Biopsy, endoscopy, gastroscopy, EGD

[kickingfrog]

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Biopsy, endoscopy, gastroscopy.


Originally on Old Supp

From Cassie:

Can someone please describe to me what actually happens when you go along for an endoscopy? I am awaiting mine and have been promised that it will be 6 more weeks tops (although i can't wrangle a definate date out of them which is unnerving) before i can have it and go gluten free. I need a calm factual description of what is done, are cameras used? Can you watch the whole thing if you chose conciousness? How long does it take? Is it best to take a friend? Does it hurt? I'd be grateful for a complete start to finish description so I, and others waiting and wondering will have some idea of what to expect in a description that will not disappear over the edge of the Coeliac message board in a couple of days. Thanks in advance.X

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Emma

Reply Re: Biopsy

I had mine done under anistetic but i am told ....what they do is numb ur throat and put down a tube wich has a camera on it....i did have something simlar done....u can jus feel a bit of a niggle goin down ur throat...i wud advise to get in sum numbers (or throat sothers) for afterwards because it can sometimes be sore afterwards...the best thing is not to panic...and if u feel better with a friend take one! I hope this helps
Emma xXx

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adodman

Reply Re: Biopsy

You dont say how old you are, the proceedure is different according to age.
In children they use a very narrow stiff piece of tubing and on the end of it is a small sampling device around the size of a peanut. The child is given a small dose of sedative and placed on an x-ray viewing table. The capsule is passed into the mouth and down into the stomach where an x-ray image is taken.A small dose of a drug that helps the stomach to empty is then given to help the capsule pass into the duodenum, another image is taken to make sure it is in the correct place and when it is ok suction is applied to the end of the tube that is outside the body and this trigers the sampling mechanism. A very tiny peice of the lining of the bowel is taken and this is examined under a microscope.
In adults and older children the technique is slightly easier because they use a thin flexible camera called an endoscope that is introduced into the back of the throat and down into the stomach. This is easier because thay can see where the camera is going. This is sometimes done with a small dose of sedative but if you are particularly brave it can be done with a spray of local anaesthetic at the back of the throat. I won't deny that it is a bit uncomfortable but it is probably nothing compared to the way coeliac disease can make you feel. Don't worry just let them get on with what they need to do and don't panic, it will be over with very quickly. You wont feel the sampling process, they take such a small portion of the bowel. Taking a friend along seems like a good idea but they will have to sit around alone for a while and I don't think that they will be allowed into the endoscopy room, there are usually more that enough staff in the room with not much space.
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LynG

Reply Re: Biopsy

I was told by other people who had a biopsy before I had mine to 'take the Valium' if it was offered. If you have a sedative it means that you don't remember anything about the tube going down your throat etc. Before you are given the sedative a needle, with plastic device attached to it, is put into the back of your hand (just a sharp scratch). It is done by a nurse on the ward before you go into the area where the biopsy is done. When you get there you have a plastic dummy-type thing put into your mouth (this is where the tube goes through later on). Then the (cold) sedative is put into the back of your hand. I don't remember anything after that until I woke up back on the ward and it was all over. If you have the sedative you will need someone to take you home as you might feel a bit drunk.

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Kate
Reply Re: Biopsy

Again, endoscopies are different depending on age, and the centre to which you go.
A small child does not usually get this new capsule to swallow, instead, a smaller version of the endoscope is used to effect the same procedure. This is done under Deep Intra Veinous Sedation, using one of the drugs from the Valium family, that causes a loss of memory of the procedure, as well as sedating fully. It is in many ways just like the effect of a general anaesthetic, but without the attendant problems of anaesthetising the very young. The drug is introduced through a canula in the back of the hand (the same thing used when on a drip), and this enables the sedation to be topped up if necessary.
The blood gases and pulse are monitored throughout, and once the biopsy has been taken, and the Dr has had a good look with the scope, the procedure is finished, and does not take long at all.
The child sleeps for a period after, certainly anything up to 4 hours(!), and when they wake, they can have a drink, something to eat, and go home!
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linda

Biopsy


i had the general anaesthetic so the only proof i had that it had been done was some coloured photos of my insides and a positive diagnosis!
i was in hospital for about 4 hours all told. a friend waited for me and we went out for lunch afterwards! don't worry - you'll be fine. Linda
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cassie B

Reply Biopsy

I remember the whole thing distinctly since i've had it done and thought i'd write down my version of events since the 27 July when it happened. Sat waiting for 2 hours which was pretty bad then was taken into a little room by a nurse who stayed with me throughout. She had a book with diagrams of a cross section of a human and showed me where the camera was to go and that bits were going to be taken from my duodenum.There was a question and answer period then i went back into the waiting room to await my turn.
I was then taken into theatre and lay on my left side, the monitor was behind me, the doctor in front. I was given some spray that tasted like bananas and petrol (apparently) and a plastic hollow tube was put into my mouth. Very slowly a black plastic flexible tube was put down. I was gagging alot and heaving but not panicking,the nurses were very supportive. I felt him pushing at the cardiac sphincter muscle at the beginning of the stomach (stops food being passed back up), it honestly doesn't hurt just felt for a second like pushing or a burp that won't come up.He then passed another thinner tube into the black one. This had the little scoop for the biopsy, he put that in, took the biopsy and pulled it out then went back in for another biopsy, this is apparently normal procedure to get it in at least two places in the duodoenum just to make sure. Then it was all pulled out. He told me everything looked normal apart from a Hiatus Hernia that is a totally seperate thing. I was burping alot afterwards, at some point they pump gas in so that they can see everything without it all your pipe work sticking to the camera tube. For some hours afterwards i felt like i still had a burp in there. It was embarrassing because of the retching and heaving but i had no medication and was not in pain at any time. I found it a very informative experience. It isn't something that i'd want to do every day but nothing scary (the wait was the worst part). The good thing was a) i remember so can tell other people and b) i was out straight away and in the pub for my last gluten pint. I feel i can help someone have an informed choice on how they want their biopsy done now and will answer any questions as i know i wanted to know as much as possible about it beforehand. Good luck to all. It aint so bad. X
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Re: endoscopy

