43238 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent stru

Name of the Procedure:

Esophagogastroduodenoscopy (EGD), flexible, transoral; with transendoscopic ultrasound-guided fine needle aspiration/biopsy(s). Also known as EUS-FNA.

Summary

An Esophagogastroduodenoscopy (EGD) with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a procedure where a flexible tube with a camera and ultrasound probe is inserted through the mouth to examine the esophagus, stomach, and duodenum, and to collect tissue samples.

Purpose

The procedure is used to diagnose and assess conditions affecting the esophagus, stomach, and upper intestines. It aims to obtain tissue samples for biopsy from abnormal areas detected during the examination, which helps in diagnosing conditions such as cancer, ulcers, or infections.

Indications

• Unexplained gastrointestinal symptoms like pain or bleeding
• Suspicion of tumors or cancers in the upper digestive tract
• Chronic inflammation or infections
• Evaluation of abnormal imaging results

Preparation

• Patients are usually required to fast for 6-8 hours before the procedure.
• Medication adjustments may be necessary, especially for blood thinners.
• Pre-procedure assessments such as blood tests and imaging studies might be required.

Procedure Description

1. The patient is given a mild sedative and a local anesthetic to numb the throat.
2. A flexible endoscope with an ultrasound probe is inserted through the mouth.
3. The endoscope transmits images of the esophagus, stomach, and duodenum to a monitor.
4. The ultrasound provides detailed images of the digestive tract lining and nearby structures.
5. Fine needle aspiration biopsy is performed on the targeted areas using guidance from the ultrasound.
6. The tissue samples are collected for further pathological examination.
7. The endoscope is carefully withdrawn.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

It is performed in an endoscopy suite within a hospital, outpatient clinic, or specialized surgical center.

Personnel

• Gastroenterologist or a specialized endoscopic surgeon
• Endoscopy nurse
• Anesthesiologist or sedation nurse

Risks and Complications

• Sore throat or discomfort
• Bleeding at the biopsy site
• Perforation of the digestive tract (rare)
• Infection
• Adverse reaction to sedatives or anesthetics

Benefits

• Accurate diagnosis through direct visualization and biopsy
• Early detection of cancers and other gastrointestinal diseases
• Minimally invasive with relatively quick recovery

Recovery

• Patients are usually observed for a short period after the procedure.
• Avoid eating or drinking until the gag reflex returns (usually a few hours).
• Mild throat discomfort and bloating are common and typically resolve quickly.
• Follow-up appointments to discuss biopsy results.

Alternatives

• Imaging tests such as CT scans or MRI
• Traditional endoscopy without the ultrasound and fine needle aspiration
• Non-invasive tests like barium swallow studies

Patient Experience

Patients may experience mild discomfort and numbness in the throat. Sedation helps minimize pain and anxiety. Post-procedure, there might be slight soreness in the throat and a feeling of gaseousness. Appropriate measures are taken to ensure patient comfort and pain management during and after the procedure.