of the lining of the large intestine. This involves taking medicine for the entire day prior to the procedure to provoke some diarrhea to clear the colon or stool.
During a colonoscopy, a flexible tube with a camera on the end called a colonoscope, is carefully pushed through the entire colon, usually to the last part of the small intestine (the terminal ileum). Before taking the tube out, the physician obtains small pieces of tissue called biopsies, throughout the terminal ileum and colon. The child then goes to the recovery room and is discharged to go home.
Alert your gastroenterologist immediately if your child experiences a lot of bleeding, severe abdominal pain, high fever, or a dramatic change in his/her behavior following a colonoscopy.
A colonoscopy is also useful to evaluate chronic abdominal pain, suspected inflammatory bowel disease, or other forms of colitis and polyps. Polyps also can be removed during a colonoscopy and is called a polypectomy.
Most children undergoing colonoscopy are able to return to normal activities the same day or the following day.
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A small intestinal biopsy, also called a push enteroscopy, is performed to take several biopsies of the upper and middle parts of the small intestine and/or to remove polpys, also called polypectomies.
During this procedure, your child is put to sleep by a pediatric anesthesiologist on staff at Children's Hospital and a flexible, long endoscope is passed through the mouth, stomach and into the small intestine. The scope then is advanced carefully through the upper and middle sections of the small intestine where several biopsies are performed. During this procedure, a large amount of air is pushed into the stomach to provide a better view of the intestinal tract. This may result in passing of gas after the procedure.
This relatively new technology enables your physician to look into the small iintestine and diagnose or follow the growth of polyps and other small intestinal diseases such as celiac and inflammatory bowel disease (IBD). Because the small intestine is so long, it is virtually impossible to pass an endoscope through its entire length and look for abnormalities. Capsule endoscopy allows your doctor to give an older child (usually 10 years or older) a small (jelly-bean sized) camera that sends us thousands of pictures, making up a movie of the small intestine that is transmitted to a device outside the patient - this is then reviewed for abnormalities. The camera is eventually harmlessly passed with stool.
Hydrogen breath test
The hydrogen breath test uses the measurement of hydrogen in the breath to diagnose several conditions that cause gastrointestinal symptoms. Hydrogen is released from the body when bacteria in the colon are exposed to unabsorbed foods such as sugars and carbohydrates. Although some hydrogen is produced from the small amounts of unabsorbed food that normally reach the colon, large amounts of hydrogen may be produced when there is a difficulty with the digestion or absorption of food in the small intestine that allows more unabsorbed food to reach the colon. Large amounts of hydrogen also may be produced when the colonic bacteria move back into the small intestine, a condition called bacterial overgrowth of the small bowel.
Hydrogen breath testing is used in the diagnosis of three conditions. These include a condition in which dietary sugars are not digested normally such as lactose intolerance or to diagnose problems with the digestion of other sugars such as sucrose, fructose and sorbitol. Hydrogen breath testing also is used to diagnose bacterial overgrowth of the small bowel, a condition in which an excessive amount of colonic bacteria are present in the small intestine. The third condition is associated with rapid travel of food through the small intestine. All of these conditions may cause abdominal pain, abdominal bloating and distention, flatulence (passing gas in large amounts) and diarrhea.
Impedance pH monitoring
Impedance monitoring is a test like pH monitoring that records information regarding the movement of stomach contents into the esophagus. Results of this study will be helpful in making decisions in regards to treatment for your child's condition.
With impedance monitoring, the tube can sense both acid and nonacid contents that come up into the esophagus, whereas, pH monitoring only senses acidic contents. This test is particularly helpful to determine if reflux is playing a role in children on medication to suppress acid. It also is able to detect reflux after meals when the stomach is not as acidic because of food. The monitor records how long the stomach contents stay in the esophagus and also how far up the esophagus the contents go. Like esophageal pH monitoring, it is performed by passing a thin tube through the nose and into the esophagus. The tube is connected to a monitor that records this information over a 24-hour period. Your child will remain in the hospital for this test. During the monitoring period, your child will be able to continue their normal activities and will be expected to have somewhat normal feeding patterns. You will be asked to keep a diary of symptoms, feeding times and sleeping periods.
Esophageal pH monitoring
Esophageal pH Monitoring is a test that measures how often and for how long stomach acid enters the esophagus(the tube that leads from the mouth to the stomach). Results of this study will be helpful in making decisions in regards to treatment for your child's condition. Esophageal pH monitoring is performed by inserting a thin tube that is passed through the nose, down the back of the throat and into the esophagus as your child swallows. On the tip of the catheter is a sensor that senses acid. This is positioned in the esophagus just above the lower esophageal sphincter (the valve at the end of the swallowing tube). The tube is attached to a monitor that measures the level of acidity in your esophagus. This allows the sensor to record each time the acid is brought up into the esophagus on a recorder that is connected to the catheter. Your child will most likely remain in the hospital for the test but at times they are done as an outpatient. The staff will discuss the options with you. If done as an outpatient, you will need to return the next day to have the tube removed. During the monitoring period, your child will be able to continue their normal activities and will be expected to have somewhat normal feeding patterns. You will be asked to keep a diary of symptoms, feeding times and sleeping.
During this procedure, small pieces of liver tissue are removed and are sent to a laboratory for examination. A liver biopsy may be performed for many reasons including: alcoholic liver, elevated liver enzymes of unknown cause, biliary tract obstruction/jaundice, fatty liver disease, hemochromatosis, Wilson disease, autoimmune liver disease, alpha-1-antitrypsin deficiency, possible injury due to drug therapies, hepatitis B, hepatitis C, hepatomegaly of undetermined cause, cancers that originate in the liver, cancers that spread to the liver from other sites, or noncancerous tumors or abnormalities in the liver.