43205 Esophagoscopy, flexible, transoral; with band ligation of esophageal varices

Name of the Procedure:

Esophagoscopy, flexible, transoral; with band ligation of esophageal varices

Summary

An esophagoscopy with band ligation is a procedure where a flexible tube with a camera is inserted through the mouth to examine the esophagus and treat esophageal varices by placing rubber bands around them to stop bleeding.

Purpose

This procedure is used to diagnose and treat esophageal varices, which are enlarged veins in the esophagus that can bleed dangerously. The goal is to prevent or stop bleeding, thus reducing the risk of severe blood loss and associated complications.

Indications

• Presence of esophageal varices, often due to liver cirrhosis or portal hypertension.
• History of variceal bleeding.
• Signs and symptoms such as vomiting blood, black stools, or severe anemia.

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Avoiding certain medications (e.g., blood thinners) as advised by the doctor.
• Pre-procedure blood tests to assess liver function and clotting.

Procedure Description

1. The patient is sedated or given anesthesia for comfort.
2. A flexible endoscope is gently inserted through the mouth and passed down the esophagus.
3. The endoscope transmits images to a monitor, allowing the surgeon to locate varices.
4. Rubber bands are placed around the varices using special tools attached to the endoscope.
5. The endoscope is carefully withdrawn once the procedure is complete.

Duration

Typically, the procedure takes about 30-60 minutes.

Setting

Performed in a hospital or outpatient surgical center.

Personnel

• Gastroenterologist or endoscopic surgeon
• Nursing staff
• Anesthesiologist or sedation nurse

Risks and Complications

• Sore throat or discomfort post-procedure
• Bleeding or infection
• Perforation of the esophagus (rare)
• Recurrent variceal bleeding

Benefits

• Effective treatment to stop or prevent variceal bleeding.
• Immediate reduction in the risk of severe blood loss.
• Improved survival and quality of life.

Recovery

• Observation in a recovery area until sedation effects wear off.
• Avoid eating or drinking until fully alert and swallow reflex returns.
• Gradual reintroduction of normal diet as tolerated.
• Follow-up appointments to monitor esophageal health and recurrence of varices.

Alternatives

• Medication to reduce portal hypertension.
• Sclerotherapy (injecting a solution into varices to shrink them).
• Transjugular intrahepatic portosystemic shunt (TIPS) procedure.
• Liver transplantation in severe cases.

Patient Experience

• Mild sore throat or discomfort post-procedure.
• Sedation helps minimize pain and anxiety during the procedure.
• Most patients can return home the same day but should arrange for someone to drive them.
• Instructions for pain management and dietary adjustments will be provided.