43241 Esophagogastroduodenoscopy, flexible, transoral; with insertion of intraluminal tube or catheter

Name of the Procedure:

Esophagogastroduodenoscopy (EGD), flexible, transoral; with insertion of intraluminal tube or catheter

Summary

An Esophagogastroduodenoscopy (EGD) is a medical procedure where a flexible tube with a camera (endoscope) is passed through the mouth to examine the lining of the esophagus, stomach, and the first part of the small intestine (duodenum). During this procedure, an intraluminal tube or catheter is also inserted to assist with various treatments or diagnostic evaluations.

Purpose

The procedure is used to diagnose and sometimes treat conditions affecting the upper digestive tract. Common goals include identifying the cause of symptoms like abdominal pain, nausea, vomiting, swallowing difficulties, or gastrointestinal bleeding. It can also be used to perform interventions like dilating a stricture or placing a stent.

Indications

• Persistent upper abdominal pain
• Chronic nausea or vomiting
• Difficulty swallowing (dysphagia)
• Gastrointestinal bleeding
• Suspected tumors or growths
• Abnormal imaging results
• Gastroesophageal reflux disease (GERD) complications

Preparation

• Patients are usually required to fast for 6-8 hours before the procedure.
• Certain medications may need to be adjusted or stopped before the procedure.
• Pre-procedure diagnostic tests, such as blood tests or imaging studies, may be ordered.

Procedure Description

1. The patient is given a sedative and possibly a local anesthetic to the throat.
2. Once the patient is sedated, the flexible endoscope is gently inserted through the mouth and guided down the esophagus into the stomach and duodenum.
3. The doctor can visualize the inside of the upper digestive tract on a video monitor.
4. If needed, an intraluminal tube or catheter is inserted through the endoscope to perform additional procedures, like delivering medications, collecting tissue samples (biopsy), or dilating strictures.
5. Once the examination and any necessary treatments are complete, the endoscope is carefully withdrawn.

Duration

The procedure typically takes about 15 to 30 minutes.

Setting

EGD is usually performed in a hospital endoscopy suite, outpatient clinic, or specialized surgical center.

Personnel

• Gastroenterologist or general surgeon
• Nurse or endoscopy technician
• Anesthesiologist or sedation nurse

Risks and Complications

• Mild sore throat post-procedure
• Bleeding (rare)
• Perforation of the gastrointestinal tract (very rare)
• Adverse reaction to sedation/anesthesia
• Infection

Benefits

• Accurate diagnosis of upper GI tract conditions
• Ability to perform therapeutic interventions during the same procedure
• Minimal recovery time, with most patients resuming normal activities the following day

Recovery

• Patients are monitored for a short time post-procedure for any adverse reactions.
• It’s generally recommended to avoid eating or drinking immediately after the procedure until the throat numbness wears off.
• Mild throat discomfort may be experienced, which usually resolves within a day.
• Follow-up instructions and any necessary dietary or activity restrictions will be provided based on the findings and interventions performed.

Alternatives

• Barium swallow or upper GI series (X-ray studies)
• Capsule endoscopy
• CT or MRI imaging studies
• Each alternative has pros and cons, such as less invasiveness but potentially less diagnostic accuracy or inability to perform therapeutic interventions.

Patient Experience

During the procedure, patients are usually under sedation, so they typically do not feel discomfort. After waking, they might experience mild throat soreness and a groggy feeling until the sedative fully wears off. Pain management and comfort measures will be provided as needed.