Posted by Mary H on 3/3/2007
Gf board

...For my first endoscopy I asked if I could have the anaesthetic throat spray AND the sedation (because I was quite nervous) and they agreed! The throat spray wasn't very pleasant because it made me gag a bit and I couldn't swallow my saliva properly. But then they gave me the intravenous sedation (midazolam) and I don't remember a thing from then until well after it was over, by which time the spray had completely worn off as well.
If you are very nervous I would recommend asking for both, if they will allow this in your hospital. No harm in asking anyway!
.....


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Re: endoscopy

Posted by shamish on 3/3/2007

Thankfully i remembered nothing
I just remember getting the sedation sitting there then waking up in the ward was brilliant compared to the first time when i was awake ….


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[kickingfrog]

Biopsy Question
I was surprised that after the procedure we had to have tea and toast!
Ofcource I had no Gf food with me the first time when I had the
gastroscope. I said to the nurse I can't have toast as I can't take
gluten as it is poison to me, she didn't seem to know what I meant!
She got the nurse in charge to speak to me, so I told her the problem
and thankfully she was able to get some Gf biscuits for me. The next
time for the colonoscopy I had my own GF biscuits at the ready! I
was the only one on both occasions not to be able to take the normal
toast!

Best wishes,

Briar

health.groups.yahoo.com/group/UK-Coeliac/message/3146


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[kickingfrog]

Endoscopy

From Sue on GF board

My 15 year old daughter is going to Plymouth hospital for an endoscopy in 3 weeks time. I understand she can have a choice of being sedated or just having a throat spray. I have had about 4 done on me - the last one being about 5 years ago but I am sure I had both throat spray and an injection in my hand for sedation. My point is what to recommend to my daughter - probably sedation would be best - but will she have the throat spray as well? I would add that she has great difficulty in swallowing tablets and tries to avoid them at all cost preferring soluble paracetomols etc.
Personally I have never found the tests to be too bad and have always felt quite good afterwards - although I know some people dread them terribly.
This will be a first experience for my daughter of anything medical other than blood tests, injections, and an x-ray.
I would be grateful for any comments or suggestions.
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From Sue Taylor

Hi Sue,
I have had a few endoscopys done both ways and would if my daughter were to have one done would go for the sedation. I have never liked the throat spray found it a very bad experience. Being a little bit drowse for a few hours is not that bad.

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From Sarah
I had the throat spray, and was ok, but its not somethig I would ever want to repeat.
I would advise the sedation for your daughter, but as someone has already said I would give her as much info as you can and let her decide

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From Ellen

had an endoscopy also at Derriford in August last year. I had a sedative and knew nothing about it until I came to in the recovery ward when the nurse gave me a cup of tea and biscuit. I must admit I was rather worried before the procedure as I cant swollow tablets either.


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From Jill

The first one i had i just had the throat spray (i was not given a choice) and it was an absolutely awful experience and would never go through that again. The next time a different doctor showed real surprise that i was not sedated and said he wouldn't dream of doing it without. Yes you feel a bit sleepy for the rest of the day but that's all. I'd definetly suggest sedation to your daughter if you ever might need to get her near a hospital again!
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I had an endoscopy at the end of January and this time elected to have sedation. It was getting worse each time I had to have an endoscopy with just the throat spray - overanxious etc and I hated the gagging and the feeling afterwards.
This time I had throat spray and sedation. I remembered nothing about the endoscope going into my mouth and woke up a little while later so cheerful. I'll never have just the throat spray again.
Vee


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From Annie B
My last endoscopy was at Derriford in 2002 and I'm pretty sure I had both the throat spray and the sedative. I certainly wouldn't have gone through the procedure without the sedative! Everything went smoothly and I couldn't recall anything about it. I was awake again within about half an hour and went straight home.
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From Ann

This is very much personal choice. In 2002 my, then 17 year old, daughter had an endoscopy under sedation. It was done as a day case, and after the procedure only slept for about an hour or so before we were allowed to take her home. She remained groggy for the rest of that day and a bit the next. I don't recall that she had the spray as well.
For my procedure I elected to have the spray - it tasted of banana! It wasn't exactly pleasant but then again it wasn't awful. The worse bit is when you have to 'swallow' the tube and it triggers the 'gag' reflex - didn't like that bit much! Also I found the sensation of having air pumped into the stomach quite unpleasant - it caused cramp like feelings, and wind to be proud of afterwards . But the big plus was that after it was all over I could go home with no ill effects.
I'd advise giving your daughter as much info as you can and then let her choose what feels best for her. I wish her well.


