<<Disclaimer: Verify this information before applying it to your situation.>>
 
Dana wrote,
 
I'm new to the list and just read the FAQ but still have a couple
questions.
 
In obtaining the biopsy to diagnose Celiac Disease, how is this done?  The
FAQ stated that children sometimes need to be sedated.  I can't picture how
this is done to the small intestine without sedation - for adults too.
 
The following is a procedure note on how a Gastroscopy - (gastric biopsies)
is done.
 
The patient was fasted overnight.  She was premedicated with Demerol 75 mg,
Gravol 50 mg, and Atropine 0.6 mg intramuscularly 30 minutes preop.  She
was brought to the Operating Room Suite and was administered topical
Xylocaine and IV propofol.  Excellent sedation was achieved and the Olypmus
gastrovideoscope easily introduced into the esophagus; no abnormality of
the upper midesophagus.  GE junction is located at 37 cm from the incisors.
 There was active reflux with pearly discoloration of the mucosa and
streaks of erythema just at the GE junction.  Evidence of GE reflux
esophagitis.  There were no actual ulcers, stricture or organic narrowing
that might explain her dysphagia per se, but reflux with esophageal spasm
certainly could be occurring independent of this examination.  Good
visualization was obtained of the body and antrum.  The pylorus itself was
concentric and the endoscope advanced to the first and second part fo the
duodenum in which there was active duodenitis with friability +1 and some
erythema present even before I advanced the scope into the duodenum.  There
was no actual ulcer per se.  Markings were rather prominent here.  Biopsies
were taken to look for Helicobacter pylori.  The scope was retroflexed to
view the fundus which was unremarkable apart from the obvious incompetence
of the GE sphincter.  I then directed attention to the GE junction of the
esophageal side thereof.  Picture was taken for the permanent record and
biopsies were obtained.  The remainder of the esophagus was very carefully
inspected on withdrawal, and a thorough examination revealed absolutely no
significant pathology otherwise.  There is no abnormality of the
hypopharynx that I could visualize either and the patient tolerated the
procedure well and returned to the PAR in good condition.
 
If anyone needs any more explicits details or has direct question related
to biopsies, please let me know and I will ask on of the
gastroenterologist's at work.
 
Dorothy Hilde
Salmo, British Columbia
Canada