Optimal Care, Minimal Risk

For children with eosinophilic esophagitis (EoE), constant monitoring is crucial to keep this chronic immune disease under control and ensure that treatments continue to be effective. EoE leads to build up in the esophagus because of allergic and immune responses, which can cause difficulty with feeding, swallowing and failure to thrive due to malnutrition. The only way to monitor inflammation and build up is frequent imaging and biopsies so that the care team can see the progress of the disease. But for kids, this means undergoing endoscopy under general anesthesia up to four times per year, a time consuming and uncomfortable process.

Le Bonheur Gastroenterologist Dong Xi, MD, brought a new option to Le Bonheur Children’s — transnasal esophagoscopy (TNE). TNE has been used in the adult population but is new to pediatrics. With this procedure, children with an esophageal condition, like EoE, can have imaging and biopsies without general anesthesia in a fraction of the time. Le Bonheur Children’s is the only center in the area offering TNE for children.

“For conditions like eosinophilic esophagitis, no blood test or other diagnostic is available, and most kids need to undergo endoscopy regularly,” said Xi. “With TNE we are able to avoid the risk of general anesthesia and provide optimal care for these patients.”

Xi works with a team of technicians and nurses to conduct TNE. A child life specialist explains the process to kids and offers different distraction therapies — music, video, toys — to make sure they are relaxed and comfortable during the procedure. Then, Xi numbs the nose and throat with a spray and, using the smallest available tube between 1/10 and 1/5 inch in diameter, inserts the tube through the nose to the esophagus. Using TNE, he is able to capture the same quality photos as a traditional endoscopy.

Once in the esophagus, Xi can look for signs of active inflammation and take any necessary biopsies. TNE is currently used at Le Bonheur for patients 12 years and older. It takes no more than 15 minutes to complete the test, meaning what was once a three to six hour appointment for families is now a quick outpatient visit.

“Most children tolerate TNE without much difficulty,” said Xi. “We can better and more easily monitor kids with eosinophilic esophagitis and keep an eye out for signs of active inflammation.”

Xi has seen further benefits in the way TNE allows for continuous, uninterrupted care of children with EoE. While the recommendation for children with EoE is to undergo an endoscopy every three months, compliance is a known issue. Concerns about frequent general anesthesia may mean less orders for endoscopy and therefore poor management of the disease. Parents may also be less compliant in their child’s care. They may avoid clinical follow-up visits if they anticipate the physician will recommend endoscopy. TNE alleviates many of these fears, making follow up and continuous monitoring much easier for physicians, patients and families.

“With TNE we can offer kids and their caregivers a procedure to optimally monitor the disease with fewer risks,” said Xi. “We believe that this can improve the compliance to care and the quality of life for our patients.”

Benefits of TNE Include:

• No general anesthesia. This means a shorter procedure time, easier recovery and no anesthesia-associated risks.
• A full TNE appointment takes one to two hours in an outpatient setting compared to three to six hours for endoscopy with anesthesia.
• No need for line placement. No anesthesia means no unnecessary needle sticks.
• Patients can immediately return to all normal activities without limitations. Children miss less school and other activities.