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From Frank

I have had two done and took the spray on both occasions, the main difference is you can get up and leave right away, no hanging about, the first time I done it the nurse said breath rhythmically, and it worked a treat, did it the second time with no trouble, just concentrate on the breathing and it’s a lot easier.



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Endoscopy
Posted by Annie B (Plymouth) on 9/3/2004, 5:07 pm, in reply to "Re: Endoscopy"

(GF board)

My mum found the procedure to be fine, Sue. The main consultant, Dr Wilkinson, performed the endoscopy. When I went a couple of years ago, it was done by specialist nurses. She had both the throat spray and the sedative - she wasn't really offered the choice of not having the sedative!
When she got there she had to answer a few medical questions and then wait a little while. She had the throat spray and was given an injection in the hand and she said she didn't remember anything from then on. She was awake in a short space of time too! Mum was given tea and biscuits afterwards. Your daughter should have no need to worry!
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endoscopy

Posted by Vee Durham on 12/1/2008
GF board

I had my fifth endoscopy yesterday as I have refactory sprue and they are keeping an eye on me. As usual I was very anxious beforehand (went to the loo four times whilst in the ante-room!) but the consultant had promised to do it himself and he did. I had sedation and everything went well, with no after-effects of tummy pain or sore throat.

For the first time I was offered tea and biscuits (not gf, of course) but when I pointed this out they immediately sent up to the canteen for Glutafin choc digestives. It's the most relaxed I've ever been after this procedure.

They've done a dry biopsy this time (last one was five years ago) so it will be interesting to see if there have been any changes with my T cells. However, I won't find out until my appointment in April. ........

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Endoscopy

Posted by Charlotte, Ward-Perkins on 10/3/2004 on GF board in reply to "Re: Endoscopy"

My understanding was that all children are fully sedated but I'm not sure up until what age. Both my children had an a anaesthetic and because both were done near the end of the day they were still very groggy when I had to wheel them to the car park in a wheel chair - they kept falling out, like wheeling an old drunk! They were very comical though I'm not sure I would want to "transport" my 15 year old today now he's 6'!
I have had 3 endoscopies all with sedation. You're not actually unconscious, it's just you don't remember what happened. The first was fine, the second I didn'd get enough and remember the first part struggling against the tube and unable to talk which was unpleasant, so when I had it done recently and happened to have the senior consultant I said "I want lots of sedation!" "OK" he replied "This will feel like 8 gin and tonics" He was right and I didn't remember a thing. Trouble was, 6 hours later, the after effects of 8 gin and tonics were rather evident and I was pretty tired and 'emotional'...!
My experience is that for any procedure where sedation is an option there is usually a very good reason for offering it and not much for being stoical...
Incidentally the amount of sedation/anaesthetic each person needs varies a lot and is not always predictable: my 5'2" 86 year old mother (who weighs under 6 stone) always needs masses: at her last endoscopy (which she hates) the gastro complained that he had to give her twice as much sedation as for large man and she was still very much awake!

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sedation/ throat spray

Posted by jean on 25/10/2005
GF board

..... I ....decided on the throat anaesthetic rather than sedation cos i had things to do that evening and the next morning. I was glad i did- it was over with a lot quicker. I got home sooner and felt okay straight away- bit of a numb mouth for an hour or so. It was not painful in the least- during or after. Uncomfortable but i can think of worse things to have done. In my hospital, they leave the decision of sedation over numbing entirely up to you . I was told i can try with the throat spray and if i couldn't manage it, i could then have the sedation. Some people find it difficult to swallow with the tube in the throat but your reaction is that you can't. Its a weird feeling but not painful .I found the worst bit was when the tube was almost back out. I burped a couple of times and it made my eyes water.
Got to do it all again in a couple of months and i'll probably go for the throat spray again.



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Carol T on 25/10/2005

I agree totally,I've had two now with just the throat spray,as you say its just uncomfortable and so much better being able to go home straight away,The consultant I see doesn't like to give the sedation,I was very scared before the first one, having had other unpleasant experiences in various departments. But could honestly say it wasn't nearly as bad as anticipated.


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Eileen on 25/10/2005

I had the throat spray last December for an endoscopy and would never opt for that again. (Carried out by understudy of the gastro). I was warned beforehand that it would feel as though I couldn't breathe but that I really would be able to. I had what one can only be described as a panic attack, (there were other issues in the way I was treated whilst in theatre that were really patient un-friendly).
When I returned to see the gastro a few weeks afterwards, he asked me what had gone wrong. He told me that he seldom uses the throat spray!
We're all different. The sedation procedure has slight inconveniences, and it is uncomfortable for approx 2 secs. I had the endoscopy carried out this way some 13 years ago and it was fine.

