43248 Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire

Name of the Procedure:

Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire
Common Name: EGD with guide wire-assisted dilation

Summary

An EGD with guide wire-assisted dilation is a procedure where a thin, flexible tube (endoscope) is inserted through the mouth to examine the esophagus, stomach, and the beginning of the small intestine. A guide wire is then inserted to help pass dilators through the esophagus to widen any narrow areas.

Purpose

This procedure is used to diagnose and treat esophageal strictures or blockages, allowing for better passage of food and drink. The goal is to identify the cause of the narrowing and safely enlarge the esophagus to improve swallowing and reduce discomfort.

Indications

• Difficulty swallowing (dysphagia)
• Esophageal strictures (narrowing)
• Blockages in the esophagus
• Persistent heartburn or acid reflux not responsive to medication
• Previous history of esophageal strictures

Preparation

• Patients may need to fast (no food or drink) for at least 6-8 hours before the procedure.
• Medication adjustments may be necessary, particularly blood thinners.
• Pre-procedure diagnostic tests such as throat cultures or imaging studies might be required.

Procedure Description

1. Sedation/Anesthesia: The patient will be sedated to ensure comfort.
2. Insertion of Endoscope: A flexible endoscope is inserted through the mouth and gently guided down the throat to visualize the esophagus, stomach, and duodenum.
3. Guide Wire Placement: A guide wire is inserted through the endoscope to the area of narrowing.
4. Dilator Passage: Dilators of increasing size are passed over the guide wire to gradually enlarge the stricture.
5. Withdrawal: The guide wire and endoscope are carefully removed.

Duration

The entire procedure typically takes about 30-60 minutes.

Setting

This procedure is usually performed in an outpatient clinic, hospital endoscopy suite, or specialized surgical center.

Personnel

• Gastroenterologist or endoscopic surgeon
• Registered nurse or endoscopy technician
• Anesthesiologist or nurse anesthetist (for sedation)

Risks and Complications

• Sore throat post-procedure
• Bleeding
• Perforation of the esophagus
• Infection
• Adverse reaction to sedation

Benefits

• Relief from symptoms such as difficulty swallowing and pain
• Improved ability to eat and drink
• Immediate or short-term improvement in quality of life

Recovery

• Patients are observed for a short period post-procedure until the effects of sedation wear off.
• Instructions may include avoiding eating or drinking for a few hours, following a soft diet initially, and avoiding strenuous activities.
• Follow-up appointments may be necessary to monitor progress and ensure the dilation was effective.

Alternatives

• Medication management (e.g., proton pump inhibitors, steroids)
• Esophageal stenting
• Surgery (in severe cases) Pros and Cons: Medications may be less invasive but less effective for severe strictures. Stenting and surgery can provide long-term solutions but come with higher risks.

Patient Experience

Patients might experience mild discomfort or a sore throat immediately after the procedure. Pain management includes over-the-counter pain relievers and throat lozenges. Most patients can return to normal activities within a day, but they should follow specific post-procedure care instructions for optimal recovery.