43229 Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

Name of the Procedure:

Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

Summary

An esophagoscopy is a procedure where a flexible tube with a camera (endoscope) is passed through the mouth to examine the esophagus. This particular procedure also involves removing or destroying abnormal growths like tumors or polyps in the esophagus using various ablation techniques. The process can include dilating (widening) the esophagus and passing a guide wire.

Purpose

This procedure addresses abnormal growths in the esophagus, such as tumors and polyps, which may be benign or malignant. The goals are to remove or destroy these lesions, alleviate symptoms, and improve the patient's ability to swallow and eat.

Indications

• Difficulty swallowing (dysphagia)
• Esophageal tumors or polyps
• Previous endoscopic findings of abnormal lesions
• Recurrent esophageal strictures or narrowing
• Symptoms such as persistent heartburn or unexplained weight loss

Preparation

• Patients are generally required to fast for at least 6-8 hours before the procedure.
• Medications such as blood thinners might need adjustment.
• Pre-procedural assessments, like blood work or imaging studies, may be necessary.

Procedure Description

1. Anesthesia: The patient is typically sedated using conscious sedation or general anesthesia.
2. Insertion: A flexible endoscope is gently inserted through the mouth and guided down the esophagus.
3. Examination: The esophagus is closely examined for any abnormal lesions or growths.
4. Ablation: Identified tumors, polyps, or lesions are ablated using techniques like laser, radiofrequency, or cryotherapy.
5. Dilation: If there is significant narrowing, the esophagus is dilated using specialized balloons or dilators.
6. Guide Wire: A guide wire may be passed if needed to facilitate other endoscopic procedures.
7. Conclusion: The scope is carefully withdrawn, and the patient is monitored as they wake up from sedation.

Duration

This procedure typically takes about 30 minutes to an hour, depending on the complexity and number of lesions.

Setting

Typically performed in a hospital or an outpatient clinic with endoscopic facilities.

Personnel

• Gastroenterologist or surgical endoscopist
• Nurse(s)
• Anesthesiologist
• Endoscopy technician

Risks and Complications

• Sore throat or minor bleeding
• Infection
• Perforation or tears in the esophagus
• Adverse reaction to sedation
• Strictures or scarring

Benefits

• Removal or destruction of abnormal growths in the esophagus.
• Relief from symptoms like difficulty swallowing and pain.
• Minimal invasiveness compared to surgical alternatives.
• Early detection and treatment of potential malignancies.

Recovery

• Patients are generally observed for a few hours post-procedure.
• Mild discomfort or a sore throat can be expected.
• Restrictions on eating or drinking until fully awake from sedation.
• Follow-up appointments to monitor healing and assess for recurrence.

Alternatives

• Surgery to remove esophageal tumors or polyps.
• Radiation therapy for malignant tumors.
• Medication management for underlying conditions like acid reflux.
• Watchful waiting for small, benign lesions.

Patient Experience

• During the procedure, patients under sedation typically feel minimal discomfort.
• Post-procedure, a sore throat and mild discomfort are usual but manageable.
• Pain management includes throat lozenges or mild analgesics as needed.