Triple Endoscopy

What is triple endoscopy?

A triple endoscopy allows doctors to look at the throat, voice box, airways, and upper gastrointestinal tract at the same time. This avoids needing separate procedures, which would expose your child to more anesthetic (the drugs used during anesthesia). A triple endoscopy can help find out why your child may be having trouble breathing, swallowing, eating, growing, or speaking.

A triple endoscopy is usually performed by a team of specialists, including a gastroenterologist, pulmonologist, otolaryngologist (ear, nose, and throat doctor), and anesthesiologist. The procedure involves using a flexible or rigid tube with lights and a camera at one end, called a scope. The scope is passed through your child’s mouth or nose while they are asleep and comfortable. Triple endoscopy consists of the following:

• Esophagogastroduodenoscopy – A test that uses a scope to look at the inside of the esophagus (food pipe), stomach, and the first part of the small intestine. It also allows a doctor to collect small pieces of tissue, called a biopsy.
• Laryngoscopy and bronchoscopy – A test that uses a special scope to look at the larynx (voice box), vocal cords, and trachea (the upper airway).
• Flexible bronchoscopy with bronchoalveolar lavage – A test that uses a scope to look inside the big and small airways. This test also allows a doctor to collect fluid samples from the lungs (called bronchoalveolar lavage) to test for abnormal cells and infections.

Why should we do the endoscopies all at once?

Triple endoscopy allows doctors to examine the entire airway and digestive tract in one procedure and can help diagnose problems more accurately and quickly. By combining three procedures into one, your child will only need to receive general anesthetic once, reducing the potential risks. Better understanding of your child's symptoms and condition can help doctors develop a more effective treatment plan to help your child feel better.

Why might a child need a triple endoscopy?

A child may need a triple endoscopy for several reasons, including:

• Difficulty breathing, swallowing, or speaking
• Repeated pneumonia or wheezing that has not responded to medications
• Lingering cough or throat clearing
• Voice changes or hoarseness
• Choking, gagging, or aspiration (breathing in food or liquid)
• Chest pain or abdominal pain
• Gastroesophageal reflux (stomach contents coming back up into the esophagus)
• Failure to thrive (inability to gain weight or grow properly)

What may happen before the triple endoscopy procedure?

• Medication changes: You may be asked to stop or start certain medications for a certain period of time before the procedure. This is important to prevent any interactions with the anesthetic used during the procedure.
• Fasting: Your child will need to fast, which means they cannot eat or drink for several hours before the procedure. This helps reduce the risk of complications during the test.
• Tests: Your child may need to complete additional tests before or after the procedure, such as a swallowing test or X-rays of the upper gastrointestinal tract. These tests help doctors better understand your child's anatomy and health to make sure the procedure is safe.

It is important to follow all instructions from your medical team before the procedure. If you have any questions or concerns, discuss them with your doctor before the day of the procedure.

What should I expect on the day of the triple endoscopy?

A typical day of triple endoscopy usually looks like this:

• Anesthesia: The procedure is performed while your child is under general anesthesia, which means they will be asleep and unable to feel any pain or discomfort.
• Triple endoscopy test: Doctors will use different scopes to look at your child’s airways and digestive tract. They may also collect biopsies of tissues to examine more closely.
• Additional procedures: If needed, the doctors may perform additional procedures to help diagnose and treat any problems found during the triple endoscopy.
• Recovery: After the procedure, your child will be taken to a recovery room to be monitored until they are fully awake. You will then be able to see your child and ask the doctor questions.

The triple endoscopy is rather quick (typically about an hour) but can take several hours from start to finish, given the preparation and recovery involved. The specific steps and the amount of time needed may vary depending on your child's specific condition and the procedures performed.

What are the risks of triple endoscopy?

Like any medical procedure, a triple endoscopy carries risks and potential complications. Some common risks, although rare, can include bleeding, infection, perforation, soreness in the throat, or voice changes. If there are concerns for any of these complications, your child may need to be admitted to the hospital for an overnight stay after the procedure for observation.

It is important to discuss the specific risks and potential complications of a triple endoscopy with your medical team, who can provide you with more detailed information based on your child's health history and condition. In general, the benefits of the procedure outweigh the risks, and the procedure is considered safe for most children.

What might a triple endoscopy reveal?

The procedure can help diagnose conditions such as laryngomalacia (floppy larynx), tracheomalacia (floppy windpipe), laryngeal cleft (a gap on the back of the voice box), tracheoesophageal fistula (an abnormal opening between the windpipe and esophagus), esophageal strictures (narrowing of the esophagus), or inflammation of the lungs or esophagus.

What should we watch for after the triple endoscopy, and when should we seek medical advice?

After the triple endoscopy, it is important to look out for any signs of complications and seek medical advice if you notice any of the following:

• Persistent pain or discomfort in the throat, chest, or abdomen
• Difficulty breathing or shortness of breath
• Persistent nausea or vomiting
• Bleeding from the mouth or nose
• High fever
• Changes in the voice, such as hoarseness or loss of voice

If you notice any of these symptoms, contact your child's medical team. It also is important to attend all follow-up appointments with your medical team to monitor your child's recovery, review results of the endoscopy, and discuss your child’s care plan.

Authors: Amornluck “Pang” Krasaelap, MD; Vrinda Bhardwaj, MD; Jason Brown, DO; Erin Khan, MD
Editor: Amanda Deacy, PhD
August 2023