43270 Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

Name of the Procedure:

Esophagogastroduodenoscopy (EGD), flexible, transoral with ablation of tumor(s), polyp(s), or other lesion(s). Also referred to as upper endoscopy with ablation.

Summary

An Esophagogastroduodenoscopy is a medical procedure where a doctor uses a flexible tube equipped with a camera (endoscope) to examine the lining of your esophagus, stomach, and the first part of the small intestine. If any tumors, polyps, or lesions are detected, they can be ablated (removed or destroyed) during the same procedure.

Purpose

Medical Conditions Addressed:

• Esophageal, gastric, or duodenal tumors
• Polyps or abnormal growths
• Other lesions such as ulcers

Goals:

• Diagnose the cause of symptoms such as bleeding, pain, or difficulty swallowing
• Treat the detected abnormalities by removing or destroying them

Indications

Symptoms:

• Persistent upper abdominal pain
• Difficulty swallowing (dysphagia)
• Chronic or unexplained nausea and vomiting
• Gastrointestinal bleeding

Patient Criteria:

• Identified abnormal growths through imaging studies or previous endoscopy
• High risk for or presence of gastrointestinal cancers

Preparation

• Patients are usually required to fast (not eat or drink) for at least 6-8 hours before the procedure.
• Medication adjustments may be necessary; patients should inform their doctor of all medications they are taking.
• Blood tests or imaging studies may be conducted prior to the procedure to assess overall health and specific conditions.

Procedure Description

1. Sedation/Anesthesia: The patient is given a sedative to help relax and minimize discomfort. In some cases, a local anesthetic is sprayed into the back of the throat.
2. Insertion: The doctor inserts a flexible endoscope through the mouth and gently guides it down the esophagus, into the stomach, and the duodenum.
3. Examination: The endoscope transmits video images to a screen, allowing the doctor to closely examine the upper digestive tract.
4. Ablation: If abnormal growths are found, the doctor uses special tools passed through the endoscope to remove or destroy them.

5. Dilation and Guide Wire Passage: If necessary, the esophagus can be dilated (stretched) and a guide wire can be passed to assist in further treatment steps.

   Tools and Equipment:

   • Flexible endoscope
   • Ablation instruments (e.g., lasers, electrical probes)
   • Dilation devices and guide wires

Duration

The procedure typically takes 20 to 90 minutes, depending on the complexity of the condition being treated.

Setting

This procedure is usually performed in a hospital, outpatient clinic, or a surgical center specializing in gastrointestinal procedures.

Personnel

• Gastroenterologist or specialized surgeon
• Nurses and medical assistants
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

Common Risks:

• Sore throat
• Minor bleeding
• Discomfort or bloating

Rare Complications:

• Perforation (a small tear in the lining of the digestive tract)
• Severe bleeding
• Reaction to sedation

Benefits

• Accurate diagnosis of upper gastrointestinal conditions
• Immediate treatment of detected abnormalities
• Potential prevention of cancer progression through removal of pre-cancerous growths

Benefits are often realized immediately or within a few days following the procedure.

Recovery

• Most patients can go home the same day after monitoring for a few hours.
• Instructions may include a temporary diet of soft foods and avoiding strenuous activity.
• Follow-up appointments may be scheduled to monitor recovery or further treatments.

Alternatives

• Non-invasive Imaging: Such as barium swallow or CT scans, which do not allow for direct treatment.
• Medications: To manage symptoms but may not address structural abnormalities.
• Surgery: More invasive and may involve longer recovery time than endoscopic procedures.

Patient Experience

During the procedure, the patient will be sedated and likely will not feel any discomfort. Post-procedure, they may experience a sore throat, mild bloating, or gas. Pain management is typically minimal, and over-the-counter pain relief can be used if necessary.