What is an endoscopy?
An endoscopy is a procedure that is used to evaluate a patient’s digestive tract. Two types of endoscopy are an upper endoscopy and a capsule endoscopy.
An upper endoscopy is a look inside the esophagus, stomach, and beginning of the small intestine. In this procedure, the doctor passes a long, thin, flexible tube with a light on the end through your child’s mouth and esophagus. The tube goes down into the stomach and small intestine. As the doctor passes the tube, they look at these areas and may take small samples of tissues called biopsies.
A wireless capsule endoscopy is an exam of the small intestine using a capsule containing a tiny camera, which can be easily swallowed by most children. The capsule is about the size of a large vitamin.
Who should undergo an endoscopy?
An upper endoscopy is done to help find the cause of your child’s symptoms, such as abdominal pain or vomiting.
A capsule endoscopy allows for a full look of the small intestine because the capsule travels to places where an endoscope cannot reach or examine. This is important for patients with bleeding lesions in the small intestine that have gone undetected by upper endoscopy and x-ray. Capsule endoscopy has also been useful in the diagnosis of small bowel Crohn’s disease. Your child must be able to swallow pills about the size of a jellybean to have this procedure done.
What happens during an endoscopy?
These tests are performed on an empty stomach. Your child’s care team will instruct you how to prepare for an endoscopy.
For an upper endoscopy, your child will have an IV (intravenous) line placed and will be given medicine through the IV. This will make your child sleepy and very relaxed. The doctor will spray a numbing medicine in your child’s mouth to make the test more comfortable. This does not hurt, but some children do not like the taste.
Throughout the procedure, your child will be attached to a heart monitor by wires connected to three stickers on the chest. They will also have a small-lighted sticker on a finger or toe attached to an oxygen monitor. The test usually takes about 30 minutes to complete.
For a capsule endoscopy, a clinician will measure your child’s waist, height, and weight, and place eight stickers on your child's abdomen, which will be connected to a recording device about the size of a portable CD player. A loose, soft wrap will be wrapped around your child’s abdomen to keep the stickers in place.
Your child will then swallow the capsule with a small amount of water. The recorder and battery pack will be belted around your child’s waist. The recorder must be worn for about eight hours. The pictures captured by the recorder are downloaded into a computer program and reviewed by a gastroenterologist.
What happens after an endoscopy?
When the upper endoscopy is complete, a nurse will be with your child and carefully observe them during the entire recovery time. When your child is fully awake, they may have clear liquids to drink. Once your child is able to keep liquids down, the IV will be removed. Children do not usually experience discomfort after this test. Some children have a slight sore throat.
Children are usually able to go home about one hour after the test is done. The nurse will review all instructions with you and give you information sheets. Since your child may still be sleepy or unsteady, please arrange to have private transportation to go home. Do not plan to take a bus or the MBTA. If you have not arranged a ride, we may cancel the procedure.
Following a capsule endoscopy, your child may resume normal activities, including exercise, and may resume all medications immediately. Until the capsule passes out of the body, further testing, including any type of MRI, should be avoided. The capsule will pass naturally in a bowel movement, typically in about 24 hours.
How will we be informed of the results?
Your child’s doctor will speak with you as soon as the procedure is done. If biopsies were obtained, it will take about five to seven days for results.
Endoscopy | Advanced Endoscopy
Boston Children’s is one of very few locations in the Northeastern U.S. to offer therapeutic endoscopy procedures by physicians specially trained in using this technique in children. These state-of-the-art procedures allow us to view your child’s esophagus and other gastrointestinal tract anatomy, take biopsies if needed, and, in some cases, even treat the condition in a minimally invasive way.
- endoscopic retrograde cholangiopancreatography (ERCP)
- endoscopic ultrasound (EUS)
- peroral endoscopic myotomy (POEM)
- transnasal endoscopy
Endoscopic retrograde cholangiopancreatography (ERCP)
This procedure combines an endoscopy with x-ray technology to help visualize your child’s digestive tract, as well as the important ducts in the liver and pancreas. In ERCP, a physician will guide the endoscope through your child’s mouth and into the small intestine, and then inject a special dye so that these small ducts become visible on x-rays. This allows them to view your child’s bile ducts and pancreas ducts to look for stones or abnormalities that your child may have been born with or acquired later in life.
Not only does ERCP allow your child’s gastroenterologist to identify and evaluate problems in the ducts of the liver and pancreas, but it also allows then to treat many of these problems using additional therapies through the scope itself. These include sphincterotomy, stone removal, dilation, and stent placement, just to name a few.
Endoscopic ultrasound (EUS)
This technique combines endoscopic and ultrasound imaging technologies to produce high-quality images of your child’s digestive tract. In EUS, a physician will use a special endoscope with an ultrasound processer at the tip, which is called an echoendoscope. This allows them to examine both the lining and wall of the digestive tract, along with nearby organs such as the liver, bile ducts, and pancreas. EUS also allows your child’s physician to visualize their lymph nodes. While most of its use in adults involves identifying and evaluating cancers of the gastrointestinal tract, it can be used in children to evaluate chronic liver and pancreatic conditions such as chronic pancreatitis.
This procedure also allows your gastroenterologist to obtain a sample of tissue from organs in the abdominal cavity using a small fine needle, such as a liver biopsy or pancreas biopsy. Obtaining tissue samples in this manner is less invasive than surgery and is often a simple day procedure. EUS is also used to drain fluid collections in the abdomen.
Peroral endoscopic myotomy (POEM)
Certain problems, such as esophageal strictures, can affect the upper gastrointestinal tract, making it difficult for children to swallow. To treat a stricture, the doctor will pass a tiny balloon through the endoscope into the duct and then inflate the balloon under high pressure. When the balloon inflates, it causes a slight tear in the scar tissue that has built up in the duct and caused it to narrow. Once the balloon has created space in the duct, the doctor may insert a small tube called a stent or a sponge through the endoscope and into the area of the stricture. The stent or sponge will remain in place to keep the esophagus open as the tissue heals around it. It will be removed in a follow-up procedure later.
A transnasal endoscopy (TNE) is a type of test used to examine your child’s upper gastrointestinal tract. Like a traditional endoscopy, it uses a thin, flexible tube with a light and small camera on the end to view the esophagus. The tube is used to look in the esophagus and into the stomach. A small piece of tissue is then removed from the esophagus and taken to our lab for testing. Your child’s test results should arrive about one week post-procedure.
What makes TNE different is that the tube is passed through one of your child’s nostrils rather than their mouth. The test usually takes only five to 15 minutes, but you should expect to be at the hospital for about two hours total.
Because TNE can be performed without general anesthesia, it can be a convenient option for older children or teens with eosinophilic esophagitis who must undergo regular endoscopies. In place of anesthesia, numbing medicine is given for their nose and throat to make sure your child is comfortable.
TNE is best for children and teens who are used to medical procedures and is commonly used for repeat endoscopies, not a patient’s first endoscopy.