43215 Esophagoscopy, flexible, transoral; with removal of foreign body(s)

Name of the Procedure:

Esophagoscopy, flexible, transoral; with removal of foreign body(s)

• Common Names: Flexible Esophagoscopy, Endoscopic Foreign Body Removal
• Medical Terms: Transoral Flexible Esophagoscopy

Summary

A flexible esophagoscopy is a minimally invasive procedure where a thin, flexible tube with a camera (endoscope) is inserted through the mouth to examine the esophagus. This specific procedure also involves the removal of any foreign bodies lodged in the esophagus.

Purpose

The procedure addresses issues related to the ingestion of foreign objects that have become trapped in the esophagus. The goals are to safely and effectively remove the foreign body, alleviate discomfort, and prevent complications such as obstruction or injury to the esophagus.

Indications

• Swallowed non-food items (e.g., coins, small toys)
• Symptoms of esophageal blockage (e.g., difficulty swallowing, pain in the chest or throat)
• Suspected or visible foreign body on imaging tests

Preparation

• Patients may need to fast for 6-8 hours prior to the procedure.
• Adjustments or temporary discontinuation of certain medications may be required.
• Pre-procedure diagnostics, like X-rays or CT scans, might be performed to locate the foreign body.

Procedure Description

1. The patient is usually given a sedative to help them relax. Local anesthesia may be sprayed into the mouth and throat.
2. The flexible endoscope is carefully inserted through the mouth and advanced down the esophagus.
3. The camera on the endoscope allows the physician to visualize the esophagus and locate the foreign body.
4. Specialized instruments, passed through the endoscope, are used to grasp and remove the foreign object.
5. The endoscope is then withdrawn.

Tools and Technology:

• Flexible endoscope with camera
• Grasping instruments, such as forceps or retrieval nets

Anesthesia:

• Local anesthesia for the throat and sedation for comfort

Duration

The procedure typically takes about 30 minutes to an hour, depending on the complexity of the foreign body removal.

Setting

• Performed in a hospital endoscopy suite or an outpatient clinic designed for such procedures.

Personnel

• Gastroenterologist or an ENT specialist
• Nursing staff
• Anesthesiologist or sedation nurse (if deep sedation is used)

Risks and Complications

• Common risks: Sore throat, minor bleeding
• Rare risks: Perforation of the esophagus, infection, adverse reactions to sedation or anesthesia

Benefits

• Effective and minimally invasive method to remove foreign bodies from the esophagus
• Immediate relief from symptoms following successful removal
• Reduction in risk of esophageal injury or obstruction

Recovery

• Patients are usually observed for a short period post-procedure to ensure they recover from sedation.
• Instructions may include avoiding solid foods for a few hours.
• Recommended rest for the remainder of the day.
• Follow-up appointments as needed to monitor recovery.

Alternatives

• Watchful waiting if the foreign body is not causing symptoms and is expected to pass naturally.
• Surgical removal through an open or laparoscopic procedure (more invasive).

Pros and Cons:

• Esophagoscopy: Minimally invasive, quick recovery, performed under sedation
• Surgery: More invasive, longer recovery time, higher risk of complications, but may be necessary for complex cases

Patient Experience

During the procedure, the patient is sedated and generally will not feel discomfort. Afterward, there may be a mild sore throat or grogginess from the sedation. Pain management includes throat lozenges and over-the-counter analgesics. Comfort measures such as rest and hydration are recommended.