Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker's diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed
CPT4 code
Name of the Procedure:
Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (e.g., Zenker's diverticulum), with cricopharyngeal myotomy, including use of telescope or operating microscope and repair (when performed)
Summary
This procedure involves the insertion of a rigid endoscope through the mouth (transoral) to view and treat Zenker's diverticulum, a pouch that can form in the hypopharynx or upper esophagus. It includes cutting the cricopharyngeal muscle (myotomy) to improve swallowing. A telescope or microscope aids precision, and any needed repairs are done during the procedure.
Purpose
The procedure addresses Zenker's diverticulum, which causes swallowing difficulties, aspiration, and regurgitation of food. The goal is to remove the diverticulum and alleviate symptoms, improving the patient's ability to swallow and reducing the risk of complications like aspiration pneumonia.
Indications
- Dysphagia (difficulty swallowing)
- Regurgitation of undigested food
- Chronic cough or aspiration
- Unintentional weight loss
- Halitosis (bad breath)
- Patients diagnosed with Zenker's diverticulum
Preparation
- Fasting for several hours before the procedure
- Medication review and adjustments as directed by the physician
- Pre-operative physical examination and possible imaging studies like barium swallow or endoscopy
Procedure Description
- The patient is placed under general anesthesia.
- A rigid endoscope is inserted through the mouth to provide a clear view of the hypopharynx and cervical esophagus.
- The diverticulum is identified, and a diverticulectomy (removal of the pouch) is performed.
- A cricopharyngeal myotomy (cutting of the cricopharyngeal muscle) is done to prevent recurrence and improve swallowing.
- A telescope or operating microscope is used for enhanced visualization.
- Any necessary repairs are made before the endoscope is withdrawn.
Duration
Approximately 60 to 90 minutes.
Setting
The procedure is typically performed in a hospital operating room or a dedicated surgical center.
Personnel
- Surgeon specialized in otolaryngology or gastroenterology
- Anesthesiologist
- Surgical nurses
- Surgical technologists
Risks and Complications
- Bleeding or infection
- Perforation of the esophagus
- Aspiration pneumonia
- Injury to nearby structures
- Anesthesia-related complications
- Pain or swelling
Benefits
- Relief from dysphagia and regurgitation
- Improved quality of life and nutritional intake
- Reduced risk of aspiration and related complications
Recovery
- Close monitoring in a recovery room post-procedure
- Pain management with prescribed medications
- Soft or liquid diet initially, transitioning to a regular diet as tolerated
- Follow-up appointments to monitor progress and address any issues
- Patients may return to normal activities within a week
Alternatives
- Conservative management with dietary modifications
- Endoscopic stapling or laser treatment of the diverticulum
- Open surgical approaches (external neck surgery)
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel anything. Post-procedure, there may be throat soreness, mild discomfort, and restricted diet. Pain management will be provided, and most patients experience significant relief of symptoms within a few days to weeks.