The rest of the family waited for about an hour and half for everything to be completed. Afterwards we met with Dr. Kaul and his nurses to discuss how it went. Overall it went really well. Dr. Kaul did not see anything obviously wrong (visually, at least). He did mention a few things though. He mentioned that the g-tube was probably placed too close to the pylorus (opening at the bottom of the stomach). He also asked if Jonathan had been tested for Celiac, as the very beginning of his small intestines were pretty smooth/flat, which can be a sign of this disease. We have had Jonathan tested for this, but it is something to keep in mind. This is also the second doctor to mention that area of Jonathan's intestines - last time there were some questions about friability in this area. We will have to wait for the biopsies to be examined before anything can confirmed, but chances are nothing will come from this as things looked pretty good.
Below is a list of things Jonathan had done, any notes on this item, and the corresponding pictures below.
Upper Endoscopy w/Biopsies - images 1-3 are Jonathan's esophagus, 4-5 are the top and side of his stomach (including parts of his g-tube visible), and 6-7 are of the pylorus (the bottom opening of his stomach). There was nothing to note from these pictures. 8-9 are the beginning's of his small intestine, with the foreground in image 8 being the smooth area I mentioned above that is consistent with Celiac patients.
Pyloric Botox and Balloon Dilation - images 10-12 show Dr. Kaul injecting Botox into Jonathan's pylorus and then dilating it with a balloon. The effects of Botox and dilation are supposed to last about six months. Botox relaxes the muscles that control the opening at the bottom of the stomach (as is moves into the small intestine) and the balloon, enlarges this opening. The idea is that if there is a problem with this area or a sensory problem with his stomach feeling prematurely full, we will see improvement in his appetite and calorie consumption in the next several months. It's really as simple as relaxing and enlarging the drain hole from his stomach to his small intestine.
Colonoscopy w/Biopsies - images 15-20. Biopsies were taken, but nothing of note for right now.
Antroduodenal Manometry Catheter Placement - not pictured. After these procedures Dr. Kaul removed Jonathan's g-tube and replaced it will a catheter for the upcoming manometry (pressure test). They kept all the sensors that would be hooked up to the machine in a plastic bag that was taped to Jonathan's stomach.
