43216 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

Name of the Procedure:

Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

Summary

An esophagoscopy is a procedure in which a flexible tube with a light and camera, known as an endoscope, is inserted through the mouth to inspect the esophagus. During this procedure, any tumors, polyps, or other abnormal growths are removed using hot biopsy forceps.

Purpose

This procedure is used to diagnose and treat abnormal growths in the esophagus. The goals are to remove potentially cancerous tumors or polyps, alleviate symptoms, and obtain tissue samples for biopsy if needed.

Indications

• Persistent difficulty swallowing (dysphagia)
• Unexplained weight loss
• Chronic acid reflux or GERD symptoms
• Suspected tumors or polyps seen on imaging studies
• Unexplained chest pain

Preparation

• The patient may need to fast for at least 6 to 8 hours before the procedure.
• Medication adjustments may be required, particularly if the patient is on blood thinners.
• Pre-procedure diagnostic tests could include an EKG, blood tests, or imaging studies like a barium swallow.

Procedure Description

1. The patient is positioned on their side, and local anesthetic is applied to the throat to minimize discomfort.
2. Sedation or light anesthesia may be administered for relaxation.
3. The flexible endoscope is gently inserted through the mouth and guided down the esophagus.
4. The physician inspects the esophagus and identifies any tumors, polyps, or lesions.
5. Hot biopsy forceps, a tool that uses electric current, are used to remove the abnormal growths.
6. The endoscope is withdrawn, and the patient is monitored as they wake up from sedation.

Duration

The procedure typically takes about 20 to 40 minutes.

Setting

The esophagoscopy is generally performed in an outpatient clinic, endoscopy center, or hospital.

Personnel

• Gastroenterologist or surgeon
• Nurse or endoscopy technician
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Common risks include mild sore throat, bloating, and nausea.
• Rare risks include bleeding, perforation of the esophagus, infection, or adverse reaction to anesthesia.
• Complications are addressed based on their nature and severity, such as administering medications or performing additional surgical procedures if needed.

Benefits

• Direct visualization and removal of abnormal growths, promoting early diagnosis and treatment of potential esophageal cancer.
• Symptomatic relief from conditions causing dysphagia or pain.
• Rapid recovery with minimal downtime, most patients returning to normal activities within a day.

Recovery

• Patients may need to rest for a few hours post-procedure to allow sedation effects to wear off.
• Eating and drinking should be gradually resumed starting with clear liquids.
• Avoid heavy lifting or strenuous activities for 24 hours.
• Follow-up appointments may be needed to discuss biopsy results and ongoing care.

Alternatives

• Barium swallow study: non-invasive imaging but only diagnostic.
• Optical fiber endoscopic examination: similar diagnostic but does not offer therapeutic interventions.
• Surgical resection: more invasive with longer recovery but essential if extensive tumor removal is needed.

Patient Experience

During the procedure, under sedation, the patient should feel little to no discomfort. Post-procedure, a sore throat or mild bloating may be experienced, managed by over-the-counter pain relievers and resting. Full recovery and a follow-up visit to discuss the findings occur within a few days.