Pediatric Ileoscopy for Intestinal Transplant Patients

What Is an Ileoscopy?

For an ileoscopy (ill-ee-ah-sco-pee), doctors use a thin, flexible, lighted tube called an endoscope (en-doh-scope) – or "scope" for short – to get a good look at a person's digestive system. For this procedure, the particular part of the digestive system being looked at is the ileum.

The ileum is the last and longest section of your small intestine. The ileum is where most of the nutrients from your food are absorbed before emptying into the large intestine.

The ileoscopy surgery is done through a person's ileostomy (ill-ee-ah-sto-mee). An ileostomy is an artificial opening (called a stoma), created in the abdomen by surgeons. The ileum is brought out to the surface of the abdominal wall, allowing waste to drain into a sealed pouch on the outside of the body. Ileostomies are sometimes created as a temporary measure, to allow the intestine a chance to rest and heal after surgery. Surgeons may reconnect the intestine later, when it has healed. In a permanent ileostomy, the entire large bowel is removed before the stoma is made.

Body Parts Involved

  • Ileostomy
  • Ileum

Why Does My Child Need an Ileoscopy?

The endoscope transmits an image of the inside of your child's ileum, so the doctor can carefully examine its lining. Through the endoscope, doctors can see abnormalities (like inflammation or bleeding) that don't show up well on X-rays. The doctor can also insert instruments into the scope. By doing this, he or she can remove tiny samples of tissue (biopsy) for further tests, or treat bleeding problems.

Taking biopsies through ileoscopy is essential for diagnosing rejection in a transplanted intestine. At UPMC Children’s Hospital of Pittsburgh, intestinal transplant recipients will typically have an ileoscopy with biopsy twice a week in the first month after intestinal transplantation. In the second month, the frequency goes down to once a week.

Some children with ileostomies have not had intestinal transplants. They may have permanent ileostomies because of problems with certain muscles that are supposed to absorb nutrients and push food through the intestine. You might hear doctors use the word "motility" to describe the ability of these muscles to contract. If your child has motility problems, he or she may periodically undergo an ileoscopy.

Is There Any Reason My Child Should Not Undergo an Ileoscopy?

Before an ileoscopy, as with any endoscopy, let the doctor know if your child has any type of blood clotting disorder. Such disorders may prevent your child from being able to safely undergo this procedure.

What Is It Like to Get an Ileoscopy?

What to Expect: Before Procedure

Unlike many other endoscopy procedures, ileoscopy normally requires little to no preparation. Sometimes the doctor will tell you to have your child fast (not eat or drink) for four hours before the ileoscopy. This is usually only required if your child will be receiving sedation for the procedure.

Your child's ileoscopy may be performed in the endoscopy suite or, if your child is an inpatient at the hospital, at his or her bedside.

What to Expect: During Procedure

The endoscope is lubricated, and placed into your child's stoma. A doctor guides the tube gently through the ileostomy and into the ileum.

The scope blows a small amount of air into the intestine; this expands the folds of tissue and makes it easier to see all parts of the ileum's lining. While this air may cause the sensation of abdominal fullness, it should not be painful. Your child may also feel pressure on the surface of his or her skin, where the scope enters. This also should not cause any pain. In many cases, an ileoscopy can be done without sedation or anesthesia.

Once the scope is about three to ten inches inside, a small biopsy sample is quickly taken. Then the scope is removed. The entire procedure takes three to ten minutes.

What to Expect: After Procedure

Unless your child received sedation for the ileoscopy, no special after-care is required. Your child can go back to his or her regular diet and activities immediately. Many children undergoing an ileoscopy as part of an outpatient clinic visit have the procedure done in the morning, then go out to lunch with their families before returning for the rest of clinic in the afternoon. Unless your child is an inpatient at the hospital for another reason, there is no hospital stay involved.

Your child may feel slightly bloated from the air that was placed in his or her intestine during the examination. This feeling will gradually go away on its own.

If your child did receive sedation for the procedure, he or she will probably need one or two hours to rest at the hospital. This way, the sedative has a chance to wear off somewhat.

Since the effects of the sedatives may take up to 24 hours to wear off completely, you should plan to take your child directly home – not to a restaurant. Your child may have a light meal if he or she wants it. It is a good idea to take it easy for a few more hours at home. While the sedative is still wearing off, your child may feel groggy and uncoordinated.

After the sedation has completely worn off, your child may resume his or her normal diet. Your child's doctor may give other special instructions.

Are There Any Complications Associated with This Procedure?

Possible complications of ileoscopy include bleeding, infection, and puncture of the stomach lining. However, such complications are rare. Your child's doctor will know what to do in the unlikely event your child does experience any of these complications.

When Will We Find Out the Ileoscopy Results?

The turnaround time on results from an ileoscopy is relatively quick. If your child has undergone an ileoscopy as part of a post-transplant clinic, the ileoscopy is often done in the morning. Your doctor will likely discuss the results with you later that same day. If the ileoscopy is done later in the day, the findings may be available in the evening or the next day.

Learn about other Intestinal Transplant Procedures.