Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance
CPT4 code
Name of the Procedure:
Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance
Summary
An esophagogastroduodenoscopy (EGD) is a procedure where a flexible scope is inserted through the mouth to examine the esophagus, stomach, and the first part of the small intestine. During this procedure, a substance is injected into the submucosal layer for therapeutic or diagnostic purposes.
Purpose
The EGD with submucosal injection is used to diagnose and treat conditions affecting the upper gastrointestinal tract. The injection can deliver medications, mark areas for surgical removal, or treat bleeding lesions.
Indications
This procedure is indicated for patients experiencing symptoms such as abdominal pain, persistent vomiting, difficulty swallowing, gastrointestinal bleeding, or anemia. It is also used to investigate abnormalities found in imaging studies.
Preparation
Patients are typically instructed to fast for at least 6-8 hours before the procedure. They may need to adjust or stop certain medications, especially blood thinners. Pre-procedure assessments may include blood tests, imaging studies, and a review of the patient's medical history.
Procedure Description
- The patient is given a sedative and possibly local anesthesia to the throat.
- A flexible endoscope is inserted through the mouth and gently advanced down the esophagus, into the stomach, and through to the duodenum.
- The physician visualizes the upper gastrointestinal tract on a monitor.
- A substance is injected submucosally to deliver a therapeutic effect or mark an area.
- The scope is then carefully withdrawn.
The endoscope used has a camera and light source, and the injection is administered through a special channel in the scope.
Duration
The procedure typically takes about 15 to 30 minutes but may vary depending on the complexity of the case.
Setting
The EGD is performed in a hospital, outpatient clinic, or surgical center equipped with specialized endoscopy facilities.
Personnel
A gastroenterologist or a specially trained surgeon performs the procedure. Anesthesiologists, nurses, and endoscopy technicians may also be involved.
Risks and Complications
Common risks include sore throat, minor bleeding, and reaction to sedatives. Rare risks include perforation of the gastrointestinal tract, significant bleeding, infection, and adverse reactions to the injected substance.
Benefits
The primary benefit is the accurate diagnosis and treatment of gastrointestinal conditions. Symptomatic relief and prevention of potential complications can be realized soon after the procedure.
Recovery
Post-procedure, patients are monitored until the effects of sedation wear off. They are advised to rest for the remainder of the day. Dietary and medication adjustments may be needed. Follow-up appointments will depend on the findings and interventions performed.
Alternatives
Alternative diagnostic procedures include barium swallow X-rays and capsule endoscopy. Medical therapy, such as medications, might be considered instead of or in conjunction with EGD. Each alternative has its benefits and limitations, which should be discussed with a healthcare provider.
Patient Experience
During the procedure, patients may feel pressure or a gagging sensation as the scope passes through the throat, though sedation usually minimizes discomfort. Post-procedure, a sore throat or mild bloating is common but typically resolves within a day. Pain management includes over-the-counter analgesics and throat lozenges.