Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with transendoscopic stent placement (includes predilation)
CPT4 code
Name of the Procedure:
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with transendoscopic stent placement (includes predilation).
Common name(s): Enteroscopy with stent placement
Summary
Enteroscopy with stent placement is a medical procedure where a flexible tube with a camera (endoscope) is inserted into the small intestine beyond the second portion of the duodenum. The procedure involves placing a stent (a small tube) to keep a narrowed or blocked section of the intestine open. Predilation, or the widening of the intestine, is included before the stent is placed.
Purpose
Medical Condition or Problem:
This procedure addresses obstructions or severe narrowings (strictures) in the small intestine that can cause symptoms like pain, vomiting, and difficulty digesting food.
Goals or Expected Outcomes:
The goal is to alleviate obstruction, improve food passage, relieve symptoms, and enhance the patient's quality of life.
Indications
Specific Symptoms or Conditions:
- Chronic abdominal pain
- Vomiting
- Unexplained nausea
- Severe weight loss
- Malnutrition due to intestinal blockage
Patient Criteria:
Patients with confirmed small intestinal obstructions or strictures that cannot be managed with medication alone.
Preparation
Pre-procedure Instructions:
- Fasting (usually for 8-12 hours before the procedure)
- Adjustments to current medications as directed by the physician
- Complete any prescribed bowel preparation solutions
Diagnostic Tests:
- Blood tests
- Imaging studies like a CT scan or MRI
- Review of medical history and physical examination
Procedure Description
- Anesthesia: The patient is usually given conscious sedation or general anesthesia.
- Insertion: The endoscope is carefully inserted through the mouth and advanced beyond the second portion of the duodenum.
- Navigation: The endoscope’s camera allows the doctor to navigate through the intestines.
- Assessment: The narrowed area is located and assessed.
- Predilation: The area is dilated (widened) using a special balloon.
- Stent Placement: A stent is placed in the dilated area to keep it open.
- Confirmation: Placement is confirmed with imaging, and the endoscope is carefully withdrawn.
Tools, Equipment, Technology:
- Flexible endoscope with a camera
- Balloon dilator
- Stent deployment system
Duration
The procedure typically takes between 1 to 3 hours, depending on the case complexity.
Setting
Enteroscopy with stent placement is performed in a hospital or an outpatient surgical center equipped with endoscopic facilities.
Personnel
- Gastroenterologist or surgeon performing the procedure
- Nurses or endoscopy technicians assisting
- Anesthesiologist (if general anesthesia is used)
Risks and Complications
Common Risks:
- Sore throat
- Mild abdominal discomfort
Rare Risks:
- Perforation (tear) of the intestine
- Infection
- Bleeding
- Stent migration or occlusion
Management of Complications:
Complications are managed with medications, additional procedures, or surgery, if necessary.
Benefits
- Relieves symptoms of obstruction
- Improves nutritional absorption
- Reduces pain and discomfort
- Enhances overall quality of life ##### Realization of Benefits: Benefits are often realized immediately after the procedure with gradual improvement over days to weeks.
Recovery
Post-procedure Care:
- Observational period in a recovery area
- Pain management as needed
- Gradual reintroduction of diet
Recovery Time:
Full recovery typically takes a few days, with most patients resuming normal activities within a week.
Restrictions and Follow-up:
- Avoid strenuous activities for a few days
- Follow-up appointments to monitor stent position and efficacy
Alternatives
Other Treatment Options:
- Medication to manage symptoms
- Surgical intervention to bypass or remove the obstruction
Pros and Cons:
- Medications: Less invasive but often less effective for severe obstructions.
- Surgery: More definitive but involves longer recovery and higher risk.
Patient Experience
During Procedure:
The patient may experience a sensation of pressure or discomfort initially, generally well-managed with sedation.
After Procedure:
Soreness in the throat or mild abdominal discomfort may occur. Pain is typically mild and managed with over-the-counter analgesics.
Pain Management:
Mild pain relief medications and supportive care ensure patient comfort during recovery.