Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire
CPT4 code
Name of the Procedure:
Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire
Summary
This procedure involves using a flexible tube equipped with a camera (endoscope) inserted through the mouth to examine the esophagus. A guide wire is inserted to help pass dilators that stretch narrow areas.
Purpose
The procedure evaluates and treats narrowing (stricture) of the esophagus. It aims to identify causes of difficulty swallowing and improve the swallowing function by dilating strictures.
Indications
- Difficulty swallowing (dysphagia)
- Esophageal strictures or narrowing
- Potential blockages or tumors
- Scar tissue from GERD or surgery
- Achalasia or other motility disorders
Preparation
- Fasting for 6-8 hours before the procedure
- Adjusting medications as advised by the physician
- Pre-procedure assessments like blood tests, chest X-ray, or EKG
Procedure Description
- Anesthesia/Sedation: Patient receives sedation to ensure comfort.
- Insertion: An endoscope is gently inserted through the mouth and advanced into the esophagus.
- Guide Wire: A guide wire is placed through the stricture under endoscopic guidance.
- Dilators: Dilators are passed over the guide wire, gradually increasing in size to widen the stricture.
- Monitoring: Continuous monitoring of vital signs throughout the procedure.
Duration
Approximately 30 minutes to 1 hour.
Setting
Hospital endoscopy suite or outpatient surgical center.
Personnel
- Gastroenterologist or specially trained surgeon
- Anesthesiologist or nurse anesthetist
- Nurses and endoscopy technicians
Risks and Complications
- Sore throat or discomfort
- Bleeding or infection
- Perforation of the esophagus
- Reactions to anesthesia or sedation
- Stricture recurrence
Benefits
- Immediate improvement in swallowing
- Relief from discomfort associated with strictures
- Minimally invasive with a short recovery time
Recovery
- Observation for a few hours post-procedure
- Instructions to avoid eating/drinking for a few hours until the anesthesia wears off
- Soft diet for a day or two
- Follow-up appointment for assessment
Alternatives
- Medication management (e.g., proton pump inhibitors)
- Surgical intervention for severe strictures
- Balloon dilation or other minimally invasive techniques
Patient Experience
Patients may feel a mild sore throat after the procedure, managed with pain relievers if necessary. Sedation ensures minimal discomfort during the procedure. Most patients can return to normal activities within a day or two.