Name of the Procedure:

Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)

• Common Name(s): Flexible Esophagoscopy with EUS-guided FNA/Biopsy

Summary

This procedure involves using a flexible tube with a camera (endoscope) to examine the esophagus and perform a fine needle aspiration (FNA) or biopsy guided by ultrasound. It is done through the mouth (transoral) to collect tissue samples from within or beyond the esophageal wall.

Purpose

The procedure is used to diagnose or evaluate abnormalities in the esophagus, such as tumors, cysts, or other lesions. It helps in obtaining tissue samples for further pathological examination to determine the nature of these abnormalities.

Indications

• Suspicion of esophageal cancer or tumors.
• Presence of esophageal lesions or abnormalities detected on imaging studies.
• Unexplained esophageal symptoms, such as difficulty swallowing or persistent pain.

Preparation

• Patients are usually required to fast for at least 6-8 hours before the procedure.
• Medication adjustments may be needed, especially anticoagulants or blood thinners.
• Pre-procedure evaluations may include blood tests, imaging studies, and a review of the patient's medical history.

Procedure Description

1. The patient is given a sedative or light anesthesia to ensure comfort.
2. A flexible endoscope is inserted through the mouth and advanced into the esophagus.
3. Ultrasound technology is used to visualize the esophageal wall and surrounding structures.
4. Under ultrasound guidance, a fine needle is guided to the target area to obtain tissue samples.
5. The tissue samples are collected and sent to a lab for analysis.
6. The endoscope is carefully withdrawn.

Duration

The procedure typically takes about 30-60 minutes.

Setting

Esophagoscopy with transendoscopic ultrasound-guided FNA/biopsy is usually performed in a hospital endoscopy suite or an outpatient surgical center.

Personnel

• Gastroenterologist or Endoscopist
• Nurses
• Anesthesiologist or Nurse Anesthetist (if sedation or anesthesia is used)

Risks and Complications

• Bleeding at the biopsy site
• Infection
• Perforation (rare)
• Adverse reactions to sedation or anesthesia
• Sore throat or discomfort after the procedure

Benefits

• Accurate diagnosis of esophageal conditions
• Minimally invasive with a short recovery time
• Helps in planning further treatment, if necessary

Recovery

• Patients are usually observed for a short period before discharge.
• Mild throat discomfort or bloating may occur but typically resolves quickly.
• Patients are advised to avoid driving or operating heavy machinery for 24 hours due to sedation effects.
• Follow-up appointments may be needed to discuss biopsy results and further treatment.

Alternatives

• Standard endoscopy without biopsy
• Imaging studies like CT scan or MRI
• Surgical biopsy (more invasive)
• Pros and Cons: Standard endoscopy and imaging are less invasive but do not provide tissue samples. Surgical biopsy offers definitive diagnosis but involves more risk and longer recovery.

Patient Experience

• During the procedure, patients are typically sedated and experience minimal discomfort.
• After the procedure, a sore throat or mild discomfort may be present but is usually well managed with over-the-counter pain relievers.
• Clear fluids are recommended initially, and normal diet can usually be resumed shortly after.