44381 Ileoscopy, through stoma; with transendoscopic balloon dilation

Name of the Procedure:

Ileoscopy, through stoma; with transendoscopic balloon dilation

Summary

An ileoscopy through stoma with transendoscopic balloon dilation is a medical procedure where a specialized scope (endoscope) is inserted through a surgically created opening (stoma) to access the ileum (the last part of the small intestine). A balloon is then used to dilate (widen) any narrowed sections within the ileum that are causing problems.

Purpose

This procedure addresses narrowing (strictures) in the ileum that can cause obstructive bowel symptoms. The goal is to alleviate symptoms such as pain, cramping, and obstruction by widening the narrowed sections of the intestine to improve bowel function.

Indications

• Symptoms like abdominal pain, bloating, and bowel obstruction.
• Conditions such as Crohn's disease that cause stricture formation in the ileum.
• Candidates typically have a surgically created stoma and have developed strictures that cannot be managed with medication alone.

Preparation

• Patients may be advised to fast for 6-12 hours before the procedure.
• You may need to adjust or stop certain medications prior to the procedure.
• Pre-procedure assessments could include blood tests and imaging studies like a CT scan or an MRI to evaluate the extent of the strictures.

Procedure Description

1. The patient is positioned appropriately, possibly in a supine (lying on the back) position.
2. Sedation or local anesthesia is administered to ensure patient comfort.
3. An endoscope is gently inserted through the stoma to reach the ileum.
4. The scope transmits images to a monitor, allowing the doctor to locate the stricture.
5. A balloon is passed through the endoscope to the site of the narrowing.
6. The balloon is carefully inflated to widen the narrowed segment.
7. The balloon is then deflated and removed, and the scope is withdrawn.

Duration

The procedure typically takes about 30 minutes to 1 hour, depending on the complexity of the case.

Setting

This procedure is usually performed in a hospital or an outpatient surgical center equipped for endoscopic procedures.

Personnel

• Gastroenterologist or surgeon specializing in endoscopic procedures
• Nurses
• Anesthesiologist or sedation specialist

Risks and Complications

• Bleeding
• Infection
• Perforation (a tear in the intestinal wall)
• Pain or discomfort
• Complications related to sedation or anesthesia

Benefits

• Relief from symptoms such as pain and obstruction.
• Improved bowel function.
• Often a minimally invasive alternative to surgery with quicker recovery times.

Recovery

• Patients may be monitored for a few hours post-procedure.
• Instructions typically include a special diet for a day or two and medication to manage any discomfort.
• Normal activity can often be resumed in a few days.
• Follow-up appointments may be necessary to monitor progress and ensure the stricture has not returned.

Alternatives

• Medication management to control underlying conditions like Crohn's disease.
• Surgical resection of the narrowed segment if dilations are ineffective or if there are multiple strictures.
• Each alternative has its own risks and benefits, and the choice may depend on the patient’s overall health, the severity of the stricture, and previous treatments.

Patient Experience

During the procedure, patients may feel some pressure but should not feel pain due to sedation or anesthesia. After the procedure, there might be mild discomfort which can typically be managed with over-the-counter pain medication. Some patients may experience minor bloating or gas. Most can return to their regular activities within a few days.