43255 Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method

Name of the Procedure:

Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method (EGD with hemostasis).

Summary

An esophagogastroduodenoscopy (EGD) is a procedure where a specialized flexible tube with a camera (endoscope) is inserted through the mouth to examine the lining of the esophagus, stomach, and the first part of the small intestine. If any bleeding is found during the examination, the procedure includes methods to control the bleeding.

Purpose

EGD with hemostasis is primarily done to diagnose and treat conditions causing bleeding within the upper digestive tract. The goal is to identify the source of bleeding and safely stop it using various methods, potentially preventing severe blood loss and other complications.

Indications

• Gastrointestinal bleeding.
• Anemia with an unknown source of gastrointestinal blood loss.
• Chronic indigestion and unexplained pain.
• Difficulty swallowing.
• Suspicion of ulcers, tumors, or other abnormalities.

Preparation

• Fasting for 6-8 hours before the procedure.
• Adjusting or stopping certain medications as advised by your doctor, particularly blood thinners.
• Pre-procedure assessments like blood tests may be required.

Procedure Description

1. The patient lies on their side.
2. A mouthguard is used to protect the teeth and the endoscope.
3. Throat may be numbed with a local anesthetic spray.
4. Intravenous (IV) sedation or general anesthesia is administered to ensure comfort.
5. The endoscope is gently inserted through the mouth and guided down the esophagus, into the stomach, and the duodenum.
6. The camera transmits images to a monitor, where the physician can examine the lining for bleeding, ulcers, or growths.
7. If bleeding is detected, the physician uses tools inserted through the endoscope to apply treatments such as clipping, cauterizing, or injecting medications to control the bleeding.
8. After treatment, the endoscope is carefully withdrawn.

Duration

Typically, the procedure lasts about 15-30 minutes, although it may take longer if extensive treatment is needed.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or specialized surgical center.

Personnel

• Gastroenterologist or Endoscopist
• Anesthesiologist or Nurse Anesthetist (if sedation or general anesthesia is used)
• Nursing staff and technicians

Risks and Complications

• Sore throat or discomfort after the procedure
• Bleeding from the site of the intervention
• Perforation (a tear in the wall of the digestive tract)
• Reaction to sedation or anesthesia
• Infection

Benefits

• Direct visualization and diagnosis of the cause of upper gastrointestinal bleeding.
• Immediate treatment to control and stop bleeding.
• Reduced risk of complications from uncontrolled bleeding.
• Quicker symptom relief and stabilization.

Recovery

• Spend a short time in a recovery area for monitoring post-procedure.
• Arrange for transportation home due to the sedation effects.
• Resume normal activities usually within 24 hours unless otherwise directed.
• Avoid alcohol and other sedatives for 24 hours.
• Follow-up appointments may be necessary to monitor recovery and any treatment success.

Alternatives

• Capsule endoscopy for diagnostic purposes, but it does not allow for treatment.
• Radiologic imaging (CT scan, MRI) can help diagnose but does not offer direct treatment.
• Surgery, which is more invasive and carries higher risks compared to endoscopy.

Patient Experience

• During the procedure, patients usually do not feel pain due to sedation or anesthesia.
• Post-procedure, there might be mild soreness in the throat and a feeling of bloating or gas, which typically resolves within a day.
• Pain management measures and supportive care will be provided to ensure comfort during recovery.