Gastroenterology Procedure Unit Endoscopy Unit

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The Endoscopy Unit at Boston Children's Hospital is a subspecialty area within the Division of Gastroenterology. The Endoscopy Unit supports various programs within the hospital, including the Clinical Nutrition, GI Motility and Pulmonary programs. Our specialists provide some of the most comprehensive and cutting-edge endoscopic services in the country for infants, children, adolescents and young adults who require routine endoscopic procedures, as well as advanced diagnostic and therapeutic procedures.

Families of patients requiring these types of endoscopic procedures are referred to our program by pediatricians and pediatric gastroenterologists from New England, all of the United States and from around the world.


Our Services

The Endoscopy Unit is committed to providing state of the art care and endoscopic procedures to children with gastrointestinal, pancreatic and hepatobiliary disorders. We offer comprehensive services for patients, their families and referring physicians, including:

  • Complete range of sedation and anesthesiology services as needed
  • Diagnosis and treatment using a variety of specialized endoscopic and radiographic examinations
  • Access to investigational procedures in clinical trials
  • Coordination of scheduling and care plans with primary care and other specialty physicians
  • Long-term follow-up care

For more information about our services or to schedule an appointment, please contact the Endoscopy Unit at 617-355-6172.

For families residing outside of the United States, please contact Boston Children's International Health Services which facilitates the medical review of patient records and appointment scheduling, and provides assistance with customs and immigration, transportation, hotel and housing accommodations.

Endoscopy Unit Procedures

Using the latest technological advances, the Endoscopy Unit in Boston Children's Hospital's GI/Nutrition Department performs routine and advanced tests and procedures to evaluate and treat patients. We also provide comprehensive sedation and anesthesiology services for patients as needed. Procedures performed include:

Capsule Endoscopy

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A wireless capsule endoscopy (WCE) 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.

It takes pictures throughout the small intestine by sending images to a recorder -- about the size of a portable CD player -- that you or your child wears around the waist. The recorder must be worn for about eight hours. Eight stickers are placed on you or your child's abdomen to assist the capsule in capturing the pictures. The pictures captured by the recorder are downloaded into a computer program and reviewed by the Gastroenterologist.

Why is the test necessary?

The capsule travels throughout the entire small intestine to places where an endoscope cannot reach or examine, allowing for a full look of the small bowel. 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.

The day before the test

The day before the test, your child may eat a regular breakfast and lunch. After 2 p.m., only clear liquids are allowed. Please avoid all red colored liquids!

Examples of clear liquids are:

  • apple juice
  • white grape juice
  • ginger ale
  • powdered drink mixes such as Kool-aid or Crystal Lite
  • clear soup broths
  • Jello
  • Popsicles without real fruit juice

Your child should not have any solid food, milk and milk products, or juices with pulp (such as orange, pineapple or grapefruit juice) after 2 p.m. Medications may be taken as usual the day before the test.

Please note: Your child must be able to swallow pills about the size of a jelly-bean to have this procedure done. If he or she is unable to do this, please let us know. The capsule may be placed endoscopically if necessary.

The morning of the test

  • Please allow enough time to get to the hospital on time. If you arrive late, the procedure will have to be cancelled.No medications should be taken the morning of the test. However, you should bring medications with you to the hospital.
  • Your child may drink clear liquids until three hours before the scheduled procedure time. Nothing else -- including water, gum or hard candy -- should be ingested after this time.

What happens during the test?

The test is usually done in the Endoscopy Unit on Farley 3 in the main hospital at Boston Children's Hospital. The capsule will be administered by a registered nurse from the Endoscopy staff. A gastroenterologist (doctor) will answer any questions you may have prior to the test.

After your child's waist, height and weight are measured, eight stickers will be placed on your child's abdomen, which will be connected to the recording device. 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 nurse will review diet, exercise and return time instructions with you.

What happens after the test?

Following the exam, 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.

If you have any questions or concerns, please call the page operator at
617-355-6369 and ask for the GI fellow on call.

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Impedance Study

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An impedance study is a test done to find out if contents from the stomach are coming up into the esophagus (food tube). It helps evaluate acid and non-acid gastroesophageal reflux.

