43257 Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease

Name of the Procedure:

Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease. Commonly referred to as EGD with thermal energy treatment for GERD.

Summary

This procedure involves using a flexible tube inserted through the mouth to examine the esophagus, stomach, and upper part of the small intestine. It also involves delivering thermal energy to the muscles of the lower esophageal sphincter and/or gastric cardia to treat gastroesophageal reflux disease (GERD).

Purpose

The procedure is designed to treat GERD, a condition where stomach acid frequently flows back into the esophagus, causing irritation. The goal is to strengthen the sphincter muscles to reduce acid reflux and improve patient symptoms.

Indications

• Persistent GERD symptoms not adequately controlled by medication.
• Confirmed diagnosis of GERD through diagnostic tests.
• Complications from GERD such as esophagitis or Barrett's esophagus.
• Patients without contraindicating conditions who are seeking long-term relief from GERD symptoms.

Preparation

• Fasting for at least 6-8 hours prior to the procedure.
• Adjustments or temporary cessation of specific medications as advised by the doctor.
• Completion of pre-procedure blood work or imaging studies if required.

Procedure Description

1. The patient is sedated or given general anesthesia for comfort.
2. A flexible endoscope is inserted through the mouth and gently guided down the esophagus, into the stomach and duodenum.
3. The endoscope is equipped with a camera to visualize these areas.
4. Thermal energy is then applied to the muscle of the lower esophageal sphincter and/or gastric cardia to strengthen the muscles and prevent reflux.
5. The endoscope is carefully withdrawn.

Duration

The procedure typically takes 30 minutes to 1 hour.

Setting

Performed in a hospital or outpatient clinic equipped with endoscopy facilities.

Personnel

• Gastroenterologist or specially trained endoscopist.
• Nurse or endoscopy technician.
• Anesthesiologist or nurse anesthetist.

Risks and Complications

• Sore throat or discomfort post-procedure.
• Bleeding or infection at the site of thermal energy application.
• Perforation of the esophagus or stomach.
• Adverse reactions to sedatives or anesthesia.
• Temporary difficulty swallowing.

Benefits

• Reduction or elimination of GERD symptoms.
• Potential decrease in acid reflux with long-lasting effects.
• May reduce the need for long-term medication.

Recovery

• Patients are monitored for a few hours post-procedure.
• Instructions on diet (usually starting with liquids and soft foods) and activity restrictions.
• Pain management for any throat discomfort.
• Follow-up appointments to monitor progress and healing.

Alternatives

• Long-term use of anti-reflux medications like PPIs (proton pump inhibitors).
• Lifestyle and dietary modifications.
• Other surgical options such as Nissen fundoplication.
• Pros: Non-surgical alternatives are less invasive.
• Cons: They may not be as effective or provide long-term relief.

Patient Experience

• Patients might feel sedated and relaxed during the procedure.
• Post-procedure, there could be a mild sore throat and slight discomfort.
• Effective pain management strategies will be utilized to ensure patient comfort.