43214 Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)

Name of the Procedure:

Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)

Common name(s): Flexible Esophagoscopy with Balloon Dilation

Summary

Flexible esophagoscopy with balloon dilation is a medical procedure where a thin, flexible tube with a camera (endoscope) is passed through the mouth to view the esophagus. A balloon is then inflated to dilate, or widen, parts of the esophagus. This procedure often uses fluoroscopic guidance to ensure precision.

Purpose

This procedure is performed to treat esophageal strictures or narrowing, allowing for better passage of food and liquids. The expected outcome is an improvement in symptoms like difficulty swallowing (dysphagia) and preventing complications related to esophageal constriction.

Indications

• Persistent difficulty swallowing (dysphagia)
• Strictures caused by GERD (gastroesophageal reflux disease)
• Esophageal rings and webs
• Post-surgical narrowing
• Conditions like achalasia

Preparation

• Patients may be asked to fast for 6-8 hours before the procedure.
• Adjustments in medication (e.g., blood thinners) as advised by the healthcare provider.
• Pre-procedure diagnostic tests such as barium swallow X-rays.

Procedure Description

1. The patient is given a sedative or general anesthesia.
2. The flexible endoscope is gently inserted through the mouth and guided down the esophagus.
3. The camera allows the healthcare provider to identify the narrowed area.
4. A balloon catheter is threaded through the endoscope to the narrowing.
5. The balloon is inflated to dilate the esophagus to a diameter of 30 mm or larger.
6. Fluoroscopic guidance may be used to ensure accurate placement and dilation.
7. The balloon is deflated and removed along with the endoscope.

Duration

Typically 30 to 60 minutes.

Setting

Performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Gastroenterologist or surgeon
• Anesthesiologist or nurse anesthetist
• Nursing staff for assistance and monitoring

Risks and Complications

• Perforation or tear of the esophagus
• Bleeding
• Infection
• Allergic reaction to sedation
• Chest pain or discomfort
• Aspiration pneumonia

Benefits

Patients can expect relief from swallowing difficulties and improved esophageal function. Improvement is often noticeable soon after the procedure.

Recovery

• Recovery usually involves a few hours of observation to ensure there are no immediate complications.
• Patients may have a mildly sore throat.
• Instructions may include a soft or liquid diet for a short period.
• Follow-up appointments to monitor progress and ensure the esophagus remains open.

Alternatives

• Medication: Acid suppressors for GERD
• Dietary changes: Avoiding certain foods that might exacerbate symptoms
• Surgical options: Esophageal stenting or fundoplication
• Each alternative has its own benefits and risks. For instance, medications may offer relief without invasive procedures but might not address significant narrowing.

Patient Experience

During the procedure, the patient may feel groggy due to sedation and might not remember the process. Post-procedure, they could experience some throat discomfort, but pain management will be provided. Maintaining comfort and ensuring proper care immediately following the procedure is a priority for the healthcare team.