43251 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

Name of the Procedure:

Esophagogastroduodenoscopy (EGD), flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

Summary

Esophagogastroduodenoscopy, often abbreviated as EGD, is a minimally invasive diagnostic and therapeutic procedure. It involves using a flexible, transoral endoscope to visualize the esophagus, stomach, and the first part of the small intestine (duodenum). During the procedure, tumors, polyps, or other lesions are removed using a snare technique.

Purpose

EGD is used to diagnose and treat conditions affecting the upper gastrointestinal (GI) tract. The primary goal is to remove abnormal growths, such as tumors or polyps, thereby alleviating symptoms and preventing potential progression to more serious conditions.

Indications

Indications for EGD with removal of lesions include:

• Persistent upper abdominal pain, nausea, or vomiting
• Difficulty swallowing (dysphagia)
• Gastrointestinal bleeding
• Unexplained weight loss
• Suspicion of tumors, polyps, or other GI lesions

Preparation

• Patients are typically required to fast for 6-8 hours before the procedure.
• Certain medications may need to be adjusted or stopped under a doctor's guidance.
• A pre-procedure assessment, including blood tests and a physical examination, may be conducted.

Procedure Description

1. The patient is positioned lying on their side.
2. Sedation or anesthesia is administered to ensure comfort.
3. A flexible endoscope is gently inserted through the mouth and guided through the esophagus, stomach, and duodenum.
4. The physician examines the lining of these organs for abnormalities.
5. If a tumor, polyp, or lesion is found, a snare (a wire loop) is used to encircle and remove the abnormal tissue.
6. The removed tissue is collected for histopathological examination.
7. The endoscope is then carefully withdrawn.

Duration

The procedure typically takes about 20 to 45 minutes.

Setting

EGDs are usually performed in hospitals, outpatient clinics, or specialized surgical centers.

Personnel

• Gastroenterologist or a trained endoscopist
• Nurses or endoscopy technicians
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Common risks: Sore throat, mild bloating, and discomfort.
• Rare complications: Perforation of the GI tract, bleeding, infection, and adverse reactions to sedation.
• These complications are typically managed with prompt medical intervention.

Benefits

• Removal of abnormal growths reduces the risk of cancer and alleviates symptoms.
• Provides definitive diagnosis through tissue biopsy.
• Most benefits are realized shortly after the procedure.

Recovery

• Patients are monitored for a few hours for any immediate complications post-procedure.
• Mild throat discomfort and bloating may occur, but these generally resolve quickly.
• Most patients can resume normal activities within 24 hours, but should follow specific dietary and activity restrictions advised by their doctor.
• Follow-up appointments may be scheduled to discuss biopsy results and further care if necessary.

Alternatives

• Other diagnostic tools like a barium swallow or CT scans, which do not allow for immediate lesion removal.
• Surgical options for more invasive or advanced cases.
• Alternatives may have longer recovery times and different risk profiles compared to EGD.

Patient Experience

• During the procedure, patients are usually sedated and should feel minimal discomfort.
• After the procedure, patients may experience mild throat soreness and bloating.
• Pain management includes over-the-counter pain relievers and warm salt water gargles for throat discomfort.
• Comfort measures and clear instructions help ensure a smooth recovery.