Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
CPT4 code
Name of the Procedure:
Small intestinal endoscopy, enteroscopy beyond the second portion of the duodenum, not including the ileum. Commonly referred to as enteroscopy or small bowel endoscopy.
Summary
In simple terms, small intestinal endoscopy is a procedure where a thin, flexible tube with a camera (endoscope) is inserted through the mouth, passed through the stomach, and into the small intestine. This allows doctors to see inside the small intestine and take samples if needed.
Purpose
This procedure is used to diagnose conditions affecting the small intestine that may be causing symptoms such as unexplained bleeding, persistent abdominal pain, or chronic diarrhea. The goal is to identify and sometimes treat the underlying issues.
Indications
- Unexplained gastrointestinal bleeding
- Chronic abdominal pain
- Persistent diarrhea
- Suspected small intestine tumors or polyps
- Malabsorption disorders
Preparation
- Fasting for at least 6-8 hours before the procedure.
- Stopping certain medications as directed by the healthcare provider.
- Possibly performing a bowel prep to clear the intestines.
- Blood tests or imaging studies might be required beforehand.
Procedure Description
- The patient is given a sedative or anesthesia to relax and minimize discomfort.
- The endoscope is gently inserted through the mouth, down the esophagus, through the stomach, and into the small intestine.
- The endoscope transmits video images to a monitor, allowing the doctor to examine the intestinal lining.
- If necessary, the doctor can collect tissue samples using special tools inserted through the endoscope.
- Any unusual findings, such as inflammation or lesions, are documented.
- The endoscope is slowly withdrawn once the examination is complete.
Duration
The procedure usually takes around 30 minutes to an hour.
Setting
It is typically performed in a hospital or an outpatient clinic equipped with endoscopic facilities.
Personnel
- Gastroenterologist (specialist doctor)
- Nurse or medical assistant
- Anesthesiologist (if general anesthesia is used)
Risks and Complications
- Mild sore throat or discomfort post-procedure
- Rare risks include bleeding, infection, or perforation of the intestinal wall.
- Adverse reactions to sedation or anesthesia.
Benefits
- Accurate diagnosis of small intestine issues.
- Possible immediate treatment of minor problems such as polyps.
- Relief from unexplained gastrointestinal symptoms.
Recovery
- Patients are monitored until the sedative wears off.
- Rest for the remainder of the day is recommended.
- Avoid operating heavy machinery or making critical decisions for 24 hours due to sedation effects.
- Follow-up instructions on diet, activity, and medications will be provided.
- Any taken biopsy results typically take a few days to be processed.
Alternatives
- Capsule endoscopy (swallowable camera pill)
- Radiographic imaging studies (e.g., CT enterography, MRI)
- Conservative management with medication and monitoring.
Pros and Cons of Alternatives:
- Capsule endoscopy is less invasive but doesn't allow for biopsies.
Imaging studies are non-invasive but may not detect all mucosal abnormalities.
Patient Experience
During the procedure, the patient is unlikely to feel any discomfort due to sedation. They might experience a mild sore throat afterward. Pain management and comfort measures, like throat lozenges or warm fluids, are recommended to alleviate any discomfort.