Endoscopy

Boston Children’s is one of very few locations in the Northeastern U.S. to offer therapeutic endoscopy procedures by physicians specially trained in using this technique in children. These state-of-the-art procedures allow us to view your child’s esophagus and other gastrointestinal tract anatomy, take biopsies if needed, and, in some cases, even treat the condition in a minimally invasive way.

• endoscopic retrograde cholangiopancreatography (ERCP)
• endoscopic ultrasound (EUS)
• peroral endoscopic myotomy (POEM)
• stenting
• transnasal endoscopy

Endoscopic retrograde cholangiopancreatography (ERCP)

This procedure combines an endoscopy with x-ray technology to help visualize your child’s digestive tract, as well as the important ducts in the liver and pancreas. In ERCP, a physician will guide the endoscope through your child’s mouth and into the small intestine, and then inject a special dye so that these small ducts become visible on x-rays. This allows them to view your child’s bile ducts and pancreas ducts to look for stones or abnormalities that your child may have been born with or acquired later in life.

Not only does ERCP allow your child’s gastroenterologist to identify and evaluate problems in the ducts of the liver and pancreas, but it also allows then to treat many of these problems using additional therapies through the scope itself. These include sphincterotomy, stone removal, dilation, and stent placement, just to name a few.

Endoscopic ultrasound (EUS)

This technique combines endoscopic and ultrasound imaging technologies to produce high-quality images of your child’s digestive tract. In EUS, a physician will use a special endoscope with an ultrasound processer at the tip, which is called an echoendoscope. This allows them to examine both the lining and wall of the digestive tract, along with nearby organs such as the liver, bile ducts, and pancreas. EUS also allows your child’s physician to visualize their lymph nodes. While most of its use in adults involves identifying and evaluating cancers of the gastrointestinal tract, it can be used in children to evaluate chronic liver and pancreatic conditions such as chronic pancreatitis.

This procedure also allows your gastroenterologist to obtain a sample of tissue from organs in the abdominal cavity using a small fine needle, such as a liver biopsy or pancreas biopsy. Obtaining tissue samples in this manner is less invasive than surgery and is often a simple day procedure. EUS is also used to drain fluid collections in the abdomen.

Peroral endoscopic myotomy (POEM)

POEM is a type of endoscopic procedure used to treat esophageal achalasia — a disorder of the esophagus that makes swallowing difficult — in some older children and teens. Read more.

Stenting

Certain problems, such as esophageal strictures, can affect the upper gastrointestinal tract, making it difficult for children to swallow. To treat a stricture, the doctor will pass a tiny balloon through the endoscope into the duct and then inflate the balloon under high pressure. When the balloon inflates, it causes a slight tear in the scar tissue that has built up in the duct and caused it to narrow. Once the balloon has created space in the duct, the doctor may insert a small tube called a stent or a sponge through the endoscope and into the area of the stricture. The stent or sponge will remain in place to keep the esophagus open as the tissue heals around it. It will be removed in a follow-up procedure later.

Transnasal endoscopy

A transnasal endoscopy (TNE) is a type of test used to examine your child’s upper gastrointestinal tract. Like a traditional endoscopy, it uses a thin, flexible tube with a light and small camera on the end to view the esophagus. The tube is used to look in the esophagus and into the stomach. A small piece of tissue is then removed from the esophagus and taken to our lab for testing. Your child’s test results should arrive about one week post-procedure.

What makes TNE different is that the tube is passed through one of your child’s nostrils rather than their mouth. The test usually takes only five to 15 minutes, but you should expect to be at the hospital for about two hours total.

Because TNE can be performed without general anesthesia, it can be a convenient option for older children or teens with eosinophilic esophagitis who must undergo regular endoscopies. In place of anesthesia, numbing medicine is given for their nose and throat to make sure your child is comfortable.

TNE is best for children and teens who are used to medical procedures and is commonly used for repeat endoscopies, not a patient’s first endoscopy.