43245 Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie)

Name of the Procedure:

Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (e.g., balloon, bougie)
Common Names: EGD with dilation, Upper Endoscopy with dilation

Summary

An Esophagogastroduodenoscopy (EGD) with dilation involves using a flexible tube with a camera to view the esophagus, stomach, and the beginning of the small intestine, and to widen any narrowed areas. This is done through the mouth and uses either a balloon or bougie to perform the dilation.

Purpose

This procedure is used to diagnose and treat narrowing (strictures) in the esophagus, stomach, or duodenum, which can cause difficulty swallowing, pain, and other gastrointestinal symptoms. The goals are to relieve symptoms, improve swallowing, and prevent complications like obstruction.

Indications

• Difficulty swallowing (dysphagia)
• Chronic Gastroesophageal Reflux Disease (GERD) with strictures
• Peptic ulcer disease leading to scarring and narrowing
• Scarring from radiation or caustic injury
• Unexplained weight loss or anemia due to stricture
• Symptoms of blockage such as vomiting or inability to eat

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjustments or temporary discontinuation of certain medications, such as blood thinners
• Pre-procedure blood tests and assessments, if necessary
• Arranging transport as sedatives used during the procedure impair driving abilities

Procedure Description

1. Administering sedatives and local anesthetic to the throat.
2. Inserting the endoscope through the mouth, down the throat, into the esophagus, stomach, and duodenum.
3. Visual inspection to locate the stricture.
4. Utilizing a balloon or bougie device to gradually and carefully dilate the narrowed section.
5. Inspecting the dilation site to ensure it is patent (open) and no complications are evident.
6. Removing the endoscope carefully.

Duration

Approximately 20-45 minutes.

Setting

This procedure is typically performed in a hospital endoscopy suite or an outpatient surgical center.

Personnel

• Gastroenterologist or endoscopic surgeon
• Nursing staff
• Anesthesiologist or nurse anesthetist (if deeper sedation is required)
• Endoscopy technician

Risks and Complications

• Common: Sore throat, minor bleeding, bloating
• Rare: Perforation of the esophagus, stomach, or duodenum, severe bleeding, infection, adverse reaction to sedation

Benefits

• Relief from symptoms like difficulty swallowing and pain
• Improved ability to eat and maintain nutrition
• Prevention of complications like severe obstructions

Recovery

• Monitoring in a recovery area until sedation effects wear off (1-2 hours)
• Possible sore throat for a day or two
• Instructions to avoid certain foods/drinks for a short period
• Typically, a quick return to normal activities, with some restrictions on heavy lifting or strenuous activity
• Follow-up appointment to assess the success of the dilation

Alternatives

• Medication management for underlying conditions (e.g., GERD)
• Repeated endoscopic dilations if initial dilation is ineffective
• Surgical intervention in severe cases
• Cons of alternatives include potentially prolonged symptom relief and higher risks with surgery

Patient Experience

During the procedure, patients may feel a sensation of pressure but will generally be sedated and comfortable. Afterward, they might experience a sore throat or mild discomfort, which can be managed with over-the-counter pain relief and comfort measures like throat lozenges.