43213 Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed)

Name of the Procedure:

Esophagoscopy, Flexible, Transoral; with Dilation of Esophagus, by Balloon or Dilator, Retrograde (includes fluoroscopic guidance, when performed)

Summary

An esophagoscopy is a procedure where a flexible tube with a camera is inserted through the mouth to examine the esophagus. In this procedure, if there is a narrowing or blockage, the esophagus will be dilated (widened) using a balloon or a dilator, which may involve retrograde (reverse) techniques and fluoroscopic guidance.

Purpose

The procedure is designed to address strictures (narrowing) or blockages in the esophagus. It aims to widen the esophagus to allow normal swallowing and passage of food. The expected outcome is relief from symptoms like difficulty swallowing (dysphagia), chest pain, and regurgitation.

Indications

• Difficulty swallowing
• Painful swallowing
• Persistent or recurrent heartburn
• Unusual weight loss due to swallowing problems
• Identified narrowing or blockage of the esophagus on imaging studies

Preparation

• Fasting for at least 6-8 hours before the procedure
• Medication adjustments as instructed by the physician
• Completion of diagnostic esophageal imaging (e.g., endoscopy, barium swallow) if not recently performed

Procedure Description

1. The patient is asked to lie down on their side.
2. Sedation or anesthesia is administered to ensure comfort.
3. A flexible esophagoscope is gently introduced through the mouth into the esophagus.
4. The physician examines the esophagus using the camera on the esophagoscope.
5. If a narrowing is found, a balloon or dilator is inserted through the esophagoscope to the affected area.
6. The balloon is inflated or the dilator is used to widen the esophagus.
7. Fluoroscopic guidance may be utilized to ensure precise placement and dilation.
8. Upon successful dilation, the instruments are removed and the patient is monitored as they awaken from sedation.

Duration

The procedure typically takes around 30 to 60 minutes.

Setting

The esophagoscopy is usually performed in a hospital endoscopy unit, outpatient clinic, or surgical center.

Personnel

• Gastroenterologist or surgeon
• Anesthesiologist or nurse anesthetist
• Endoscopy nurse or technician

Risks and Complications

• Sore throat or temporary hoarseness
• Bleeding
• Perforation of the esophagus
• Infection
• Reaction to sedation or anesthesia
• Chest pain

Benefits

• Alleviation of swallowing difficulties
• Improved nutritional intake and quality of life
• Reduced risk of food impaction in the esophagus Benefits are typically realized almost immediately, with full effects noticeable as the esophagus heals over the days following the procedure.

Recovery

• Patients are monitored for a few hours post-procedure until sedation wears off.
• Avoid eating or drinking for a few hours, then start with clear liquids progressing to a normal diet as tolerated.
• Follow any specific dietary or medication instructions provided.
• Schedule a follow-up appointment as instructed by the physician.

Alternatives

• Medication management with proton pump inhibitors or other esophageal relaxants
• Esophageal stenting
• Surgical options for more severe or refractory cases
• Each alternative has its own set of risks and benefits which should be discussed with a healthcare provider.

Patient Experience

Patients may experience mild discomfort or soreness in the throat and esophagus post-procedure, which typically resolves within a few days. Pain management includes over-the-counter pain relievers and throat lozenges, and comfort measures may include eating soft foods and avoiding very hot or cold beverages.