43217 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

Name of the Procedure:

Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

Summary

Esophagoscopy with snare technique is a minimally invasive procedure where a doctor inserts a flexible tube through the mouth to examine the esophagus and remove any tumors, polyps, or lesions using a snare—a wire loop device.

Purpose

This procedure addresses abnormalities in the esophagus, such as tumors, polyps, or lesions. The goal is to remove these growths to prevent further complications, allow for biopsy to diagnose conditions, and alleviate symptoms like difficulty swallowing or pain.

Indications

• Persistent symptoms such as difficulty swallowing (dysphagia)
• Persistent heartburn or acid reflux
• Suspected or diagnosed tumors or polyps in the esophagus
• Unexplained weight loss
• Persistent chest pain not related to the heart

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Adjustments or temporary discontinuation of certain medications like blood thinners, as directed by your doctor.
• Pre-procedure diagnostic tests might include blood tests, imaging studies, or an initial endoscopic examination.

Procedure Description

1. Patient is positioned comfortably and given sedation or general anesthesia, depending on the case.
2. A flexible endoscope is gently inserted through the mouth and guided down the esophagus.
3. The endoscope allows the doctor to visualize the esophagus lining.
4. Upon locating a tumor, polyp, or lesion, a snare device attached to the endoscope is used to encircle and remove the growth.
5. The removed tissue is collected for further pathological examination if needed.
6. The endoscope is carefully withdrawn.

Duration

The procedure typically takes between 20 to 40 minutes, though it may vary depending on the complexity.

Setting

The procedure is typically performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Gastroenterologist or endoscopic surgeon
• Nurses and/or endoscopy technicians
• Anesthesiologist or nurse anesthetist (if sedation or anesthesia is administered)

Risks and Complications

• Bleeding at the site of removal
• Perforation or injury to the esophagus
• Infection
• Adverse reactions to sedation or anesthesia
• Stricture formation (narrowing of the esophagus)

Benefits

• Removal of abnormal growths to relieve symptoms and prevent complications.
• Potentially diagnostic as removed tissue can be analyzed.
• Minimally invasive with generally quicker recovery compared to open surgeries.

Recovery

• Patients may be monitored for several hours post-procedure, especially if sedation was used.
• Temporary throat discomfort, bloating, or minor bleeding might occur.
• Instructions include resting for the day, avoiding driving or operating machinery, and gradually reintroducing a normal diet.
• Follow-up appointments to discuss biopsy results, if applicable, and assess healing.

Alternatives

• Medications to manage symptoms may be tried first.
• Observation and monitoring with periodic endoscopy if the lesion appears benign.
• Surgical removal if the growth is large or not suitable for snare removal.
• Pros and cons: Medication may only manage symptoms without removing the lesion. Surgery might be more invasive with longer recovery but may be necessary for certain conditions.

Patient Experience

During the procedure, patients under sedation wouldn't feel discomfort. Post-procedure, they might experience mild sore throat, bloating, or minor bleeding. Pain management will include over-the-counter medications, and comfort measures like resting and hydration are recommended.