Dilation of esophagus, by unguided sound or bougie, single or multiple passes
CPT4 code
Name of the Procedure:
Dilation of Esophagus, by Unguided Sound or Bougie, Single or Multiple Passes
Summary
Dilation of the esophagus involves using a medical instrument called a bougie or sound to stretch and widen a narrowed or constricted section of the esophagus. This procedure does not use fluoroscopic or endoscopic guidance.
Purpose
The procedure aims to address esophageal strictures or narrowings, which can cause difficulty swallowing (dysphagia) and lead to other complications such as malnutrition or dehydration. By widening the esophagus, the patient is able to swallow more comfortably and eat a wider variety of foods.
Indications
- Difficulty swallowing (dysphagia)
- Esophageal strictures due to acid reflux, scarring from previous surgeries, radiation, or disease processes like eosinophilic esophagitis
- Achalasia or other motility disorders
- Benign or malignant esophageal tumors
Preparation
- Fasting for at least 8 hours prior to the procedure
- Temporary discontinuation of certain medications as advised by the doctor
- Pre-procedure diagnostic evaluations such as barium swallow X-rays, esophagoscopy, or esophageal manometry
Procedure Description
- The patient is positioned lying down.
- A local anesthetic spray is applied to the throat, and in some cases, mild sedation is given to ensure comfort.
- A lubricated bougie or sound is gently inserted through the mouth and into the esophagus.
- The instrument is carefully moved through the esophagus to stretch and dilate the narrowed area. Multiple passes may be made to achieve the desired dilation.
- The instrument is then removed.
Duration
The procedure typically takes about 20-30 minutes.
Setting
Dilation is usually performed in a hospital, outpatient clinic, or surgical center equipped for minor procedures.
Personnel
- Gastroenterologist or a trained doctor
- Nurse or medical assistant for support
- Anesthesiologist, if sedation is used
Risks and Complications
- Common: Temporary sore throat, discomfort during swallowing, minor bleeding
- Rare: Perforation of the esophagus, severe bleeding, infection, reactions to sedation
Benefits
- Improved ability to swallow and eat normally
- Reduction in symptoms like pain and discomfort associated with dysphagia
- Benefits are often realized shortly after the procedure
Recovery
- Observation for a short period to ensure there are no immediate complications
- Aftercare instructions, including dietary recommendations such as a soft or liquid diet initially
- Most patients can resume their normal activities within a day or so
- Follow-up appointments to monitor progress and determine if additional dilations are needed
Alternatives
- Medications to reduce acid reflux and assist with healing (e.g., PPIs)
- Esophageal stenting
- Surgical procedures such as esophagomyotomy (for achalasia)
- Each alternative has its own set of benefits and risks, and the most appropriate treatment is based on the patient's specific condition and overall health.
Patient Experience
- During the procedure: Mild discomfort or gagging; any sedation used will help manage these sensations
- After the procedure: Sore throat, mild discomfort when swallowing
- Pain management: Over-the-counter pain relievers, lozenges, and following aftercare dietary instructions will help improve comfort.