PROCEDURES

COLONOSCOPY

This procedure involves the insertion of an endoscope through the anus, allowing the doctor to see inflammation, erosion, bleeding or ulcers on the wall of the colon.

During the exam, Dr. Krigsman will perform biopsies which involve taking small samples of tissue from parts of the colon so they can be viewed with a microscope or sent to a laboratory for analysis. The procedure is performed under general anesthesia.

UPPER ENDOSCOPY

If abdominal pain or perceived abdominal pain is a significant symptom, or if there is suspicion of reflux or chest discomfort, an upper endoscopy may be recommended as well.

This procedure involves the insertion of an endoscope through the mouth to check the esophagus, stomach and upper small intestine for inflammation, erosion, bleeding or ulcers. The procedure is performed under general anesthesia.

WIRELESS CAPSULE ENDOSCOPY

The wireless capsule endoscopy (pill cam) is a non-invasive method for visualization of the entire small bowel.

The pill cam video capsule is an ingestible pill the size of a large vitamin. The capsule is equipped with a miniature video camera inside that is designed to capture color images from inside the body. As it moves through the GI tract, it wirelessly transmits the images to sensors that are contained within a belt that is worn around the waist. The images are then stored on a data recorder that is about the size of a hand held voice recorder.

The capsule can either be swallowed or placed endoscopically under general anesthesia.

OTHER PROCEDURES

Additional diagnostic tests are at times necessary in this group of patients. All such diagnostic testing will, of course, be discussed and explained with the family well in advance.

DIAGNOSTIC TESTING QUESTIONS

What is the point of a diagnostic endoscopy/colonoscopy in a child with an Autism Spectrum Disorder?

ASD children with chronic GI symptoms often have treatable gastrointestinal diagnoses. Some of these diagnoses appear related to the co-occuring diagnosis of ASD, while others occur with similar frequencies in both autistic and non-autistic children.

As with most other medical conditions, accurate diagnosis is the cornerstone to appropriate therapy. In the case of ASD-associated bowel disease, accurate diagnosis can be definitively made only upon macroscopic endoscopic examination and subsequent microscopic examination of tiny pieces of tissue obtained at biopsy.

What can be done for a child who has autistic enterocolitis?

Medication and dietary intervention can be prescribed to alleviate any or all of the symptoms, which might include diarrhea, pain, constipation, abdominal distention, malabsorption and growth retardation.

Treating autistic enterocolitis does not treat autism as such, but relieving these children of chronic physical pain can make them more responsive to Autism specific therapies.

Why not empirically treat for autistic enterocolitis or other suspected GI diagnoses?

It is poor medical practice to treat conditions that have not been demonstratively diagnosed.

This is especially true for treatments involving medications with potentially unpleasant or dangerous side effects and for conditions in which empiric treatment would obscure the validity of subsequent proper diagnostic tests.

COMMON PROCEDURE AND BOWEL PREP QUESTIONS

Why give a laxative and enema bowel prep if my child is already experiencing diarrhea/loose stool?

It is common to have significant amounts of stool in the colon even in the presence of diarrhea. It must be removed beforehand so that the colonoscopy can be done as safely and accurately as possible.

Why can't my child drink red fluids on the day of the bowel prep?

The red dye used as food coloring could stain the intestinal lining or luminal fluid which could be confused with blood in the intestine.

How long does the endoscopy take?

An upper endoscopy takes about 20 minutes and a lower endoscopy takes about 30-45 minutes.

Will my child experience discomfort during the procedure and how long will he/she be in recovery?

Endoscopy in children is routinely performed under general anesthesia. Patients under general anesthesia experience no discomfort and have no memory of the procedure.

The recovery period immediately following diagnostic endoscopy/colonoscopy is one to two hours, after which time you can leave the surgery center.

If we are from out of town, how soon can we leave to return home?

We ask that patients remain locally overnight following diagnostic endoscopy. They may return home the morning following the procedures.