GI Services

Testimonials

Jack climbed into your arms and played with your watch, despite the fact that he had severe separation anxiety and constantly clung to me. He wouldn’t even allow his aunts or grandparents to hold him… You met Jack for the first time at 3 pm on a Wednesday and cleared your afternoon the very next day to accommodate his bronchoscopy… Every patient should have such a tireless advocate – and I know every one of your patients does. You are a champion of children, Dr. Pransky. From the bottom of our hearts, we owe you our world.

Amy B.

A sincere thank you for all you have done for Logan. We would not be in the place of health he is in without you. May you go on to help another few hundreds of Logans over your career. In complete sincerity–you have impacted our lives in such a positive way.

Carrie B.

Thank you so much for the many years you have helped me and [my daughter].  We appreciate all the appointments, MyChart answers, and endoscopies we have had with you.  You have always been so kind and understanding and we couldn’t have done it without you!

Sandy R.

GI Services

Medical Appointments

 

New patient consultation
Follow-up visit
Telemedicine consultation
Telemedicine follow-up
Shared appointment

 

GI Procedures

 
Upper endoscopy (EGD)
Colonoscopy
Anal sphincter Botox injection
Rectal disimpaction

 

For information about clinical hypnosis appointments, please click here.

 

Other services

– Talks and lectures, including to parent and school groups

– Expert witness services

 


 

Medical appointments

 

New patient consultations (approx. 80 minutes)

  

Before the visit:
Dr. Cherry will review any available medical records to prepare for the appointment.  We will also ask you to fill out a questionnaire to provide useful background information.

 

During the visit:
You and Dr. Cherry will have a detailed discussion of symptom course, past medical history, dietary history, and family history.   Whenever possible, she prefers that the patient answer the questions, although sometime parents have to jump in!  Dr. Cherry will also perform a physical exam.  When relevant, a rectal exam may be suggested, but is never forced.   Potential diagnoses and treatment options will be described and discussed.   Dr. Cherry may recommend lab tests (blood and/or stool), imaging (such as ultrasound or MRI), or other studies.  She also may recommend treatments which could include dietary adjustments, over-the-counter or prescription medications, or herbal supplements.

 

After the visit:
– If tests are recommended, you can use the lab of your choice.  Any studies will be processed by your insurance in a standard manner.  We do not have a lab in the building.
– When test results are back, Dr. Cherry will contact you.
– Dr.  Cherry will send her notes to the pediatrician and to any other specialists involved, and will be available to discuss the case with them.
– Whenever needed, Dr. Cherry will touch base with you in a “check-in” call to follow up on symptoms and/or response to treatments.
– You can find a brief video of Dr. Cherry discussing new consultations here.

 

 

Follow-up visits (approx. 40-60 minutes)*

 

Any patient who has seen Dr. Cherry within the last 3 years, and who is returning with a related issue, is considered to be “following up.”  These appointments generally have a tighter focus, but are flexible enough to bring up new issues or concerns.  The process for testing and treatments will be the same as for a new consultation.  Also as for a new consultation, Dr. Cherry will send her notes to the pediatrician and to any other specialists involved and will be available to discuss the case with them.

 

 

Telemedicine consultation (approx. 60 minutes)

 

Telemedicine consultations are performed either as a phone call or via a video platform, and are similar in many ways to “in-office” consultations.  They may be appropriate when distance or logistics make it difficult to come to the office.  Since Dr. Cherry is unable to perform a physical exam, recommendations may be somewhat less complete.

 

 

Telemedicine follow-up (approx. 40 minutes)

 

Telemedicine follow-ups are performed either as a phone call or via a video platform, and are similar to an office follow-up.  However, for purposes of safety, Dr. Cherry may at times require that a patient come in to be examined before she makes further recommendations.

 

 

Shared appointments (approx. 2 hours)

 

Patients who have a known diagnosis may prefer a shared appointment to a standard follow-up visit.  In this type of appointment, a small group of children with a similar diagnosis come in at the same time, allowing for more interaction among families.  For further information, please click here.

 

 

*Families who anticipate a need for 4 or more visits over the course of a year may prefer to enroll in an annual plan.