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Tips for sedative free endoscopy


Posted by Jos on 27/7/2007
GF board


I've just had my second endoscopy without sedative (just over an hour ago) and thought I'd pass on a few tips. The first time I gagged all the way through so this time I asked them to use more spray and it helped a lot, I only gagged at the beginning and end this time - much better. Make sure they spray lots, I had at least 15 sprays this time, possibly more. Then, think of some questions to ask after the spray to make sure it has time to work fully. It didn't start wearing off until I was half way home so you don't need to worry about it running out before the end. Last time I don't think they used enough spray or gave it enough time to work. Also, concentrate on pushing your breath out, like they teach in child birth classes. Even if you haven't had these classes, most people have seem them on TV. It helped me a lot to concentrate on my breathing.
Why have it without a sedative after last time? My appointment was at 10.20 and I was home by 11 despite living 25 minutes drive away from the hospital, I was able to go by myself and will be OK for work (and play!) today and tomorrow so, for me, it's worth not having the sedative though I know it wouldn't suit everyone. Another incentive for me is that I don't like the sensation of sedatives so I'm not being particularly brave by going without the sedative, the opposite if anything!



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Follow-up report, gastroscopy without sedation

Posted by Gale (back home in Aus) on 30/3/2010

GF board

….re gastrocopy / endoscopy without sedation. I had mine this morning so I thought I'd report back on how it went.

It took three goes but the doctor eventually did manage to get the scope down without me gagging too much (apologies to anyone reading this whilst eating )...


It was quite uncomfortable while she had the scope in, and I did burp a lot (they pump air inside your stomach so they can see what they're doing) and drool a lot, which wasn't exactly dignified, but then again who knows what you do while sedated, could be worse!!

I was pleased with myself afterwards for having been able to go through with it, but I have to say, I'm not sure if I'd do it again this way. It's a toss up between which is worse, the five minutes of gagging and nausea while having the scope or the horrid groggy feeling after the sedation.

To anyone else who thinks they might want to have the procedure without sedation, I'd say make sure you are prepared to resort to sedation as a back-up, i.e. have someone prepared to come pick you up if necessary. I nearly ended up not having mine done, because I couldn't have the sedation (didn't have anyone to pick me up) but luckily the third go was lucky last.

The best thing about it was that I walked away five minutes after the procedure was finished, and because I didn't have to go straight home, and I was absolutely famished from the fast, I took myself straight off for a big plate of bacon and eggs and a pot of tea!



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Endoscopy

Endoscope is the generic term applied to a piece of medical imaging equipment used to view the interior of the body's hollow viscera. Examples include colonoscopes to view the colon and nasoscopes to view the nasal cavity. The common feature of all types endoscopy is the method to obtain a picture using two fibre optic guides; one to transmit light and the other to carry the image back to a camera which displays it on a screen. Additionally, the endoscope contains three more tubes. One tube acts as a reservoir of fluid used to clean the endoscope lens and the site under inspection. A second tube is connected to an air pump, which may be used to inflate the organ in order to achieve a better view of the internal surface. The third tube is used to pass down instruments, such as biopsy forceps, to the site of inspection

In superficial endoscopy, where viewing occurs close to the site of entry, only local anaesthetics need be employed since the proceedure is relatively rapid: for example a lignocaine spray to the back of the throat during gastroscopy. However, when examination of a deeper organs is required, such as the jejunum during enteroscopy, a stronger sedative such as pethidine is needed as the procedure can be uncomfortable especially for long periods of time.
In coeliac disease, while endoscopy is used to obtain biopsy tissue samples for histological analysis, in some cases there are macroscopic features indicative of the disease that can be observed:
· on close examination the mucosa appears cobbled due to the absence of villi,
· Kerckring´s folds may be reduced,
· and excess fluid may be present


www.portfolio.mvm.ed.ac.uk/studentwebs/session2/group24/coeliac_endoscopy.htm

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Biopsy (Child)


Biopsy - Posted by Lisa S (Yorks) on 15/5/2005
GF board

Hi,
My 9 year old daughter is having a biopsy tomorrow. (Big gulp from mum!) I know they'll go through it all again with us when we get there (Dewsbury), but does anyone know how long the biopsy will take, and how long she'll be out for? Will she feel ill after?
Thanks everyone, this board has given me the will to carry on, over the past few weeks!
Lisa


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Posted by Sarah on 15/5/2005

Hi, Sophie had hers when she was 4, they let me go as far as the anaesthetic room, and because at the time she was totally scared of needles, they put her out with gas before giving her the anaesthetic, as they tried putting in a cannula on the ward, but she was having none of it, thats when I had to go.
I can't remember how long it took, seemed like ages, but it really wasn't, then I went to recovery where she was very woozy, and confused. Shortly after she was taken to a ward, and was up and about in no time, although she looked a little drunk .
We went home a couple of hours later and she was fine, she had quite a bad sore throat for a couple of days, but was back a nursery the next morning.


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From LizS

I was fully awake and aware when I had my biopsy and it took less than 5 minutes and though not pleasant, was painless, so I shouldn't think that will be a problem, especially as your little girl presumably won't be aware of what's happening.
Can't comment about the sedation but there were plenty of people in the waiting area when I was there who had been sedated and were enjoying a cup of tea, a buscuit and a chat - none of them looked as though they were suffering at all!

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I think the timing for the actual result of the biopsy depends...The procedure itself will take not long at all, 10 to 20 minutes. As to whether little one will be ill, that will again depend on what they give her. If it is sedation which i suspect it will be, there are very few if any side effects as far as I am aware. I have said before on here, if you request it, as i do, the sedation can be reversed after the procedure, whilst little one will still be sleepy she will actualy be with it so to speak, if it is not reversed it takes a few hours in most to fully come round, but again we are all different.
Hope it helps and good luck
Stuart

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endoscopy

Posted by Karen on 14/1/2008

GF board

My daughter had the endoscopy at the Royal London in Whitechapel and they were really great. They dressed her teddy up in a gown just like hers.

