43233 Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)

Name of the Procedure:

Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) Common Names: EGD with Balloon Dilation, Upper Endoscopy with Esophageal Dilation

Summary

An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure where a flexible tube with a camera (endoscope) is inserted through the mouth to examine the lining of the esophagus, stomach, and the first part of the small intestine. During this procedure, if a narrowing (stricture) in the esophagus is found, it can be dilated (stretched) using a balloon that is inflated to at least 30 mm in diameter.

Purpose

This procedure is performed to diagnose and treat swallowing difficulties caused by a narrowed esophagus, known as esophageal stricture. The goal is to stretch the narrowed section to improve swallowing and alleviate associated symptoms, which may include difficulty eating and chronic heartburn.

Indications

• Difficulty swallowing (dysphagia)
• Painful swallowing (odynophagia)
• Chronic acid reflux leading to stricture
• Scarring or narrowing of the esophagus from conditions like GERD, esophagitis, or cancer
• Evaluation of upper gastrointestinal symptoms when other tests are inconclusive

Preparation

• Patients are typically instructed to fast (no food or drink) for at least 8 hours before the procedure.
• Medication adjustments may be necessary, including withholding blood thinners or specific medications as directed by the healthcare provider.
• Routine blood tests and imaging studies might be ordered prior to the procedure to assess overall health and specific conditions.

Procedure Description

1. The patient is given a sedative or anesthetic to ensure comfort during the procedure.
2. The endoscope is inserted through the mouth and gently guided through the esophagus, stomach, and duodenum.
3. Images captured by the camera are relayed to a monitor for the doctor to review.
4. If a narrowing is found in the esophagus, a balloon catheter is passed through the endoscope to the site of the stricture.
5. The balloon is then inflated to dilate the esophagus to a size of 30 mm or larger. Fluoroscopic guidance may be used to ensure precise dilation.
6. After achieving the desired dilation, the balloon is deflated and removed along with the endoscope.

Duration

The procedure typically takes about 15-30 minutes, although it may vary based on individual circumstances.

Setting

EGD with balloon dilation is usually performed in a hospital or outpatient endoscopy center.

Personnel

• Gastroenterologist or Endoscopic Surgeon
• Endoscopy nurses
• Anesthesiologist or Nurse Anesthetist
• Radiologic technician (if fluoroscopy is used)

Risks and Complications

• Perforation or tear in the esophagus
• Bleeding
• Infection
• Adverse reaction to sedation or anesthesia
• Chest pain or discomfort
• In rare cases, complications like mediastinitis (infection or inflammation in the chest cavity) could occur

Benefits

• Relief from symptoms like difficulty swallowing and chest pain
• Improved ability to eat and drink
• Immediate visualization and potential biopsy of suspicious areas for further diagnosis
• Minimally invasive compared to surgical options

Recovery

• Patients are monitored for a few hours after the procedure to ensure they recover well from sedation.
• Mild throat soreness or bloating may be experienced.
• Normal diet can usually be resumed gradually.
• Follow-up appointments may be scheduled to monitor progress.
• Patients should avoid heavy lifting or strenuous activities for at least 24 hours.
• Any signs of complications such as severe pain, fever, or vomiting should be reported to a healthcare provider immediately.

Alternatives

• Esophageal stenting: Insertion of a permanent or temporary stent to keep the esophagus open.
• Medication management: Use of drugs to manage symptoms associated with esophageal stricture.
• Surgical options: In severe cases, surgical intervention may be required.
• Pros and cons depend on the severity and cause of the stricture, patient's health status, and preference.

Patient Experience

During the procedure, the patient will be sedated and should not feel pain. Some discomfort and pressure might be felt as the scope is advanced and the balloon is inflated. After the procedure, there may be some throat soreness and mild discomfort, but this typically resolves within a day or two. Pain management will be addressed with appropriate medications, and patients will receive guidance on diet and activities to support recovery.