43237 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures

Name of the Procedure:

Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach, or duodenum, and adjacent structures. Often abbreviated as EGD with EUS.

Summary

This procedure involves inserting a flexible tube through the mouth to examine the esophagus, stomach, and first part of the small intestine (duodenum) using a camera and ultrasound. This allows doctors to visualize these areas and adjacent structures in detail.

Purpose

Esophagogastroduodenoscopy with endoscopic ultrasound is used to diagnose and evaluate conditions affecting the upper gastrointestinal tract and surrounding structures. The goals include identifying abnormalities, obtaining tissue samples, and guiding interventions.

Indications

• Persistent or unexplained upper abdominal pain
• Difficulty swallowing (dysphagia)
• Suspected tumors or cancers
• Gastrointestinal bleeding
• Chronic acid reflux or gastroesophageal reflux disease (GERD)
• Pancreatic diseases

Preparation

• Patients are typically required to fast for 6-8 hours before the procedure.
• Adjustments to regular medications, especially blood thinners.
• Pre-procedural diagnostic tests may include blood work and imaging studies.

Procedure Description

1. The patient is sedated to ensure comfort.
2. A flexible endoscope is inserted through the mouth and carefully advanced through the esophagus, stomach, and duodenum.
3. The camera on the endoscope provides real-time images of the inner lining of these organs.
4. An ultrasound probe on the endoscope transmits sound waves to create detailed images of the adjacent structures.
5. Tissue samples (biopsies) may be taken if abnormalities are found.
6. The procedure is performed by a gastroenterologist.

Duration

Typically, the procedure takes about 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Gastroenterologist
• Nurses
• Anesthesiologist or nurse anesthetist
• Technicians to operate ultrasound equipment

Risks and Complications

• Sore throat or bloating post-procedure (common)
• Bleeding or infection (rare)
• Perforation of the gastrointestinal tract (very rare)
• Reaction to sedation or anesthesia (uncommon)

Benefits

• Accurate diagnosis of gastrointestinal conditions
• Ability to guide treatments and take biopsies
• Improved treatment planning and patient outcomes

Recovery

• Patients are monitored until sedation wears off.
• Mild throat discomfort and bloating are common but usually resolve within a day.
• Avoid driving or operating machinery for 24 hours.
• Follow-up appointment may be necessary to discuss results.

Alternatives

• Capsule endoscopy
• Barium swallow X-ray
• Non-invasive imaging like CT or MRI
• Each alternative has different pros and cons regarding invasiveness, comfort, and level of detail provided.

Patient Experience

During the procedure, the patient will be sedated and should feel minimal discomfort. Afterward, mild throat soreness and bloating are common. The healthcare team will provide pain management and ensure the patient's comfort throughout the process.