Esophagogastroduodenoscopy, flexible, transoral; with transmural drainage of pseudocyst (includes placement of transmural drainage catheter[s]/stent[s], when performed, and endoscopic ultrasound, when performed)
CPT4 code
Name of the Procedure:
Esophagogastroduodenoscopy (EGD), flexible, transoral; with transmural drainage of a pseudocyst (includes placement of transmural drainage catheter[s]/stent[s], when performed, and endoscopic ultrasound, when performed).
Summary
An Esophagogastroduodenoscopy (EGD) with transmural drainage of a pseudocyst involves using a flexible tube with a camera (endoscope) inserted through the mouth to visualize the digestive tract. This procedure also includes draining a fluid-filled pseudocyst within the pancreas or nearby tissue using specialized tools, often with the aid of endoscopic ultrasound.
Purpose
This procedure is designed to treat pseudocysts, which are fluid-filled sacs that can develop due to pancreatitis or pancreatic injury. The goal is to relieve symptoms, prevent complications, and improve the patient’s quality of life by removing the excess fluid.
Indications
- Persistent abdominal pain
- Nausea or vomiting
- Pancreatitis-associated symptoms
- Suspected or confirmed pancreatic pseudocysts identified through imaging
- Patients suitable for endoscopic procedures
Preparation
- Fasting for at least 8 hours prior to the procedure
- Adjustments to medications as advised by the physician (e.g., stopping blood thinners)
- Pre-procedure blood tests and imaging studies such as a CT scan or MRI
Procedure Description
- The patient is given a sedative or anesthesia to ensure comfort.
- An endoscope is gently inserted through the mouth and guided down the esophagus into the stomach and duodenum.
- An endoscopic ultrasound (EUS) may be used to locate the pseudocyst accurately.
- Special instruments are used to create a small opening to access and drain the pseudocyst.
- A drainage catheter or stent is placed to facilitate continuous drainage.
- The endoscope is carefully withdrawn, concluding the procedure.
Duration
Typically, the procedure takes about 60 to 90 minutes.
Setting
This procedure is usually performed in a hospital endoscopy suite or an outpatient surgical center.
Personnel
- Gastroenterologist (specialist in digestive health)
- Nurses
- Anesthesiologist or nurse anesthetist
Risks and Complications
- Bleeding
- Infection
- Perforation of the gastrointestinal tract
- Pain or discomfort after the procedure
- Risk of stent migration or blockage
Benefits
- Relief from symptoms like pain and nausea
- Reduced risk of complications associated with pseudocysts
- Minimal invasiveness compared to surgical alternatives
- Quick recovery time
Recovery
- Monitoring in a recovery area until sedation wears off
- Instructions to restrict certain activities for 24 hours post-procedure
- Possible follow-up appointments to check stent placement and effectiveness
- Temporary dietary restrictions and guidance on hydration
Alternatives
- Surgical drainage of the pseudocyst
- Percutaneous (through-the-skin) drainage
- Observation and symptomatic treatment without drainage
- Pros: Alternative methods may be suitable for patients who cannot undergo endoscopy.
- Cons: Surgical and percutaneous options are more invasive or may carry different risks and recovery times.
Patient Experience
During the procedure, patients are sedated and usually do not feel pain or discomfort. After the procedure, there may be mild throat soreness and abdominal discomfort. Pain management includes prescribed medications and comfort measures such as resting and following a soft or liquid diet temporarily.