Endoscopic evaluation of small intestinal pouch (eg, Kock pouch, ileal reservoir [S or J]); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
CPT4 code
Name of the Procedure:
Endoscopic Evaluation of Small Intestinal Pouch (e.g., Kock Pouch, Ileal Reservoir [S or J]); Diagnostic, Including Collection of Specimen(s) by Brushing or Washing, When Performed
Summary
An endoscopic evaluation of the small intestinal pouch is a diagnostic procedure that involves using a flexible tube with a camera (endoscope) to inspect the small intestinal pouch. This may include collecting tissue samples or fluids for further testing.
Purpose
The procedure addresses medical conditions related to small intestinal pouches, such as inflammation, bleeding, infection, or abnormal tissue growths. The goal is to diagnose any issues within the pouch, ensure it is functioning correctly, and guide further treatment if necessary.
Indications
The procedure is indicated for patients experiencing symptoms such as abdominal pain, bleeding, unexplained weight loss, diarrhea, or signs of pouch dysfunction. It is also recommended for routine surveillance in patients with a history of ileal reservoir surgery.
Preparation
Patients may need to fast for several hours before the procedure and could be instructed to adjust certain medications. A bowel cleansing regimen might be required to ensure clear visibility during the endoscopy. A pre-procedural consultation will confirm any specific preparations needed.
Procedure Description
- Sedation/Anesthesia: The patient will receive sedation or anesthesia to ensure comfort.
- Insertion of Endoscope: A flexible endoscope is inserted through the anus and advanced into the small intestinal pouch.
- Visual Inspection: The doctor inspects the pouch lining for abnormalities.
- Specimen Collection: If needed, tissue samples or fluid are collected using brushes or washing techniques.
- Completion: The endoscope is carefully withdrawn, and the patient is slowly awakened from sedation/anesthesia.
Duration
The procedure typically takes about 30 to 60 minutes.
Setting
This procedure is usually performed in a hospital, outpatient clinic, or surgical center equipped for endoscopic procedures.
Personnel
A gastroenterologist or surgeon performs the procedure, accompanied by nurses and anesthesiologists.
Risks and Complications
- Common Risks: Mild discomfort, bloating, or cramping.
- Rare Risks: Bleeding, infection, or perforation of the intestinal wall. Any complications will be managed by the medical team immediately.
Benefits
The primary benefit is an accurate diagnosis of issues within the small intestinal pouch, leading to targeted treatment. The results are typically available within a few days.
Recovery
Post-procedure care includes monitoring for any immediate complications, instructions for diet and activity resumption, and managing any discomfort with medications. Most patients can resume normal activities within 24 to 48 hours, with follow-up appointments as needed.
Alternatives
Alternatives may include imaging studies (e.g., MRI or CT scans) or non-invasive tests, though they may not provide as detailed a view of the pouch interior. Compared to endoscopy, these options might not allow for immediate biopsy or fluid collection.
Patient Experience
During the procedure, the patient will be sedated and should feel little to no discomfort. Post-procedure, patients might experience some mild cramping or bloating, which is generally manageable with over-the-counter pain relief. Comfort measures include rest and hydration, with most discomfort subsiding within a day or two.