Small bowel biopsy samples can be obtained by EGD (esophagogastroduodenoscopy) or other endoscopy of the upper gastrointestinal tract. A flexible fiberoptic tube (endoscope) is inserted through your mouth or nose and into the upper gastrointestinal tract. Tissue samples removed during endoscopy are sent to the laboratory for examination.

Capsule biopsy produces a larger sample of the intestinal lining (mucosa) and allows sampling of areas that are beyond the reach of the endoscope. The procedure is similar to that of EGD. The back of your throat is sprayed with a local anesthetic to prevent gagging.

The tube and capsule is inserted through your mouth and you are asked to swallow as the tube is advanced. The position may be changed from sitting to lying on the right side to help the capsule advance through the stomach and into the small bowel.

When the capsule is properly positioned, suction is applied to the tube (which causes the capsule to close and grab tissue). Once a tissue sample has been obtained, the tube and capsule are removed.

Fasting for at least 8 hours is recommended. You must sign an consent form.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experiences, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:

• infant test or procedure preparation (birth to 1 year)
• toddler test or procedure preparation (1 to 3 years)
• preschooler test or procedure preparation (3 to 6 years)
• schoolage test or procedure preparation (6 to 12 years)
• adolescent test or procedure preparation (12 to 18 years)

The passage of the tube and capsule often makes a person feel like gagging (topical anesthetic is used to minimize this sensation).

A mild sedative can be given, but only in small doses because the person must remain alert enough to assist with the procedure (by doing such things as swallowing and turning). The biopsy sampling causes little or no pain, although it may cause some mild cramping.

Normal small bowel tissue includes finger-like projections (villi), crypts, columnar epithelial cells, and round cells.

Abnormal findings may include:

• abnormalities of the mucosa or villi (for example, flattening)
• radiation enteritis
• PAS positive macrophages
• dilated intestinal lymph nodes or lymphatic vessels

Disorders and conditions that may be indicated by changes found on small bowel biopsy include:

• celiac sprue
• coccidiosis
• folate or Vitamin B12 deficiency
• giardiasis
• infectious gastroenteritis
• inflammation of the small bowel
• Crohn's disease
• amyloidosis
• lymphangiectasia
• lymphoma
• malnutrition
• tropical sprue
• Whipple's disease

Additional conditions under which the test may be performed:

• lactose intolerance

• bowel perforation
• excessive bleeding from the biopsy site
• infection of the biopsy site leading to bacteremia (bacteria in the bloodstream)
• vomiting and subsequent aspiration into the lungs