My daughter (then 7) objects strongly to a canula going into the back of her hand. We talked to the anesthetist about it and he was happy to put it in AFTER she had gone to sleep. She blew big bubbles through a special pipe (to anaesthetise her) and found this really fun. She woke up to find the canula in her hand and a bandage around her teddy's hand too. She still didn't like the canula but the nurse took it out as soon as she had eaten rice krispies and kept them down for 15 minutes. The nurse said that it is kept in in case they have to administer an anti-sickness drug. We were allowed home soon after that.


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..... endoscopy

Posted by lins on 11/1/2008

Our 18 month old was too young to complain, and was already in hospital, she had cream put on the backs of her hand to numb the area so they could put a cannula in for the general anesthetic. She was starved from midnight the night before, we took her to be anesthetized, and they used a gas to put her to sleep and then injected the general. She was in for approx 30 mins, and the worst bit for her was coming round after waking up. She obviously didn't like the wuzzy feeling and kicked off big style for 20 mins or so. As soon as she was back on ward, she wanted crisps to eat bless her, and we saw an improvement within 2 days of going gf. ….



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Posted by jane u on 11/1/2008

Gf board

My daughter had an endoscopy age 3 - almost 5 years ago now. She had nothing to eat on the morning of the endoscopy and only sips of water. She walked with me to the theatre and then I was asked to hold her as they anaesthetised her. (I hadn't been told about this and found it quite difficult to be holding her as she lost consciousness). While they did the endoscopy I sat on the ward and then went to the recovery room as she was waking up. She was absolutely fine and enjoyed her time playing on the childrens ward. I wished I had taken some snacks and magazines to fill the time. We saw a doctor and dietician before going home. I was amazed how well she coped with it all - I think I was more stressed! She started the GF diet straight away and got better so fast. Having not grown for a long time she grew so fast she complained of leg pains and needed new shoes every 6 weeks for a while. …


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Posted by nikki on 11/1/2008

GF board

My son had his endoscopy last year - although he was quite a bit older he has special needs so didn't fully understand all what was happening.

He had the magic cream put on his hands about an hr before he went down to theatre (he had starved from midnight the night before)

We walked down to theatre where he got on to the bed and the nurses (who were excellent!) distracted him with a 'where's wally' book whilst the anaesthetist put a cannula in and injected the anaesthesia.(he really didn't feel a thing!!)
At this point I left him and went to a waiting room.
Around 30 mins later I was called back - went back up to the ward.
He was drowsy for around another 20 mins then tucked into lunch!!!

We then had to wait for the consultant paed to speak to us before we left (was told all looked normal as is often the case - under microscope proved different)

We had arrived at 7.00am and left around 4.00pm - so it is a long day.
Also - if you want your son to go gf straight after, bring some food for him to have after the procedure. ...

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Toddler
Posted by Adi on 30/8/2010,

…my daughter was exactly 18 months old, …, it is a very quick procedure and she will probably be under for 20 minutes or so. The whole thing will be over and done before you know it. I think it is quite painless for them and they will recover from the procedure within an hour of coming out of the anesthetic-. I remember when we were on the ward, most of the children who came in during the morning were out of the hospital before lunch time. I also was very hesitant about putting my daughter through the procedure as I was so worried about how weak she was. They tested her bloods before the procedure and she was given a shot of vitamin k. I was also very worried about giving her gluten in the period between the blood test and the endoscopy. I know now that this is incredibly important. If you take her off gluten before the endoscopy it might mess up her results. Children can heal very very quickly so even a few days off gluten can confuse the results. …Try not to worry too much ( I know that this is such a difficult time) but she will be in safe hands and she won't remember any of it. You will of course never forget the day. …..


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Posted by bizzimum on 31/8/2010

my DD was just 5 when she had hers done, but she was tiny and my firstborn, …

she was only out of our sight about 15 minutes in all - …and we were allowed to be with her when she was coming round (her first words were "mummy why has that lady got 4 eyes" LOL) as well as when she was counting as they put her to sleep

it really will be over in a flash and your wee one is not old enough to remember the experience








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[kickingfrog]

Is EGD invasive in a child, and is it needed anyway?

An EGD is not very invasive of a test. The endoscope goes down the esophagus just where food goes. No incision is needed. With adults a sedative is used. Usually patients don't go fully asleep, though they think they have because there is a forgetfullness about the procedure caused by the sedative. In children a stronger sedative is used, such as ketamine and midazolam (Versed) in combination. Very nice sedation, short action, just right for the 5 to 10 minutes the procedure takes.


(From StephenApple Holland on St John's)

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[kickingfrog]

Perception of Gastrointestinal Endoscopy by Patients and Examiners with and without Background Music.

Binek J, Sagmeister M, Borovicka J, Knierim M, Magdeburg B, Meyenberger C.