In this test, a thin, flexible tube is passed through the nose, down the back of the throat, and into the esophagus. The tube is carefully taped into place on your child's cheek. The end of the tube is attached to computer which will remain at your child's bedside throughout the study.

Because of the computer, your child will need to stay overnight in the hospital. Your child will need to stay in the room close to her bed. She will also need to use a bedside commode (toilet) instead of walking to the bathroom. You may want to bring books, small toys, videotapes or other items to occupy your child while she is in bed.

How long does it take?

An Impedance Study takes 18 to 24 hours. The tube is left in place for this time. You will be asked to keep a diary of your child's activity during the study. The doctor will use the diary to compare the computer reading with your child's activity.

How should I prepare my child?

Your child must have an empty stomach for an impedance study.

  • If your child is younger than six months, he must have NOTHING to eat or drink for two hours before the scheduled procedure time.
  • If your child is older than six months, he must have NOTHING to eat or drink for four hours before the scheduled procedure time.

If your child takes any medication that reduces the amount of acid in the stomach (such as ranitidine (Zantac), omeprazole (Prilosec), Prevacid, Pepcid, as well as Maalox, Tums, or Gelusil) , please ask your child's doctor if he should continue those medications as usual or if he should stop taking the medication three days before the test.

When you talk with your child about the test, explain in simple terms why it is needed.

What happens before the test?

This tube is usually placed in the Endoscopy Unit on Farley 3. You and your child will then be admitted to an inpatient floor. If your child is already in the hospital, the test will be done on his/her hospital unit.

If your child is not already a patient in the hospital, you must first register in the Admitting Department located on Main 1 in the main hospital in Boston.

Please arrive in the Admitting Department one hour before the scheduled time of the test. It is important that you are on time, so that the study does not have to be canceled. Studies usually begin on time. However, sometimes there are unexpected delays.

After you registering at Admitting, you will go to the Endoscopy Unit in the Farley Building on the third floor. (From the Main Lobby, take the stairs or glass elevator to the Farley Building. Take the Farley/Pavilion elevators to the third floor. Follow the signs for the Endoscopy Unit.)

When you arrive at the Endoscopy Unit, a nurse will greet you and your child, explain the test, and answer your questions.

What happens during the test?

  1. The nurse will check your child's height to determine where to place the tube. To help calibrate the computer, your child will dip his or her finger into liquids in two test tubes.

  2. The nurse will pass a tube through your child's nose into the stomach. You may stay with your child while the tube is passed. Infants and young children will be snuggled in a blanket to help them to feel secure and stay still while the tube is being passed. Older children, who are more likely to cooperate, may prefer to sit in a chair while the nurse passes the tube. Passing the tube may cause your child to cough, sneeze, or gag. This feeling will pass after the tube is taped in place. Once in place, the tube should not bother your child.

  3. Once the tube is taped in place, your child will have an X-ray to check the exact position of the tube. Depending on the X-ray results, the tube may have to be repositioned and retaped. Special sleeves may be put on infants and small children to prevent them from bending their elbows and pulling out the tube.

  4. You will be asked to write down what your child is doing while the tube is in place, such as eating, sleeping and coughing. Your child's nurse will explain exactly what needs to be written down to help with the study.

  5. The tube will be removed the next day by a member of the GI staff. Removing the tube takes less than a minute and does not hurt. Some children cough or sneeze.

How will we be informed of the results?

When the tube is removed, the information recorded in the computer will be interpreted by a Boston Children's GI doctor. Call your child's primary doctor one week after the study for the results.

When to call your child's doctor or nurse

If your child is sick 24 to 48 hours before the test is scheduled, call the GI/Endoscopy Unit at 617-355-6172 between 7 a.m. and 3 p.m. Ask to speak to one of the nurses.

If you have any questions about the test, call the above number.

For emergencies, you can call a GI doctor 24 hours a day. Call the hospital page operator at 617-355-6369, and ask for the GI fellow on call.

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Upper Endoscopy

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An upper endoscopy is a look inside the esophagus (food pipe), stomach, and beginning of the small intestine (bowel). In this procedure, the doctor passes a long, thin, flexible tube with a light on the end through the mouth and esophagus. The tube goes down into the stomach and small intestine. As the doctor passes the tube, he or she looks at these areas and may take small samples of tissues called biopsies.

