Specialized Procedures

To evaluate the large intestine, your child may require a barium enema exam. There are two types of barium enema exams. The first type, the full column barium enema, is designed for children with constipation or soiling. A technician inserts a small plastic tube into your child’s rectum. Liquid barium then flows through the tube to fill the colon so it can be studied. This test takes from 30 to 60 minutes.

A second type of barium enema, the air contrast barium enema, is designed to look for inflammation or polyps (growths) in the large intestine. For this test, your child’s colon must be emptied of stool. Your child will have a special diet the day before the exam and will take a special type of laxative to stimulate frequent stools. You also will give your child suppositories the night before and the morning of the exam at home. During the exam, a small plastic tube will be used to fill your child’s colon with barium and air. This helps us see the inner lining of the colon in great detail.

With this test, the physician examines the inside lining of the entire length of the colon or large intestine. In order to see well, the colon must be emptied of stool. Your child will require a special diet the day before the exam and will need to take prescribed medication to encourage passage of stool. Your child will be sedated with medication given through an intravenous line. The physician then passes a long, thin telescope through the anus and along the length of the colon. Through the telescope and its attached television camera, the physician can see the lining of the colon. Small biopsies can be obtained from this lining. At times, polyps or small growths can be removed. Sensors attached to your child monitor heart rate, blood pressure, and blood oxygen levels to ensure safe conditions during the exam. A typical colonoscopy takes about 60 minutes. Generally, your child will be awake and able to drink fluids within one hour after the exam.

Biopsy reports are usually available about 6 days after the procedure. Results will be phoned to you.

Ultrasound helps us examine the liver, gall bladder, pancreas and kidneys. Your child must fast six hours before an ultrasound to provide a clear view of the organs. During this painless procedure, your child lies quietly while the radiologist moves the ultrasound probe across the abdomen. A cool jelly coats the probe to improve the ultrasound picture quality.

Compassionate nurses who are experienced in helping children through these tests will start an intravenous line and help administer medications to relax your child and relieve potential pain. During this test, a long, thin telescope about as wide as a pen is inserted into the mouth, down the esophagus, and into the stomach and intestine. Through this telescope and its television camera, the gastroenterologist can see the inner lining of the esophagus, stomach and intestine. Small biopsies can be obtained from this lining. Sensors attached to your child also monitor heart rate, blood pressure and blood oxygen levels to ensure safe conditions throughout the procedure. A typical upper gastrointestinal endoscopy takes about 20 to 30 minutes.

The upper gastrointestinal Xray exam permits physicians to look for abnormalities in the esophagus, stomach and small intestine. This test is often performed in the morning, before your child has had anything to eat. For the test, your child will drink barium, a liquid which is visible on Xrays. A radiologist takes Xrays as the barium moves down the esophagus into the stomach and through the intestines. The test takes one to three hours to perform.

At times, children require other procedures for diagnosis or therapy. If your child should require any of these procedures, the reason for the test, details of the test, possible outcomes, and potential risks are reviewed in great detail. Briefly, these procedures include:

• Suction rectal biopsy: painless biopsy of the inner lining of the rectum without sedation, most often performed in infants or children being evaluated for severe constipation.
• Liver biopsy: needle biopsy of the liver, most often done to diagnose liver disease if blood tests do not provide an exact diagnosis.
• Acid reflux study: placement of a spaghetti-strand probe into the esophagus for prolonged monitoring to measure reflux of acid from the stomach into the esophagus.
• Endoscopic retrograde cholangiopancreatography (ERCP): examination of the ducts or tubes within the liver or pancreas, using an endoscope, with your child under sedation or general anesthesia.
• Anorectal manometry: measurement of muscle pressures within the anus.