43246 Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube

Name of the Procedure:

Esophagogastroduodenoscopy (EGD), flexible, transoral; with directed placement of percutaneous gastrostomy tube

Summary

In an EGD with gastrostomy tube placement, a doctor uses a flexible tube with a camera (endoscope) inserted through the mouth to examine the esophagus, stomach, and the upper part of the small intestine, and to place a feeding tube directly into the stomach through the skin.

Purpose

This procedure is performed to:

• Diagnose and treat conditions affecting the upper gastrointestinal tract.
• Provide nutritional support by placing a gastrostomy tube (feeding tube) for patients who cannot eat by mouth.

Indications

• Difficulty swallowing (dysphagia)
• Blockage or narrowing of the esophagus or upper GI tract
• Need for long-term nutritional support
• Conditions like stroke, neurological disorders, or head and neck cancers that impede normal eating.

Preparation

• Patient must fast for 6-8 hours before the procedure.
• Adjustments in medication may be required (e.g., blood thinners).
• Pre-procedure tests such as blood work or imaging studies may be necessary.

Procedure Description

1. The patient lies on their side, and an intravenous (IV) line is inserted for sedation.
2. A mouthguard is placed to protect the teeth and endoscope.
3. The endoscope is inserted through the mouth and guided through the esophagus, stomach, and upper small intestine.
4. The doctor examines these areas for abnormalities, and then makes a small incision in the abdomen to insert the gastrostomy tube under direct visualization provided by the endoscope.
5. The tube is secured in place, and the endoscope is gently removed.

Duration

The procedure typically takes between 30 to 60 minutes.

Setting

Usually performed in a hospital's endoscopy suite or outpatient surgical center.

Personnel

• Gastroenterologist or surgeon to perform the procedure.
• Nurses or endoscopy technicians for assistance.
• Anesthesiologist or nurse anesthetist for sedation management.

Risks and Complications

• Common risks: sore throat, bloating, mild discomfort, reaction to sedation.
• Rare but serious risks: infection, bleeding, perforation of gastrointestinal tract, adverse reaction to anesthesia, dislodgment or malfunction of the gastrostomy tube.

Benefits

• Accurate diagnosis and treatment of GI conditions.
• Direct and effective means of providing nutritional support for patients unable to eat by mouth.
• Benefits are usually realized immediately post-procedure.

Recovery

• Post-procedure monitoring for a few hours to ensure there are no immediate complications.
• Instructions on caring for the gastrostomy tube site.
• Initial diet of clear liquids before transitioning to tube feedings.
• Usually, recovery from sedation is quick, but full adjustment to the gastrostomy tube might take a few days.

Alternatives

• Nasogastric (NG) tube for shorter-term feeding.
• Jejunostomy tube placement if upper GI is not accessible.
• Intravenous nutrition (total parenteral nutrition, TPN), though this is usually less desirable for long-term use.
• Each alternative has its own risks and benefits compared to gastrostomy tube placement.

Patient Experience

• During the procedure, sedation should ensure the patient feels no pain and minimal discomfort.
• Post-procedure, there may be mild throat soreness and abdominal discomfort, which is manageable with medication.
• Careful instruction on tube care will help in adjusting to the gastrostomy tube.