….
CONCLUSIONS: Music has little influence on patients' experience of gastrointestinal endoscopy. Nevertheless, the majority of patients felt music to be helpful and expressed a preference for music during any future examination. This positive attitude to music of patients is in contrast with the assessment of some endoscopists and nurses.
Copyright 2003 S. Karger AG, Basel


www.ncbi.nlm.nih.gov/pubmed/12949433?dopt=Abstract

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[kickingfrog]

Biopsy (from Celiac Sprue Association/USA)

How is Celiac Sprue Diagnosed?

Although there may be many clinical signs and laboratory tests indicating a probable malabsorption, the only means of diagnosing celiac sprue is by a small intestine biopsy. In this test, a small flexible tube is passed down the throat, into the stomach, and out into a specific area of the small intestine. At the end of this tube is a metal capsule containing one or two holes and housing a small cylindrical knife. Suction is applied through the tube and the minute pieces of the small intestine are cut off by moving the cylindrical knife through the capsule. The tube is removed and the tissue samples are examined under a microscope for evaluation and diagnosis.

Celiac Sprue is what we call Coeliac Disease.
CSA/USA have a website:

www.csaceliacs.org/

[kickingfrog]

EGD is Esophagogastroduodenoscopy, which just means passing a flexible tube which has a scope through the mouth( they put a little mouthpiece in your mouth to protect your teeth & help guide the scope) to look down the esophagus ("food pipe")to the stomach, then into the first part of the small intestine where they usually take several biopsies (tiny pieces of tissue) if they are checking for you for celiac disease. The small intestine is the area that gets damaged from CD. They can also see if you have ulcers, inflammation, etc with an EGD. Results of biopsies take a few days but the doctor can tell you what they saw, their impression, right away.

The EGD itself takes only a few minutes and is usually done under light sedation on out-patient basis. Paperwork & getting ready (I.V. in for way to give meds) means arriving about an hour before the procedure. (We do have some people that do it without sedation!) Most people don't remember the procedure because of the meds & don't have a sore throat or anything afterwords. Usually you can eat & drink shortly after also. Our facility says that because of the sedation effects, you need someone else to drive you home.

From Shari on Delphi


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[kickingfrog]

Young child biopsy and continuing with gluten

Posted by Joanna

GF board

... my daughter, 22 months old has just been told her blood test for coeliac has come back strongly positive, has anyone else had a child that has had a jejunal biopsy as quite worried as she is so young.My other concern is that she has to continue having gluten until she has her biopsy especially when her consultant has said that she definitely has coeliac disease, is it crucial to continue with gluten before biopsy.


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Posted by Jules on 5/5/2010


Stick with the gluten containing diet for now until the biopsy - can you push for a quick date for the "op" ? My daughter was diagnosed by "strong blood tests" at 2 years old - we didn't get the choice of a biopsy (this was 11 years ago) as the Consultant said it was not necessary.

When she was 7, we had to do a gluten challenge for 6 weeks - she had to eat gluten again after 5 years of gluten free - and then have a biopsy to confirm the original diagnosis. If we hadn't have done the gluten challenge at that age, we would always have worried whether or not she was definitely a coeliac.

Given a choice, I would have gone for biopsy at 2 and never done the challenge at 7 years old - that was much harder having to re-introduce it at a later stage believe me.

Good luck and stick with it, no matter how hard it is now.


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Posted by gemma


... my daughter had her biopsy done at 2 and yes it is crucial that she stays on gluten or the biopsy could give a false negative!my daughter als showed a very high coeliac marker on bloods! i know its hard as it makes them so ill but it will be worth it in the end i promise my daughter is now four and is thriving on a gf diet!
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Posted by Chris on 4/5/2010
…
I know its really hard when you first hear that your child has CD, but the biopsy is the only real way to check the state of the intestine etc. I think you need to continue to ensure you get the proper results, otherwise the gut will start to heal and not give a true picture. It is hard to believe but within weeks of stopping gluten your daughter will get better...



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Posted by Claire on 6/5/2010

You will no doubt be going through absolute torture right now as believe me i have been through exactly the same thing with my own daughter when she was 12 months old. The rollercoaster ride of not knowing what is wrong with them, seeing them refusing to eat as they feel so awful and then when they do eat they throw up and the endless nappy disasters. Then trying to get people to listen to you that something is wrong and you aren't just a neurotic mother over reacting. Until eventually when they've lost so much weight with stick thin arms and legs and a big protruding tummy and dark circles under their eyes 'a door opens' and some starts listening to you and gets them tested. But then you have the worry and guilt of still having to 'poison' them whilst you wait for the biopsy knowing full well what could cure them, but it can only provide a small amount of relief/ comfort that it is 'only' coeliac disease and not something worse that many other parents must go through eg cancers etc, but then the sorrow and sadness sets in of you knowing what they are missing out on for the rest of their life.

I still get very emotional now talking about what we went through as a family back then, but on a lighter note she is now a happy and healthy 3 year old who doesn't mind (at the moment) that she has a 'special tummy' and has to eat diffent food to her friends. It upsets me more than it does her as she doesn't know any different and what she is missing out on.
If you aren't a coeliac yourself (like me) then a book i really found of great use is raising our Coeliac Kids by Danna Korn.

Keep your chin up - you've got this far - don't let your daughter down now. You think it is cruel still giving her gluten knowing the blood test result but in the long run it will be bizarrely one of the kindest things you will do for her.

good luck ...


