43196 Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation over guide wire

Name of the Procedure:

Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation over guide wire

Summary

This procedure involves examining the esophagus using a rigid esophagoscope inserted through the mouth. A guide wire is then placed in the esophagus, over which a dilator is passed to widen the esophageal passage.

Purpose

• Medical Condition: Addresses esophageal strictures, blockages, or lesions.
• Goals/Outcomes: To diagnose and treat obstructions and ensure a clear passage for food and liquids.

Indications

• Difficulty swallowing (dysphagia)
• Esophageal strictures or blockages due to scarring, tumors, or other causes
• Recurrent choking or aspiration
• Need for esophageal stent placement

Preparation

• Fasting: Patients are typically instructed to fast for at least 8 hours before the procedure.
• Medications: Adjustments may be needed for blood thinners or other medications.
• Pre-assessments: Blood tests, imaging studies, and sometimes an ECG may be required.

Procedure Description

1. Anesthesia: General anesthesia or deep sedation is administered for patient comfort.
2. Insertion: A rigid esophagoscope is inserted through the patient's mouth and advanced into the esophagus.
3. Guide Wire Placement: A guide wire is carefully threaded through the esophagoscope into the esophagus.
4. Dilation: Over the guide wire, a series of dilators or a balloon dilator is passed to widen the narrowed section.
5. Assessment: The esophagus is then reassessed to ensure the desired dilation is achieved.

Tools/Equipment Used:

• Rigid esophagoscope
• Guide wire
• Dilators (bougies or balloon types)

Duration

The procedure typically takes 30 to 60 minutes.

Setting

Usually performed in a hospital's endoscopy suite or an outpatient surgical center.

Personnel

• Gastroenterologist or surgeon
• Anesthesiologist
• Nurses and endoscopy technicians

Risks and Complications

• Common risks: Sore throat, minor bleeding
• Rare complications: Perforation of the esophagus, infection, adverse reaction to anesthesia

Benefits

• Expected Benefits: Improved swallowing, relief from obstruction
• Timeframe: Benefits are often realized immediately or within a few days after the procedure.

Recovery

• Post-Procedure Care: Patients may need to stay in recovery for a few hours for observation.
• Expectations: Mild discomfort or sore throat for a few days.
• Restrictions: Avoid solid foods for a specified period; follow dietary guidelines.
• Follow-up: A follow-up appointment is typically scheduled to monitor healing and effectiveness.

Alternatives

• Other Options: Medications, lifestyle adjustments, different types of dilation (e.g., balloon dilation), surgical interventions
• Pros and Cons: Each alternative has its own benefits and risks; the specific choice depends on the patient's overall condition and preference.

Patient Experience

• During Procedure: The patient will be under anesthesia; thus, they will not feel pain or remember the procedure.
• After Procedure: Initial discomfort, slight throat pain, and potential mild esophageal pain.
• Pain Management: Over-the-counter pain relievers can be used as needed.

Patients should discuss all aspects with their healthcare providers to make an informed decision.