74360 Intraluminal dilation of strictures and/or obstructions (eg, esophagus), radiological supervision and interpretation

Name of the Procedure:

Intraluminal Dilation of Strictures and/or Obstructions (e.g., Esophagus)

Summary

This procedure involves widening narrowed areas (strictures) or blockages within the esophagus using medical instruments under radiological guidance. It helps improve the passage of food and liquid through the esophagus.

Purpose

• Medical Condition: Esophageal strictures, obstructions.
• Goal: To restore normal passage through the esophagus, alleviate difficulty swallowing, and improve overall digestive function.

Indications

• Symptoms: Difficulty swallowing (dysphagia), recurrent esophageal obstruction.
• Factors: Diagnosed esophageal stricture, benign or malignant causes of narrowing, achalasia.

Preparation

• Instructions: Fasting for at least 6-8 hours before the procedure.
• Tests: Pre-procedure swallow study, esophagram, endoscopy, and blood work may be required.

Procedure Description

1. The patient is positioned on an X-ray table.
2. Sedation or anesthesia is administered for comfort.
3. A guidewire is introduced into the esophagus under fluoroscopic (X-ray) guidance.
4. A dilating instrument, balloon, or bougie is advanced over the guidewire to the site of the stricture.
5. The instrument is gradually expanded to dilate the narrowed area.
6. Radiological images are taken to confirm successful dilation.
7. The instruments are removed, and the patient is monitored for a brief period.

Duration

Approximately 30 minutes to 1 hour.

Setting

Typically performed in a hospital's radiology department or an outpatient surgical center.

Personnel

• Radiologist or Gastroenterologist
• Nurses
• Radiology Technologist
• Anesthesiologist (if sedation or anesthesia is required)

Risks and Complications

• Common Risks: Mild discomfort, minor bleeding.
• Rare Risks: Perforation of the esophagus, infection, adverse reaction to sedation or contrast dye.
• Management: Immediate medical attention and supportive care if complications arise.

Benefits

• Improved swallowing function.
• Relief from esophageal obstruction.
• Enhanced quality of life.
• Benefits may be realized immediately or shortly after the procedure.

Recovery

• Post-procedure observation for a few hours.
• Instructions: Soft diet for 24-48 hours, avoid hot liquids immediately after.
• Follow-up: Appointments to monitor healing and effectiveness.

Alternatives

• Medication management (e.g., proton pump inhibitors, steroids).
• Endoscopic stent placement.
• Esophageal surgery.
• Pros and Cons: Non-surgical options may offer fewer immediate risks but might not be as effective for severe strictures.

Patient Experience

• During the procedure: Discomfort is minimized with sedation or anesthesia.
• After the procedure: Sore throat, mild esophageal discomfort.
• Pain management: Pain relievers for discomfort as needed.

By understanding this procedure, patients and caregivers can be more informed and prepared, ensuring better outcomes and smoother recovery.