44384 Ileoscopy, through stoma; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)

Name of the Procedure:

Ileoscopy through stoma with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed).

Summary

An ileoscopy through stoma with stent placement is a medical procedure where a flexible tube with a camera (endoscope) is inserted through a surgically created opening (stoma) to examine the ileum (part of the small intestine) and place a stent. This may involve dilating the area and passing a guide wire to ensure proper placement of the stent.

Purpose

This procedure is performed to alleviate blockages, strictures, or obstructions in the ileum that may be causing symptoms such as pain, nausea, vomiting, and malnutrition. The goal is to restore normal passage through the intestine and improve the patient's quality of life.

Indications

• Bowel obstruction due to strictures or tumors
• Crohn’s disease complications
• Patients with a history of chronic ileal strictures
• Symptoms like abdominal pain, bloating, and difficulty in passing stool

Preparation

• Patients may need to fast for 6-8 hours before the procedure.
• Medication adjustments may be required as per doctor's advice.
• Pre-procedure imaging tests such as CT scans or MRI may be necessary.
• Blood tests to check clotting parameters.

Procedure Description

1. The patient is positioned comfortably, and sedation or anesthesia is administered.
2. An endoscope is inserted through the stoma to reach the ileum.
3. The area around the stricture or obstruction is dilated if necessary.
4. A guide wire is passed through the narrowed area.
5. An endoscopic stent is placed over the guide wire to keep the passage open.
6. The endoscope is withdrawn, and the patient is monitored for immediate post-procedure recovery.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is generally performed in a hospital endoscopy suite or an outpatient surgical center.

Personnel

• Gastroenterologist or endoscopic surgeon
• Endoscopy nurse
• Anesthesiologist or sedation nurse

Risks and Complications

• Bleeding
• Perforation of the intestine
• Infection
• Reaction to sedation or anesthesia
• Stent migration or blockage
• Pain or discomfort post-procedure

Benefits

• Relief from symptoms caused by bowel obstruction or stricture.
• Improved nutritional absorption and overall well-being.
• Minimally invasive with a relatively quick recovery time.

Recovery

• Patients are monitored for a few hours post-procedure.
• Pain management with medications as needed.
• Dietary instructions will be provided, often starting with liquids and gradually transitioning to solids.
• Follow-up appointment to check the stent position and effect.

Alternatives

• Surgical intervention to remove the stricture or blockage.
• Balloon dilation without stent placement.
• Medical management with medications to reduce inflammation.

Pros and cons of alternatives compared to endoscopic stent placement:

• Surgical options may be more invasive with longer recovery times.
• Balloon dilation might not be effective for all types of obstructions.
• Medical management may be limited in resolving strictures and obstructions.

Patient Experience

During the procedure, the patient might feel minimal discomfort due to sedation. Post-procedure, some abdominal pain or discomfort may occur, which can be managed with pain relief measures. Patients should adhere to dietary restrictions and activity limitations as advised by their healthcare provider.