 


GI procedures

 

All GI procedures are performed with sedation.  Many parents have questions or concerns about anesthesia. Reliable information about anesthesia in children is available from the SmartTots collaborative and from the American Academy of Pediatrics.

 

GI procedures are performed in one of two locations:

Rady Children’s Hospital Outpatient Procedure Center, 8001 Frost St., San Diego.

University Ambulatory Surgery Center, 8929 University Center Lane, San Diego.

 

 

 

Upper endoscopy/ esophagogastroduodenoscopy (EGD)

 

EGD is typically performed to identify the cause of chronic upper GI symptoms, such as nausea, vomiting, upper abdominal pain, or swallowing difficulties.  It might also be performed to confirm a diagnosis of celiac disease in patients who have positive lab testing.  It involves passing a camera, housed in a long and flexible scope, through the mouth, esophagus, stomach, and uppermost parts of the small intestine.  Dr. Cherry will take photographs of all these areas and in most cases will also take biopsies (tissue samples) which are about the size of the head of a pin.  The procedure typically takes about 15 minutes to perform, plus time for sedation and equipment setup.

A child-friendly guide to upper endoscopy can be found here.

 

 

Colonoscopy

 

Colonoscopy is typically performed to identify the cause of chronic lower GI symptoms, such as diarrhea, bloody stool, and lower abdominal pain.  It might be also be performed to continue investigation when stool testing suggests the presence of intestinal inflammation.  It involves passing a camera, housed in a long and flexible scope, through the anus and up through the entire colon, with the goal of reaching the end of the small intestine where it connects with the colon (large intestine).   Dr. Cherry will take photographs of all these areas and in most cases will also take biopsies (tissue samples) which are about the size of the head of a pin.  The procedure typically takes about 30 minutes to perform, plus time for sedation and equipment setup.  When a colonoscopy is being done, an upper endoscopy (EGD) is often also recommended.

 

Please click here for more information about colonoscopy, from the North American Society of Pediatrics Gastroenterology, Hepatology, and Nutrition (NASPGHAN).

A child-friendly guide to colonoscopy can be found here. A child-friend guide to combined upper endoscopy and colonoscopy can be found here.

 

 

 

FAQ about EGD and colonoscopy

 

Can my child eat before the procedure?  For an upper endoscopy (EGD), your child can eat until 8 hours before the procedure and drink clear liquids until 3 hours before the procedure.  For a colonoscopy, your child will typically stop eating about 24 hours before the procedure and continue to drink clear liquids until 3 hours before the procedure.  However, there can sometimes be adjustments to the period of time that a child will not be able to eat.

 

Will my child need a “cleanout” like adults do before a colonoscopy?  There is no cleanout needed for an upper endoscopy (EGD).  For a colonoscopy, a cleanout will be needed so that Dr. Cherry has a clear view of the inside of the colon.  There are several options for the kind of cleanout used based on the age of your child.  We make an effort to keep the cleanout as easy as possible and to avoid liquids with an unpleasant taste.

 

What can you test for with an endoscopy and/or colonoscopy?  Endoscopy and colonoscopy are “open ended” tests, meaning that they are used to look for any changes that are out of the ordinary.  Any injury or abnormality of the tissue will be evaluated objectively.  With endoscopy and/or colonoscopy, conditions that can be identified include (but are not limited to): celiac disease, eosinophilic esophagitis, H. pylori infection, peptic ulcer, Crohn disease, ulcerative colitis, and juvenile polyps.

 

Will we have the diagnosis at the end of the procedure?  After the procedure, it will usually take a few days to have a final diagnosis.  This is because tissue samples (biopsies) are sent to the lab and require time to be processed and studied under a microscope for evidence of inflammation, infection, or other abnormalities.  Dr. Cherry will be able to tell you immediately after the procedure if she sees any obvious abnormalities such as an ulcer, polyp, or area of bleeding.  However, she may not be able to identify the cause of the abnormalities until the biopsy results are back.

 

What are the risks of the procedure?  Complications of routine endoscopy and colonoscopy in children are rare.  However, there have been cases where there is a scrape or tear leading to bleeding or creation of a hole in the wall of an organ.  These events occur more often in children who have had intestinal surgery or chemotherapy.  To minimize these risks, no sharp instruments are used during procedures.  GI procedures can also very rarely introduce infection.  When infection occurs, it is usually from a side-viewing endoscope, which is more difficult to sterilize.  Dr. Cherry does not use this kind of equipment, and only uses forward-viewing endoscopes.

