Name of the Procedure:

Ileoscopy through stoma; with biopsy, single or multiple

Summary

Ileoscopy through stoma is a medical procedure that involves examining the inner lining of the ileum (the last part of the small intestine) through a surgically created opening called a stoma. During this procedure, tissue samples (biopsies) are taken from the ileum to help diagnose or monitor various intestinal conditions.

Purpose

The purpose of ileoscopy through stoma is to investigate symptoms or conditions affecting the small intestine. This procedure can help diagnose issues such as inflammation, tumors, or other abnormalities. Biopsies taken during the procedure are analyzed to provide a clearer diagnosis and guide treatment plans.

Indications

• Unexplained abdominal pain
• Chronic diarrhea
• Bleeding from the stoma site
• Suspected inflammatory bowel disease (IBD)
• Monitoring known IBD conditions such as Crohn's disease
• Suspected tumors or abnormal growths in the ileum

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to medications may be necessary, particularly blood thinners or anti-inflammatory drugs.
• A bowel prep may be required to ensure the ileum is clear for examination.
• Pre-procedure tests such as blood work or imaging may be conducted.

Procedure Description

1. The patient is positioned comfortably, often lying down.
2. Sedation or anesthesia may be administered to relieve discomfort.
3. An ileoscope (a thin, flexible tube with a camera) is carefully inserted through the stoma and navigated to the ileum.
4. The camera relays images to a monitor, allowing the doctor to visually inspect the ileum's lining.
5. Biopsy forceps are passed through the ileoscope, and tissue samples are collected from suspicious areas.
6. The ileoscope is then gently withdrawn.
7. The samples are sent to a lab for detailed analysis.

Duration

The procedure typically lasts 30 minutes to an hour.

Setting

Ileoscopy through stoma is usually performed in a hospital, outpatient clinic, or specialized procedural suite.

Personnel

• Gastroenterologist or colorectal surgeon
• Nurses or medical assistants
• Anesthesiologist (if sedation or anesthesia is used)

Risks and Complications

• Bleeding at the biopsy site
• Perforation of the intestine
• Infection
• Adverse reaction to sedation or anesthesia
• Discomfort or pain at the stoma site

Benefits

• Accurate diagnosis of intestinal conditions
• Targeted treatment based on biopsy results
• Monitoring disease progression or response to treatment
• Relatively quick and minimally invasive

Recovery

• Patients may experience mild discomfort or bloating post-procedure.
• Normal activities can often be resumed within 24 hours, but strenuous activities should be avoided for a few days.
• Follow-up appointments may be scheduled to discuss biopsy results and further treatment.
• Instructions on stoma care and signs of complications will be provided.

Alternatives

• Capsule endoscopy: Swallowing a small camera that takes pictures throughout the digestive tract.
• Radiologic imaging: Such as CT enterography or MRI enterography to visualize the small intestine.
• Traditional ileoscopy (non-stoma)

Pros and Cons of Alternatives:

• Capsule endoscopy is non-invasive but does not allow for biopsies.
• Radiologic imaging provides a broad view but might miss small lesions that a biopsy could detect.
• Traditional ileoscopy may not be feasible if the patient has a stoma.

Patient Experience

• The patient may feel slight pressure or discomfort during the insertion of the ileoscope.
• Sedation helps minimize pain and anxiety.
• Post-procedure, the patient might feel mild pain at the stoma site, which can be managed with over-the-counter pain medications.
• Detailed post-procedure care instructions will be provided to ensure a smooth recovery.