43249 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)

Name of the Procedure:

Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)

Summary

This procedure involves using a flexible tube with a camera (endoscope) to examine the esophagus, stomach, and the beginning of the small intestine. During the procedure, a balloon is used to stretch and dilate a narrowed area of the esophagus.

Purpose

This procedure is used to treat esophageal strictures, which are narrowings of the esophagus that can cause difficulty swallowing and other symptoms. The goal is to widen the narrowed section to allow easier passage of food and liquids.

Indications

• Difficulty swallowing (dysphagia)
• Painful swallowing (odynophagia)
• Esophageal strictures caused by conditions such as acid reflux, radiation therapy, certain disorders, or congenital issues.
• Symptoms of food getting stuck in the esophagus.

Preparation

• Patients are typically required to fast (avoid eating and drinking) for 6-8 hours before the procedure.
• Adjustments to current medications may be needed, especially blood thinners.
• Pre-procedure assessments may include blood tests and imaging studies to evaluate the esophagus.

Procedure Description

1. The patient is typically given a sedative to help them relax and may be under light anesthesia.
2. A flexible endoscope is gently passed through the mouth into the esophagus, stomach, and duodenum.
3. The endoscope transmits images to a monitor, allowing the doctor to inspect for abnormalities.
4. If a narrowing is found, a balloon catheter is inserted through the endoscope to the stricture site.
5. The balloon is carefully inflated to stretch and widen the narrowed area.
6. The balloon is then deflated and removed, and the endoscope is withdrawn.

Duration

The procedure typically takes about 15 to 30 minutes.

Setting

This procedure is usually performed in an outpatient setting, such as a hospital endoscopy unit or an ambulatory surgery center.

Personnel

• Gastroenterologist or surgeon specialized in endoscopic procedures
• Anesthesiologist or nurse anesthetist for sedation
• Endoscopy nurses and technicians

Risks and Complications

• Perforation of the esophagus
• Bleeding
• Infection
• Recurrent or new strictures
• Reactions to sedation or anesthesia

Benefits

• Improved ability to swallow
• Relief from symptoms like pain and discomfort
• Enhanced quality of life
• Typically, benefits are realized almost immediately after the procedure.

Recovery

• Monitoring in a recovery area until sedation wears off
• Patients can usually go home the same day
• Instructions will include dietary guidelines and any medications to take
• Avoid strenuous activities for a day or two
• Follow-up appointments to monitor the treated area and ensure continued improvement

Alternatives

• Medications to manage underlying causes (e.g., acid reflux)
• Surgical options for severe cases
• Serial dilation, a series of endoscopic balloon dilations
• Bougie dilation, using rigid instruments instead of a balloon

Patient Experience

• During the procedure: Minimal discomfort due to sedation. A feeling of pressure may be experienced briefly during balloon inflation.
• After the procedure: Mild sore throat and potential minor discomfort when swallowing for a day or two.
• Pain management: Over-the-counter pain relievers as advised by the physician.