Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube
CPT4 code
Name of the Procedure:
Small intestinal endoscopy (enteroscopy) beyond the second portion of the duodenum, excluding ileum, with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube.
Summary
This procedure involves using an endoscope to examine the small intestine beyond the second part of the duodenum, not including the ileum, and to convert an existing gastrostomy tube (inserted through the stomach) into a jejunostomy tube (inserted into the jejunum).
Purpose
The purpose of this procedure is to address nutritional and feeding needs for patients who cannot ingest food or nutrients orally and require direct feeding into the small intestine.
Indications
- Patients with swallowing disorders or obstructions that prevent proper gastric feeding.
- Severe gastric motility disorders.
- Persistent aspiration pneumonia due to gastric reflux.
Preparation
- Patients are usually required to fast for 8-12 hours before the procedure.
- Adjustment or temporary discontinuation of certain medications as advised by the healthcare provider.
- Blood tests and imaging studies might be conducted prior to the procedure to assess overall health and readiness.
Procedure Description
- The patient is sedated or given anesthesia.
- An endoscope is inserted through the mouth, passing through the esophagus and stomach, reaching into the small intestine beyond the second part of the duodenum.
- The gastrostomy tube is identified and converted into a jejunostomy tube by repositioning it into the jejunum.
- The endoscope is used to ensure proper placement and function of the new tube.
- The procedure is monitored using imaging technologies as needed.
Duration
The procedure usually takes around 60 to 90 minutes.
Setting
It is typically performed in a hospital's endoscopy unit or a specialized surgical center.
Personnel
- Gastroenterologist or surgeon
- Endoscopy nurses
- Anesthesiologist
Risks and Complications
- Infection at the site where the tube is inserted.
- Bleeding or perforation in the gastrointestinal tract.
- Tube displacement or malfunction.
- Abdominal pain or discomfort.
- Rare but serious risks include peritonitis or sepsis.
Benefits
- Improved and reliable method for nutritional intake.
- Reduced risk of aspiration pneumonia.
- Enhanced quality of life for patients with severe swallowing difficulties.
Recovery
- Patients are usually observed for a few hours after the procedure.
- Pain management is provided as needed.
- Instructions on care and maintenance of the new feeding tube are given.
- A follow-up appointment is essential to monitor the tube's functionality and patient’s overall health.
- Typically, normal activities can resume after a day or two, but some restrictions may apply as directed by the healthcare provider.
Alternatives
- Continued use of gastrostomy tube with additional measures to manage complications.
- Nasogastric or nasojejunal tube feeding.
- Total parenteral nutrition (TPN) where nutrients are provided intravenously.
- The choice of alternative depends on the patient's specific medical condition and needs.
Patient Experience
- The patient may feel slight discomfort or mild pain at the tube insertion site post-procedure.
- Sedation or anesthesia ensures that the patient feels no pain during the actual procedure.
- Pain management, including medication, is provided to ensure comfort during recovery.