43220 Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)

CPT4 code

#### Name of the Procedure:
Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)  
*Common Names:* Flexible Esophagoscopy with Balloon Dilation, Endoscopic Balloon Dilation of the Esophagus

#### Summary
In this procedure, a doctor uses a flexible tube with a camera (endoscope) to look inside your esophagus and then inflates a small balloon to widen any narrow areas. It is done through the mouth and is minimally invasive.

#### Purpose
This procedure is primarily used to treat esophageal strictures (narrowing of the esophagus), which can cause difficulty swallowing, pain, or even lead to food getting stuck. The goal is to stretch and widen the narrowed part of the esophagus to improve these symptoms.

#### Indications
- Difficulty swallowing (dysphagia)
- Pain while swallowing
- Recurrent food impactions
- Diagnosed esophageal strictures
- Acid reflux-related stricture if unresponsive to medications

#### Preparation
- Fasting for at least 6-8 hours before the procedure
- Adjustments to medications, such as blood thinners, as advised by your doctor
- You may need to undergo diagnostic tests such as a barium swallow or an esophagram

#### Procedure Description
1. You will be given local anesthetic and possibly a sedative.
2. The doctor will insert the flexible endoscope through your mouth and down into your esophagus.
3. The camera on the endoscope allows the doctor to see any narrows.
4. A deflated balloon is passed through the endoscope and into the stricture.
5. The balloon is then slowly inflated to stretch the narrowed area.
6. After achieving the desired dilation, the balloon is deflated and removed along with the endoscope.

#### Duration
The procedure typically takes about 10-30 minutes, depending on the complexity.

#### Setting
The procedure is usually performed in an outpatient clinic, endoscopy suite, or a hospital's endoscopy department.

#### Personnel
- Gastroenterologist or a trained endoscopist 
- Nurses
- Anesthesiologist or sedation nurse (if deep sedation is used)

#### Risks and Complications
- Sore throat or discomfort
- Bleeding 
- Perforation or tear in the esophagus
- Infection
- Adverse reactions to sedation

#### Benefits
- Improved ability to swallow
- Relief from painful swallowing
- Reduced risk of food getting stuck
- Immediate improvement can be noticed, although some discomfort might persist shortly after the procedure

#### Recovery
- You will be monitored for a few hours after the procedure
- You might experience mild discomfort or sore throat for a day or two
- Avoid heavy meals and hot foods for a day
- Follow-up appointments to monitor progress and potential recurrence

#### Alternatives
- Medication adjustments (e.g., proton pump inhibitors for acid reflux)
- Surgery, if strictures are severe or recurring
- Bougie dilation, another method where a series of increasing size dilators are used

#### Patient Experience
You may feel some pressure as the endoscope is inserted and the balloon is inflated, but you should not feel pain. Post-procedure, a sore throat and mild discomfort are common, but can be managed with over-the-counter pain relievers and a soft diet for a short time.

Medical Policies and Guidelines for Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)

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