An endoscopy is one of the investigations that will help to diagnose inflammatory bowel disease (IBD) and monitor how treatments are working.
Types of endoscopy in paediatric IBD
There are several types of endoscopy that can be used to diagnose and monitor IBD. The two main ones used in children with IBD are:
Gastroscopy (upper gastrointestinal endoscopy) - a very small camera and light on a long flexible tube goes in through your mouth and down your throat to look at the top half of your digestive system
Colonoscopy - a small camera and light on the end of a long flexible tube is inserted into your bottom (anus) to look at the bottom part of your digestive system
You will usually have both of these done at the same time under general anaesthetic (a medicine that puts you to sleep).
There are a few other types of endoscopy tests used in IBD, usually in adults but they are sometimes used in children. These are:
Sigmoidoscopy - a small camera and light is inserted into your bottom (anus) to examine your rectum and the lower part of your colon, which is called your sigmoid colon
Proctoscopy - a camera and light on a short, rigid tube is inserted into your bottom (anus) to examine your anus and rectum
Double balloon endoscopy - a small camera and light on the end of a very long flexible tube is inserted either into your mouth, or your bottom (anus) to examine your small intestine. There are two small balloons on the end of the scope, which are inflated and deflated, helping to move it through your intestine
Capsule endoscopy - you swallow a capsule which contains a camera, light and transmitter, which takes pictures of your oesophagus, stomach and small intestine. The capsule eventually comes out in your poo and is flushed away
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Why do I need an endoscopy?
Endoscopies can be used to diagnose your disease, monitor how your IBD is responding to your treatments, or be therapeutic, which means to carry out a treatment during the endoscopy. Sometimes an endoscopy may be used for a couple of these reasons at the same time.
Diagnostic - endoscopies that are used to gather information to find out if you have inflammatory bowel disease, and to help identify what type of IBD you may have. This includes looking for inflammation, and taking biopsies (tiny tissue samples) from the lining of your bowel, which are sent to the laboratory to be looked at under a microscope.
Monitoring - endoscopies that are carried out if your treatment needs to be changed, and it is necessary to look at the inside of your digestive tract to get information to be able to do that. Adults with IBD are given regular endoscopies to monitor their IBD, however this isn’t generally done in children unless there are changes that need to be investigated which can’t be done using other tests.
Therapeutic - when a treatment is carried out during the endoscopy. This could include removing polyps (small growths of tissue that stick out from the lining of your bowel) or stretching segments of your bowel (known as balloon dilation) which have become narrow from inflammation.
Endoscopies are the best investigation for diagnosing inflammatory bowel diseases. There are other investigations you may have, such as ultrasound scans, CT scans or MRI scans. These all provide a cross-sectional image of your bowel, and can show if there are changes to your bowels, but cannot diagnose IBD. Blood tests can also be useful to measure inflammatory markers in your blood, which tells you there is inflammation somewhere in your body, but again cannot diagnose IBD. Only endoscopies allow a doctor to see exactly what the inside of your bowel looks like, and also allow the taking of biopsies for further investigation.
How are endoscopies done on children?
When you are having an endoscopy, you would usually have a gastroscopy and colonoscopy at the same time.
You will need to prepare for your endoscopy by following a specific diet leading up to the procedure. You will also need to take medicines (known as bowel prep) that will make you poo a lot. This is because your bowel needs to be completely empty so that the cameras can get the best images possible. Lots of children say this is the worst thing about an endoscopy!
Children who are having an endoscopy are always given a general anaesthetic, which means you will be asleep during the whole investigation. Once you are asleep, a doctor will carry out your endoscopy by gently inserting long, thin flexible tubes with cameras on the end into your mouth and bum. These cameras will allow them to see the inside of your digestive system to look for any signs of changes.
After your endoscopy
Your endoscopy will usually take between 45 minutes and an hour. Once it’s completed, you will be taken to a recovery area. Your grown up can join you as you wake up.
Endoscopies are very safe procedures, carried out regularly by highly trained people and you will only have an endoscopy if it is absolutely necessary. There are some risks which you can learn more about here.