43266 Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)

Name of the Procedure:

Esophagogastroduodenoscopy (EGD), flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)

Summary

Esophagogastroduodenoscopy, commonly known as EGD, is a medical procedure where a flexible tube with a camera (endoscope) is inserted through the mouth and throat into the esophagus, stomach, and the first part of the small intestine (duodenum). During this procedure, a stent can be placed to keep a passage open, which might involve dilating the area and using a guide wire.

Purpose

The EGD procedure is used to diagnose and treat conditions of the upper gastrointestinal (GI) tract. The placement of an endoscopic stent aims to keep narrow or blocked areas open, allowing normal passage of food and fluids. Expected outcomes include relief of symptoms such as difficulty swallowing and improvement in overall digestive function.

Indications

• Difficulty swallowing (dysphagia)
• Obstructions or strictures in the esophagus, stomach, or duodenum
• Tumors or growths causing narrowing of the GI tract
• Post-surgical complications that result in narrowing

Preparation

• Patients are typically instructed to fast for 6-8 hours before the procedure.
• Adjustments to medications, especially blood thinners, may be required.
• Pre-procedure tests such as blood work or imaging studies may be conducted.

Procedure Description

1. The patient is sedated or given anesthesia.
2. The endoscope is inserted through the mouth and guided down the throat to the esophagus, stomach, and duodenum.
3. Areas of narrowing are identified, and a guide wire is passed through to help place the stent.
4. The stent is positioned, and the area may be dilated before and after placement to ensure proper expansion.
5. The endoscope is then carefully withdrawn.

Duration

The procedure typically takes about 30-60 minutes.

Setting

EGD with stent placement is usually performed in a hospital or outpatient surgical center.

Personnel

• Gastroenterologist or a specialized surgeon
• Nurses and possibly a technician
• Anesthesiologist or sedation nurse

Risks and Complications

• Common: Sore throat, minor bleeding
• Rare: Perforation of the GI tract, severe bleeding, infection, adverse reactions to sedation
• Potential complications may require additional interventions or surgery.

Benefits

• Relief from symptoms such as difficulty swallowing
• Improved passage of food and liquids
• Maintenance of an open passage in the upper GI tract
• Benefits are often realized immediately or within a few days of the procedure.

Recovery

• Patients may need to rest for a few hours post-procedure to recover from sedation.
• Instructions include avoiding certain foods or drinks initially and gradually returning to a normal diet.
• Follow-up appointments ensure the stent is functioning correctly and to monitor for any complications.
• Total recovery time varies but is typically a few days to a week.

Alternatives

• Esophageal dilation without stent placement
• Surgical options such as esophagectomy or gastrojejunostomy
• Medications to manage symptoms
• The choice between alternatives depends on the underlying condition, severity, and overall patient health.

Patient Experience

• Patients may feel mild discomfort or pressure during the procedure but usually do not experience pain due to sedation.
• Post-procedure, a sore throat and mild discomfort are common.
• Pain management involves over-the-counter pain relievers and following specific dietary instructions to ensure comfort.