Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis
CPT4 code
Name of the Procedure:
Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination
Commonly known as: EGD with EUS, Endoscopic Ultrasound (EUS)
Summary
Esophagogastroduodenoscopy with endoscopic ultrasound (EGD with EUS) is a procedure where a flexible tube with a camera and ultrasound device is inserted through the mouth to examine the lining and walls of the esophagus, stomach, and the beginning of the small intestine (duodenum). It can also evaluate surgically altered stomachs extending to the jejunum. This allows for detailed imaging and assessment of these areas.
Purpose
EGD with EUS is used to diagnose and assess conditions affecting the esophagus, stomach, and duodenum. It is particularly helpful in evaluating cancers, cysts, tumors, and other anomalies within these organs and their surrounding structures. This procedure aids in planning appropriate treatments or interventions based on the detailed imaging EUS provides.
Indications
- Persistent upper abdominal pain
- Difficulty swallowing (dysphagia)
- Unexplained weight loss
- Upper gastrointestinal bleeding
- Suspicion of tumors or cancers in the esophagus, stomach, or duodenum
- Assessing the extent of known cancers or tumors
- Gauging the presence of conditions affecting the wall layers of the gastrointestinal tract
Preparation
- Fasting for at least 6-8 hours before the procedure.
- Adjustments to current medications, especially anticoagulants or antiplatelet agents, as advised by the doctor.
- Pre-procedure diagnostic tests like blood work or imaging if required.
Procedure Description
- The patient is administered a sedative or light general anesthesia for comfort.
- The flexible endoscope equipped with a camera and ultrasound device is inserted through the mouth.
- The endoscope is gently advanced through the esophagus, stomach, and into the duodenum.
- The doctor examines the lining of these structures visually and uses ultrasound waves to create detailed images of their walls and surrounding tissues.
- If necessary, biopsies or tissue samples may be taken using special tools passed through the endoscope.
Duration
The procedure typically lasts between 30 to 60 minutes.
Setting
EGD with EUS is performed in a hospital, outpatient clinic, or specialized surgical center, often in a dedicated endoscopy suite.
Personnel
- Gastroenterologist or endoscopic surgeon
- Anesthesiologist or nurse anesthetist
- Endoscopy nurses and technicians
Risks and Complications
- Common risks: Sore throat, mild bloating or gas
- Rare risks: Bleeding, infection, perforation of the gastrointestinal tract, adverse reactions to sedation
- Management of complications may include medication, endoscopic interventions, or in rare cases, surgery.
Benefits
- Ability to obtain detailed imaging and information about the esophagus, stomach, and duodenum.
- Aids in accurate diagnosis and staging of tumors.
- Helps guide treatment decisions.
- Immediate results and possible biopsy collection during the same procedure.
Recovery
- Patients typically recover from sedation within a few hours.
- Post-procedure instructions include avoiding eating or drinking until fully alert, typically for a few hours.
- Minimal restrictions; most patients can resume normal activities the next day.
- Follow-up appointments may be scheduled to discuss results.
Alternatives
- Barium swallow or upper gastrointestinal series: Less invasive but offers less detailed imaging.
- CT or MRI scans: Useful for broader imaging but lack the capability for internal tissue sampling.
- Capsule endoscopy: Another non-invasive option but without the real-time visualization and biopsy capability.
Patient Experience
During the procedure, the patient is sedated and should feel minimal discomfort. Post-procedure, there may be a sore throat and mild bloating. Pain management involves over-the-counter pain relievers and rest. Most patients feel back to normal within a day and can resume regular activities shortly afterward.