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[kickingfrog]

Number of Endoscopic Biopsy Specimens Needed to Confirm CD

From Charlotte

GF board

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From Medscape Gastroenterology

Viewpoints
Number of Endoscopic Biopsy Specimens Needed to Confirm a Diagnosis of Celiac Disease

Posted 08/06/2008

www.medscape.com/viewarticle/576966

David A. Johnson, MD, FACG, FACP
How Many Duodenal Biopsy Specimens Are Required to Make a Diagnosis of Celiac Disease?
[Comment on]
Pais WP, Duerksen DH, Pettigrew NM, Bernstein CN
Gatrointest Endosc. 2008;67:1082-1087 [see below]

Summary
Celiac disease, a prevalent food hypersensitivity disorder, is an autoimmune disorder of the small intestine that occurs in genetically predisposed individuals and results in a small intestinal inflammatory reaction to gluten proteins (wheat, barley, rye). The prevalence of celiac disease in the United States is estimated to be approximately 1/133.[1] Although diarrhea is the more classic presentation, the manifestations may be quite protean (eg, abdominal pain, bloating, weakness, iron deficiency, osteoporosis).

Serologic testing is quite helpful in screening patients for this immune-mediated enteropathy, but histologic confirmation with duodenal biopsies remains the gold standard for diagnosis. However, there may be patchy distribution of duodenal villous atrophy and there is no clear consensus on the number of biopsies needed to establish or exclude the diagnosis. Although at present there are no specific recommendations from the pediatric gastroenterology guidelines, the American Gastroenterological Association recommends that ideally 6 distal duodenal biopsy specimens should be obtained.[2]

There is variability in the degree of mucosal damage in celiac disease. The first phase is an infiltration with increased numbers of intraepithelial lymphocytes. The second phase is hyperplastic with crypt hypertrophy. The third phase is destructive, with crypt atrophy.

This retrospective study from a tertiary university hospital involved a medical record audit and histology slide analysis of 247 cases of patients who underwent endoscopy to confirm the diagnosis of celiac disease. The final diagnosis was established after a chart review with consideration of clinical symptoms, signs, serologic testing, and histologic analysis of biopsies of the duodenum. All biopsies were evaluated by a single investigator and in cases of uncertainty, consensus was reached through a process review with a second investigator. Serologic testing was not available in all patients.

The diagnosis of celiac disease could be confirmed if only 2 biopsies were taken in 90% of patients. Incremental biopsies showed increased sensitivity: 3 biopsy specimens (diagnosis could be confirmed in 95% of patients) and 4 biopsy specimens (diagnosis could be confirmed in 100% of patients). The site of biopsy (second, third, or fourth portions of duodenum) had no influence on outcome. Histologic variability among duodenal biopsies was evident in 25% of cases.

Viewpoint
The clinical take-home message from this study is clear: These data suggest that 4 random biopsies should be taken to confirm the diagnosis of celiac disease. Given the variability in sensitivity and specificity of serologic testing, adequate biopsies should be taken from all patients in whom the diagnosis of celiac disease is considered. To prove this strategy absolutely, a prospective trial would be necessary to confirm or refute the diagnosis. However, at present, on the basis of these findings, I would suggest the new "gold standard" for the diagnosis of celiac disease should be as outlined in this report.

Abstract
How many duodenal biopsy specimens are required to make a diagnosis of celiac disease?
Gastrointest Endosc. 2008; 67(7):1082-7 (ISSN: 1097-6779)
Pais WP; Duerksen DR; Pettigrew NM; Bernstein CN
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

BACKGROUND: It is unknown how many endoscopic biopsy specimens are needed to diagnose celiac disease (CD). OBJECTIVE: To determine the numbers of duodenal biopsy specimens needed to diagnose CD. DESIGN: Retrospective medical record audit, histology slide analysis, and chart review. SETTING: A tertiary-care university hospital. PATIENTS: Adults who underwent EGD to diagnose CD. INTERVENTIONS: Our pathology database was searched for the keywords "consistent with celiac disease," "not consistent with celiac disease," "villous atrophy," and "intraepithelial lymphocytes" from January 2001 to May 2006. The number of biopsy specimens was determined and graded for a modified Marsh classification, and charts were reviewed for diagnosis verification. CD was confirmed if Marsh grade 3A was found, even on one biopsy specimen. MAIN OUTCOME MEASUREMENTS: The number of biopsy specimens needed to make the diagnosis of CD. RESULTS: Of 247 cases, 102 patients were diagnosed with biopsy specimen-confirmed CD. In 9 patients, CD could not be confirmed on the basis of histology alone (highest Marsh lesion was grade 1 or 2), but a clinical diagnosis was made on the basis of presentation and serology. CD could be confirmed if only 2 biopsy specimens were obtained in 84 patients (90%), if only 3 biopsy specimens were obtained in an additional 5 patients (95%), and if at least 4 biopsy specimens were taken in the remainder. CD was ruled out in 145 patients. In 142 patients, biopsy specimens were uniformly negative; 3 patients had Marsh grade 1 lesions but negative serology. LIMITATIONS: A retrospective design. CONCLUSIONS: Only 2 biopsy specimens will lead to a confirmed diagnosis of CD in 90%, and a suspected diagnosis in all. For 100% confidence in diagnosis of CD, 4 duodenal biopsy specimens should be taken.