Why is it necessary?

An upper endoscopy is done to help find the cause of your child's symptoms, such as abdominal pain or vomiting.

How should I prepare my child?

Food and Drink: Your child must have an empty stomach for an upper endoscopy. After midnight, do not give your child any solid food, milk or milk products, formula or any juices with pulp such as orange, pineapple or grapefruit juice.

  • If your child is younger than 6 months, he may drink clear liquids until two hours before the scheduled test time. Breastmilk is considered a clear liquid.
  • If your child is older than 6 months, he may drink clear liquids until three hours before the scheduled test time.

Examples of clear liquids are breastmilk, water, apple juice, cranberry juice, Pedialyte and Gatorade. Formula is not a clear liquid.

Medications:

  • Your child should not take medicines containing Ibuprofen or Naproxen for four days prior to the procedure. These medicines include, but are not limited to, Motrin, Advil, Pediaprofen, Aleve and Naprosyn.
  • Your child should not take aspirin products for 1 week prior to the procedure.

Talking to your child: It is helpful to be honest with your child about the test. Explain in simple terms why the test is needed. Let your child know that you will be nearby during the test.

 

Where is the procedure done?

Upper endoscopies are usually done in the Endoscopy Unit. Sometimes they are done in the operating room. The GI doctor will decide the best place for your child. If your child is scheduled for the operating room, a nurse will call you the afternoon before and tell you where to come. Call the Day Surgery Unit at 617-355-7921 between 2 p.m. and 5:30 p.m. if you do not receive a call.

Please do not bring other children to the procedure. If you must bring other children, please bring another adult to care for them.

Your child's primary GI doctor will perform the procedure. A nurse will stay with your child and carefully observe him or her for the entire time.

What happens before the test?

If your child is having the test in the Endoscopy Unit please arrive 45 minutes before the scheduled time of the test. It is important that you are on time. If you are late, the procedure may be canceled.

If you park your car at the Boston Children's Hospital garage, bring your parking ticket with you and have it stamped at the Lobby Information Desk.

The Endoscopy Unit is located in the Farley building on the third floor. Follow the signs for the Farley/Pavilion elevators. Take the Farley/Pavilion elevators to the third floor. Follow the signs for the Endoscopy Unit.

When you arrive at the Endoscopy Unit you will be greeted by a nurse who will explain the test and answer your questions. You will be asked to sign a consent form. You must be the childs legal guardian to sign the consent form. Then, your child will be weighed and given hospital pajamas.

What happens during the test?

You and your child will be brought into the room where the test is done. If he or she has a favorite toy, blanket, music tape or CD, you may bring it along. You may stay with your child until he or she falls asleep. You may wait in the Family Waiting Area or elsewhere in the hospital. We ask that you do not leave the hospital while your child is in the Endoscopy Unit.

Your child will have an IV (intravenous) placed. Your child will then be given medicine through the IV. This will make your child sleepy and very relaxed. The doctor will spray a numbing medicine in the 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. He or she 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.

What happens after the test?

When the test is complete, the doctor will speak with you in Family Waiting Area. From there, a nurse will bring you to the recovery area to be with your child.

In the recovery area, a nurse will be with your child and carefully observe him or her during the entire recovery time. When your child is fully awake, he or she may have clear liquids to drink. Once your child is able to keep liquids down, the IV will be removed.

We ask that you do not bring siblings or other young children into the recovery area. Children may wait with another adult in the Family Waiting Area.

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.

Patients who receive sedation must have a responsible adult with them when they leave the hospital. 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 a ride has not been arranged, the procedure may be canceled.

Children do not usually experience discomfort after this test. Some children have a slight sore throat.

How will we be informed of the results?

Your 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.

When to call your child's doctor or nurse

If you have any questions about the procedure, call the GI/Endoscopy Unit at 617- 355-6172 between 8 a.m. and 4 p.m. Ask to speak to one of the nurses.

For emergencies, you can call a GI doctor 24 hours a day. Call the hospital page operator at 617-355-6369 and ask for the GI fellow on call.

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The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
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