91037 Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation

Name of the Procedure:

Esophageal Function Test, Gastroesophageal Reflux Test with Nasal Catheter Intraluminal Impedance Electrode(s) Placement, Recording, Analysis, and Interpretation

Summary

An esophageal function test with gastroesophageal reflux evaluation involves placing a thin, flexible catheter with electrodes through the nose and into the esophagus to measure acid and non-acid reflux, and evaluate esophageal motility. Data is recorded for analysis to diagnose conditions related to reflux and esophageal function.

Purpose

This test addresses conditions like gastroesophageal reflux disease (GERD) and other esophageal motility disorders. The primary goal is to assess how well the esophagus moves food to the stomach and to determine if acid or non-acid reflux is occurring, guiding treatment options.

Indications

• Persistent heartburn or acid reflux
• Chronic cough or laryngitis suspected to be related to reflux
• Difficulty swallowing (dysphagia)
• Non-cardiac chest pain
• Pre-surgical evaluation for anti-reflux surgery candidates
• Failure of standard reflux medications

Preparation

• Fasting for at least 6 hours before the procedure.
• Temporary discontinuation of medications that affect esophageal motility and acid production, as directed by the physician.
• Possible diagnostic tests like endoscopy beforehand.

Procedure Description

1. The patient will sit in a chair while a thin, flexible catheter with impedance electrodes is gently inserted through a nostril, down the esophagus, and into the stomach.
2. The catheter is then taped to the nose for stability.
3. The patient might be asked to perform activities like eating and drinking to simulate normal swallowing and reflux events while wearing the catheter.
4. Data is continuously recorded for a specified duration, usually 24 hours.
5. After the recording period, the catheter is removed, and the recorded data is analyzed by a medical professional to interpret esophageal and reflux activity.

Duration

The procedure typically involves 20-30 minutes for placement, with a 24-hour monitoring period.

Setting

The placement and initial setup are done in an outpatient clinic or hospital setting. The patient then returns home for the recording period.

Personnel

• Gastroenterologist or specially trained nurse for catheter placement and removal.
• Medical technician or nurse for monitoring and data recording.
• Gastroenterologist for analysis and interpretation of the data.

Risks and Complications

• Discomfort or gagging during catheter insertion
• Minor nosebleeds
• Irritation of the nasal passage or throat
• Rare risk of infection

Benefits

• Accurate diagnosis of reflux and esophageal motility disorders
• Tailored treatment plan based on specific findings
• Helps in pre-surgical evaluation, improving surgical outcomes

Recovery

• Minimal recovery needed; patients can usually resume normal activities after the catheter is placed.
• Patients may experience minor nasal or throat discomfort which usually resolves quickly.
• Follow-up appointments for data interpretation and treatment planning.

Alternatives

• pH probe monitoring (acid-focused)
• Esophageal manometry (for motility disorders only)
• Barium swallow X-rays (less detailed, but non-invasive)
• Endoscopy (visual but not functional assessment)

Patient Experience

• Initial insertion can cause discomfort or gagging, but it usually subsides quickly.
• Patients often feel the catheter in their throat but can function normally during the monitoring period.
• Minor discomfort managed with hydration and throat lozenges if needed.
• Post-procedure, there may be slight nasal or throat soreness, which typically resolves within a day or two.