Gastrointestinal Endoscopy
What is endoscopy?
The word "endoscopy" means to "look inside." Endoscopy is a diagnostic test designed to look at the lining of the gastrointestinal (GI) tract, including the:
- esophagus--the tube that carries food from the mouth to the stomach
- stomach--where food is stored immediately after a meal
- small intestine--where food is digested
- large intestine--where waste is processed
The test is performed with a special instrument called an endoscope, or just 'scope' for short. It is a long thin hollow tube with a bright light and highly specialized camera at the end. The tiny camera allows the doctor to see images of your digestive system on a TV screen.
The doctor passes the scope into the child and watches the TV screen to see what the lining of the gut looks like. Using hand controls, the doctor can turn the tip of the scope to go around corners and see behind the folds in the GI tract.
How is the test performed?
The test is done with the child under anesthesia or intravenous sedation, depending on the needs of the child and the nature of the procedure.
Upper Gastrointestinal Endoscopy (also called esophagogastroduodenoscopy or EGD)
After the child is asleep, the scope is passed through the mouth and into the esophagus. After the esophagus is examined, the scope is passed into the stomach and then the first part of the small intestine. Each area is thoroughly examined.
During most endoscopies, the esophagus, stomach and small intestine are biopsied. Biopsy means to take a shallow piece of the lining layer to look at under the microscope. A biopsy is performed with a special instrument that goes through the scope. Several biopsies are taken from each area. Each biopsy site bleeds a little. The bleeding stops by itself.
Colonoscopy
Colonoscopy means to examine the lining of the large intestine and last part of the small intestine. Sometimes, only the last few inches of the large intestine are examined, called flexible sigmoidoscopy. Both are performed by passing a scope through the anus into the large intestine. Biopsies are then taken as described above.
Therapeutic Endoscopy
Therapeutic endoscopy means performing a treatment inside the intestine using special instruments that go through the scope. First, a diagnostic endoscopy is done, as described above. If a problem that is treatable through the scope is identified, the doctor may be able to treat the problem at that time. Most of the time, the doctor will know before the procedure starts that therapeutic endoscopy may be necessary and will inform you. Examples of treatment that might be necessary are removing a polyp or cauterizing a bleeding site.
What are the risks of endoscopy?
Endoscopy is a safe procedure. Few patients experience unexpected or serious complications from diagnostic endoscopy. Most patients have a mild sore throat; all have some bleeding from the biopsy sites. The blood is not visible unless the patient vomits after an upper endoscopy, or has a bowel movement after a colonoscopy. The amount of bleeding is usually small. Rarely, excess bleeding occurs, and may require a transfusion. Therapeutic endoscopy may be necessary to stop the bleeding.
Perforation, or a hole in the GI tract, is a serious complication that requires hospitalization, antibiotics and possible surgery. The likelihood of a perforation during diagnostic endoscopy is very small.
There is more risk in performing therapeutic endoscopy. Medicine may be injected into the intestine, or the lining of the intestine may be subjected to heat to stop bleeding or remove a polyp. The risk of bleeding or perforation with these procedures is higher than for diagnostic endoscopy, but still very small.
Anesthesia carries some risk as well. Adverse reactions to the medicine can occur. Allergic reactions, coughing, wheezing, hoarseness and sore throat are possible. You will have the opportunity to discuss the specifics of the anesthesia with the anesthesiologist before the test.
Does endoscopy hurt?
Under sedation or anesthesia, the patient doesn't feel anything, and won't remember anything about the endoscopy. After the patient wakes up, he or she may have a sore throat. Because the doctor will inflate the intestine with air during the exam, the gas will have to be passed and cramps may accompany that. Some patients feel some soreness in their abdomen the day after the test as well.
How long does endoscopy take?
The patient will be in the Operating Room for 20-45 minutes for an upper endoscopy, and 30-120 minutes for a colonoscopy. Many patients have both an upper endoscopy and colonoscopy under the same anesthesia, which takes 40-120 minutes.
Where is the test done?
Although endoscopy is not surgery, most endoscopies at Cincinnati Children's are performed in one of the operating rooms specially equipped for endoscopy. Occasionally, procedures are done in the Intensive Care Unit or in the Radiology and Medical Imaging Department. Some procedures can be performed at Outpatient Mason.
Where do you go when you arrive at the hospital?
Outpatients come to the Same Day Surgery area to check in 1 ½ hours before the test. After registering, the Same Day Surgery nurses and doctors will prepare the child for the test.
During the test, family members wait in the Waiting Area, next to the Operating rooms. You should check in with the receptionist at the desk in the middle of the room, and she will contact you as soon as the doctor is ready to speak with you after the test. It is best if you remain in the Waiting Area at all times, unless otherwise instructed.
What happens after the test is done?
As soon as the endoscopy is done, the child is taken to the Post Anesthesia Care Unit (recovery room) to wake up. When your child wakes up, a nurse will call you to the recovery room. Your child will be allowed to have some clear liquids to drink when he / she awakes. When the effects of the anesthesia have mostly worn off, you will be allowed to go home. The child's usual diet can be resumed when all the effects of the anesthesia have gone. Your doctor will inform you if a special diet is necessary after the test.
Normal activity is permitted when all the effects of the anesthesia have worn off. Most children go home soon after the endoscopy and are able to go to school the next day.
Preparation
Before the test, instructions for preparation will be given to you by the doctor and GI nurse. Be sure to understand and follow all directions to assure adequate preparation. Any deviation from the preparation may require cancellation and rescheduling of the procedure. The details of preparation vary by age.
There will be diet restrictions before upper endoscopy and colonoscopy. Because fecal material interferes with performing a colonoscopy, all stool must be removed from the large intestine before the procedure. Excess stool in the large intestine due to inadequate preparation will prevent the procedure from being completed.
There will be a specified period of "nothing by mouth" before upper endoscopy and colonoscopy. Eating or drinking too closely in time to the procedure will put your child at great risk of pneumonia and may require cancellation of the procedure.
Orientation Classes
Young children may benefit from orientation to the hospital, Same Day Surgery, Operating Room and Recovery Room. Classes including tours of the areas are held every week including Saturday.
If you need more information about days and times, please call 513-636-8298.
Scheduling
Our office staff will help you schedule the endoscopy. If you must change your appointment, please contact us as soon as you know that a change is necessary, 513-636-4415.
Illness
If your child becomes ill with a fever or cough within 7 days of the scheduled procedure, please contact the GI nurse immediately, 513-636-1128. Under some circumstances, the procedure may need to be rescheduled to allow the child to recover before anesthesia is given.
Reviewed 6/06