 

How will my child feel after the procedure?  Children often have a mild sore throat after their procedures and on rare occasion may have some chest pain.  It is uncommon for them to have any rectal discomfort or abdominal pain.

 

How long does it take to recover?  Your child should be back to regular activities the day after the procedure.

 

 

Anal sphincter Botox injection

 

When a child has chronic constipation, it may be due in part to overactive muscles around the anus (anal sphincter) which prevent stool from leaving the body efficiently.  Botox is medical-grade botulinum toxin which in very small doses temporarily relaxes muscles and is used for a variety of medical conditions which are caused or worsened by excess muscle tone.  Botox injections in the anal sphincter allows the muscles to relax and permit more frequent and complete stool evacuation.

 

FAQ about anal sphincter Botox injections

 

Can my child eat before the procedure?  Your child can eat until 8 hours before the procedure and drink clear liquids until 3 hours before the procedure.

 

Will my child need a “cleanout” like adults do before a colonoscopy?  There is no need for a full colon cleanout before Botox injection.  However, it is best for the rectum to be empty of stool.  For that reason, enemas are recommended the evening before and the morning of the injection.

 

How do you do the injection?  The Botox is injected using the narrowest possible needle, at 4 different points around the anus.

 

How will my child feel after the procedure?  Your child may have a small amount of bleeding at the injection sites and some mild soreness but may feel entirely well after the procedure.

 

How long does it take to recover?   Your child should be back to regular activities the day after the procedure.

 

Can Botox cause any dangerous side effects?  In large doses, Botox can cause suppression of breathing.  For that reason, Dr. Cherry uses a small enough dose to avoid any side effects outside of the anal sphincter.  The maximum total Botox dose that Dr. Cherry uses is 100 units.  For purposes of comparison, a typical Botox treatment for facial wrinkles is about 85 units.

 

Will my child have leaking of stool after a Botox injection?  Leakage of stool after anal sphincter Botox injections has been reported to occur less than 3% of the time.  When it occurs, it nearly always resolves within 1 week.

 

Is this a permanent solution?  The effects of Botox typically wear off within about 3 months.  For that reason, some patients may require more than one round of treatment.  However, a long-term improvement can often be achieved when Botox treatment is combined with additional treatments such as physical therapy.

 

 

Rectal disimpaction

 

When a child is severely constipated, hard stool can become “impacted” in the rectum and prevent the passage of normal bowel movements.  Sometimes, only small amounts of liquid stool can pass around this impaction.  Stool impactions can usually be cleared with the use of large amounts of stool softeners and/or different kinds of enemas.  When these measures are not effective, one alternative is admission to the hospital for stool softeners to be given in large volume through a nasogastric tube (a flexible tube passed through the nose and into the stomach), typically over a period of 1-3 days.  Another option is manual disimpaction.  In this procedure, stool is removed directly from the rectum using a combination of gentle manipulation and irrigation with water or saline.   This procedure takes a variable amount of time to perform.

 

FAQ about rectal disimpaction

 

Can my child eat before the procedure?  Your child can eat until 8 hours before the procedure and drink clear liquids until 3 hours before the procedure.

 

How will my child feel after the procedure?  Your child may have some soreness in the anal area after the procedure.  However, children often wake up from anesthesia feeling immediate relief from previous abdominal pain or rectal discomfort.

 

How long does it take to recover?  Your child should be back to regular activities the day after the procedure.

 

What are the risks of rectal disimpaction?  The risks of rectal disimpaction are low.  No sharp instruments are used.  However, there may be some mild anal irritation and bleeding.

 

Will a disimpaction help figure out why my child is so constipated?   Disimpaction does not usually provide direct diagnostic information.  However, once a rectal impaction is cleared, further testing (such as imaging studies) will generally be more informative.

 

How long do the effects of disimpaction last?  Disimpaction can be a first step to resolving a child’s chronic constipation but is not a long-term solution.  It is important to have a clear plan set up in advance to make sure that a child has ongoing successful bowel emptying to prevent stool “backup” and the formation of another impaction.