43252 Esophagogastroduodenoscopy, flexible, transoral; with optical endomicroscopy

Name of the Procedure:

Esophagogastroduodenoscopy (EGD), flexible, transoral; with optical endomicroscopy
Common name(s): Upper Endoscopy, EGD with Optical Endomicroscopy

Summary

An Esophagogastroduodenoscopy (EGD) with optical endomicroscopy is a medical procedure where a flexible tube with a camera and light (endoscope) is inserted through the mouth to examine the lining of the esophagus, stomach, and the beginning of the small intestine (duodenum). Enhanced imaging with optical endomicroscopy allows for a detailed cellular examination of these digestive tract areas.

Purpose

The procedure is used to diagnose and treat conditions affecting the upper digestive tract. Goals include identifying abnormalities such as ulcers, inflammation, tumors, or infections and performing targeted biopsies or treatments.

Indications

• Persistent upper abdominal pain or discomfort
• Difficulty swallowing (dysphagia)
• Unexplained weight loss
• Suspected gastrointestinal bleeding
• Chronic acid reflux or GERD symptoms
• Monitoring certain diseases like celiac or Crohn's disease

Preparation

• Patients are typically instructed to fast for 6-8 hours before the procedure.
• Certain medications may need to be adjusted or temporarily discontinued.
• Pre-procedure tests may include blood work and possibly imaging studies.

Procedure Description

1. The patient is given a sedative to ensure comfort.
2. A flexible endoscope is gently guided through the mouth and throat, passing into the esophagus, stomach, and duodenum.
3. Optical endomicroscopy is used during the procedure for high-resolution imaging at a cellular level.
4. If abnormalities are detected, biopsies may be taken using small tools passed through the endoscope.
5. The endoscope is carefully withdrawn after the examination.

Duration

The procedure typically takes between 30 to 60 minutes.

Setting

Performed in hospitals or outpatient clinics equipped with endoscopy suites.

Personnel

• Gastroenterologist or a specially trained endoscopist
• Nurses or medical assistants
• Anesthesiologist or nurse anesthetist (if sedation is required)

Risks and Complications

• Sore throat or discomfort
• Bleeding from biopsy sites
• Perforation of the digestive tract (rare)
• Adverse reactions to sedation or anesthesia

Benefits

• Accurate diagnosis of conditions affecting the upper GI tract
• Information obtained may guide effective treatment plans
• Immediate treatment of identified issues such as bleeding ulcers

Recovery

• Patients are usually monitored for a short period after the procedure.
• Avoid eating or drinking until the sedative wears off, usually within a few hours.
• Mild throat discomfort is common, but typically resolves quickly.
• Follow-up appointments as needed to discuss results and next steps.

Alternatives

• Barium swallow X-ray: Less invasive but lacks the detailed cellular imaging.
• Capsule endoscopy: Examines the small intestine but does not allow for biopsy or treatment.
• Non-invasive imaging studies (e.g., CT or MRI scans).

Patient Experience

Patients may feel groggy due to sedation and may experience a sore throat post-procedure. Appropriate pain management and comfort measures will be available to minimize discomfort. Recovery is generally quick, allowing most patients to resume normal activities within 24 hours.