0397T Endoscopic retrograde cholangiopancreatography (ERCP), with optical endomicroscopy (List separately in addition to code for primary procedure)

Name of the Procedure

Endoscopic Retrograde Cholangiopancreatography (ERCP) with Optical Endomicroscopy

Summary

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a medical procedure that uses a flexible tube with a camera (endoscope) to examine the bile ducts, pancreatic duct, and gallbladder. Optical endomicroscopy adds a high-resolution imaging method to provide detailed views of these structures.

Purpose

ERCP with optical endomicroscopy is performed to detect and treat conditions affecting the bile ducts and pancreas, such as blockages, gallstones, tumors, or inflammation. The goal is to provide a clear diagnosis and, if possible, treat the issue during the same procedure.

Indications

• Jaundice (yellowing of the skin or eyes)
• Unexplained abdominal pain
• Pancreatitis (inflammation of the pancreas)
• Suspected or known bile duct stones or tumors
• Abnormal liver function tests suggestive of bile duct obstruction

Preparation

• Patients are required to fast for at least 6-8 hours before the procedure.
• Medications may need to be adjusted or temporarily discontinued (specific instructions will be provided by the healthcare provider).
• Pre-procedure blood tests may be required to check for underlying conditions or risks.

Procedure Description

1. The patient receives sedation or anesthesia to ensure comfort.
2. A flexible endoscope is carefully inserted through the mouth, down the esophagus, and into the stomach and duodenum.
3. A contrast dye is injected into the bile and pancreatic ducts to visualize these structures using X-rays.
4. Optical endomicroscopy enhances the views by providing high-resolution images of the duct linings.
5. If blockages, stones, or other issues are found, the physician may address them immediately using small instruments passed through the endoscope.

Duration

The procedure usually takes about 30 minutes to an hour, depending on the complexity of the case.

Setting

ERCP with optical endomicroscopy is typically performed in a hospital or outpatient clinic equipped with endoscopic and imaging facilities.

Personnel

• Gastroenterologists or endoscopic surgeons
• Registered nurses
• Anesthesiologist or sedation specialist
• Radiology technologists

Risks and Complications

• Pancreatitis
• Infection
• Bleeding
• Perforation of the bile or pancreatic ducts
• Allergic reaction to the contrast dye
• Sore throat or discomfort from the endoscope

Benefits

• Provides a detailed diagnosis of bile duct and pancreatic conditions.
• Allows for immediate treatment of obstructions or stones.
• High-resolution imaging leads to more accurate assessments.

Recovery

• Patients may need to stay for observation for a few hours post-procedure.
• A sore throat or mild abdominal discomfort is common.
• Avoid heavy lifting or strenuous activities for a few days.
• Follow-up appointments may be scheduled to review results or address any complications.

Alternatives

• Magnetic Resonance Cholangiopancreatography (MRCP): Non-invasive imaging alternative, but does not allow for immediate treatment.
• Percutaneous Transhepatic Cholangiography (PTC): Invasive and typically reserved for those unable to undergo ERCP.
• Surgical exploration: Invasive and carries higher risks.

Patient Experience

• Patients typically feel sleepy and relaxed due to sedation.
• Post-procedure, some might experience a sore throat, mild bloating, or discomfort.
• Pain management and oral care are provided to enhance comfort during recovery.