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GUIDELINES FOR THE MANAGEMENT OF PATIENTS WITH COELIAC DISEASE


British Society of Gastroenterology

…It is now considered acceptable to take only an initial biopsy in patients who have typical histological features, as long as they have positive antibodies to gliadin and endomysium and experience symptomatic remission on withdrawal of dietary gluten.
The diagnosis is more secure, however, if a second biospy is taken which shows histological improvement following gluten withdrawal. …


www.bsg.org.uk/index.php

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Addenbrooke’s Hospital

What biopsies are required to diagnose coeliac disease?

Some years ago, three intestinal biopsies were considered essential to diagnose coeliac disease:

- the first demonstrated that there was damage to the intestinal lining,
- the second was taken after a period of time on a gluten free diet and would
show improvement in a coeliac patient
- the third was after a ‘gluten challenge’ – deliberately eating gluten to invoke
a response – and would show damage to the intestine in a coeliac patient.

However, coeliac disease is very common, and there are very few other conditions
that cause similar damage to the intestinal lining. Therefore it became clear that the
third biopsy was not necessary. Thereafter most experts agreed that just two
biopsies were required to diagnose coeliac disease.
Nowadays, the blood test for coeliac disease is so good that many people are
questioning whether two biopsies are still required. In some cases they are actually
asking whether a biopsy is required at all!

In Addenbrooke’s Hospital, our policy is to repeat the intestinal biopsy after nine
months on a gluten free diet.
The reasons for this are:
It provides certain confirmation of the diagnosis of coeliac disease
Many patients with coeliac disease do not experience symptoms with gluten
even thought the intestinal lining is damaged. It therefore helps patients to know
that they are managing the diet correctly and that the ‘disease’ is responding to
treatment.
We do not know how much gluten patients with coeliac disease can tolerate in
the diet. A repeat biopsy that has shown recovery of the intestine will help
patients to know that they are consuming an appropriate diet.

We recommend including oats in the diet from the outset (see the accompanying
information – ‘What about Oats’). If there is no response to the diet on repeat
biopsy, then we would recommend removing oats from the diet.

Some patients with coeliac disease will experience coeliac-like symptoms in
later life which may be due to other illnesses. If we do not know how the
intestine has responded to a gluten free diet, it may be difficult to correctly
identify the cause of such symptoms.

Rarely, patients may not show any response to a gluten free diet and the
intestine may remain damaged. Sometimes these patients have a condition
called ‘Refractory Coeliac Disease’. Patients with this condition may require
additional medication, or to have further tests as they may be at risk of a rare
type of cancer…..

www.addenbrookes.org.uk/resource ... s/patient_
information_leaflets/gastroenterology/PIN1171_coeliac_second_biopsy.pdf

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[kickingfrog]

IMPORTANCE OF DUODENAL BULB BIOPSIES IN THE DIAGNOSIS OF CELIAC DISEASE

M Rashid, A MacDonald
Dalhousie University, Division of Gastroenterology, Department of Paediatrics, Halifax, Nova Scotia

Aims: Small intestinal biopsies are essential to confirm the diagnosis of celiac disease. The patchy nature of villous lesion in celiac disease is increasingly being recognized. The current guidelines (AGA 2006, NASPGHAN 2005) recommend at least four duodenal mucosal biopsies taken from the second or more distal part of the duodenum for histological examination. Multiple biopsies are needed to limit problems with orientation of the specimens and artifact during staining.
The objective of the study was to investigate the usefulness of duodenal bulb mucosal biopsies in confirming the diagnosis of celiac disease.

Methods: All patients with a positive tissue-transglutaminase antibody requiring biopsy-confirmation of celiac disease over a two-year period were studied. Each patient had two endoscopic biopsies taken from the duodenal bulb and four biopsies from the second (or distal) part of the duodenum. Biopsies from gastric antrum were also taken for any Helicobacter pylori infection. The duodenal histology was studied using routine HandE stain and CD3 staining and counting of villous intraepithelial lymphocytes.

Results: Thirty-five patients (14 males, 21 females) were studied. The mean age was 8.1 (± 4.7 ) years, range 1.3 to 18.7 years. Of the 31 patients with abnormal distal duodenal biopsies, one had Marsh 1, one had Marsh 2 and twenty-nine had Marsh 3 lesion. All but two patients with abnormal distal duodenal biopsies also had abnormal bulb biopsies.
Four (11.4%) patients had normal distal duodenal biopsies (Marsh 0) but abnormal bulb biopsies (one patient had Marsh 2 and the other three had Marsh 3 lesion). Grossly, the duodenal bulb was completely normal in one patient, the other three had mild changes with patchy eythema, nodularity and friability with mosaic pattern respectively. The distal duodenum was grossly normal in these four patients. None had Helicobacter pylori infection. The histological diagnosis of celiac disease would have been missed in these four cases if only distal duodenal biopsies were performed.

Conclusions: Patients with celiac disease can have patchy villous lesions with duodenal bulb mucosa being the only area involved in some cases. The current recommendations regarding the site of biopsies need to be revised to include biopsies not only from distal duodenum but also from the bulb to improve the diagnostic yield.

www.pulsus.com/cddw2009/abs/075.htm