44364 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

Name of the Procedure:

Small Intestinal Endoscopy (Enteroscopy beyond the second portion of the duodenum, not including ileum) with Removal of Tumor(s), Polyp(s), or Other Lesion(s) by Snare Technique

Summary

This procedure involves the use of an endoscope—a flexible, tube-like instrument with a light and camera—to visually inspect and treat the small intestine beyond the duodenum (excluding the ileum). Using a snare, a wire loop device, the doctor can remove tumors, polyps, or other lesions.

Purpose

The primary goal is to diagnose and treat abnormalities such as tumors, polyps, or lesions in the small intestine beyond the second portion of the duodenum. The procedure helps in alleviating symptoms related to these growths and preventing potential complications like bleeding or cancer.

Indications

• Unexplained gastrointestinal bleeding
• Suspected small intestine tumors or polyps
• Chronic abdominal pain
• Abnormal findings from other imaging tests
• Confirmed diagnosis requiring therapeutic intervention

Preparation

• Fasting for 6-8 hours before the procedure
• Adjustments or temporary discontinuation of certain medications (e.g., blood thinners)
• Completion of pre-procedure evaluations such as blood tests or imaging studies

Procedure Description

1. The patient is positioned comfortably, often lying on their side.
2. Sedation or anesthesia is administered to ensure comfort.
3. The endoscope is gently inserted through the mouth, passing through the stomach into the small intestine.
4. The endoscope lights up and captures images, displayed on a monitor for real-time visualization.
5. Once the abnormal growth (tumor, polyp, or lesion) is identified, a snare is passed through the endoscope.
6. The snare encircles the lesion and tightens, allowing for removal with minimal surrounding tissue damage.
7. The tissue sample may be sent for pathology analysis if required.
8. The endoscope is carefully withdrawn.

Duration

The procedure typically takes about 60 to 90 minutes.

Setting

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

Personnel

• Gastroenterologist or surgeon specializing in endoscopy
• Nurses or endoscopy technicians
• Anesthesiologist (if deep sedation or general anesthesia is used)

Risks and Complications

• Common: Sore throat, mild abdominal discomfort, bloating.
• Rare: Bleeding, perforation of the intestinal wall, infection, adverse reactions to sedation or anesthesia.

Benefits

• Accurate diagnosis and targeted treatment of intestinal lesions
• Alleviation of symptoms like bleeding or pain
• Prevention of complications from untreated growths
• Early detection and removal of potentially cancerous lesions

Recovery

• Observation for a few hours post-procedure for any immediate complications
• Instructions to avoid driving or operating heavy machinery for 24 hours due to sedation
• Possible dietary restrictions temporarily
• Follow-up appointment for results and further management

Alternatives

• Capsule endoscopy (diagnostic only, not therapeutic)
• Barium X-rays (less detailed images, no therapeutic capability)
• Watchful waiting with periodic monitoring (in cases of small, asymptomatic lesions)

Patient Experience

Patients may feel groggy from sedation, with minor throat discomfort and bloating. Pain is usually minimal, and comfort measures include gentle care and prescribed pain relief if necessary. Most patients can resume normal activities the next day, pending specific doctor's advice.