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Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

CPT4 code

Name of the Procedure:

Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

  • Common Name: Colonoscopy through stoma with snare polypectomy
  • Medical Term: Stomal colonoscopic polypectomy

Summary

This procedure involves using a colonoscope, a long, flexible tube with a camera, to examine the colon through a stoma (a surgical opening on the abdomen). During this procedure, any tumors, polyps, or other lesions found are removed using a snare, a wire loop instrument.

Purpose

Indication:

  • To find and remove abnormal growths like polyps and tumors in the colon that can potentially be cancerous. Goals and Outcomes:
  • Removal of polyps and tumors to prevent or diagnose colorectal cancer.
  • Relief of symptoms such as bleeding or obstruction caused by these lesions.

Indications

  • Presence of polyps or tumors found during initial examinations or imaging studies.
  • Symptoms such as rectal bleeding, changes in bowel habits, abdominal pain.
  • Follow-up for patients with a history of polyps or colorectal cancer.

Preparation

  • Fasting is typically required for 8-12 hours before the procedure.
  • Bowel preparation involves taking laxatives or enemas to clear the colon.
  • Adjustments or temporary discontinuation of certain medications may be necessary.
  • Pre-procedure assessments like blood tests or imaging studies may be performed.

Procedure Description

  1. Initial Setup: The patient is positioned comfortably, usually on their back or side.
  2. Sedation: Mild sedation or anesthesia is administered to ensure comfort.
  3. Insertion: The colonoscope is gently inserted through the stoma.
  4. Examination: The colonoscope is navigated through the colon to inspect for abnormalities.
  5. Snare Removal: If lesions like polyps or tumors are found, a snare is deployed through the colonoscope to encircle and remove the lesions.
  6. Completion: The colonoscope is carefully withdrawn, and the removed tissue is sent for histological analysis.

Duration

Typically, the procedure takes about 30 minutes to 1 hour, depending on the complexity and the number of lesions removed.

Setting

The procedure is usually performed in an outpatient setting such as a hospital, outpatient surgical center, or specialized endoscopy clinic.

Personnel

  • Gastroenterologist or Surgeon
  • Nurses or Endoscopy Technicians
  • Anesthesiologist (if general anesthesia or deep sedation is used)

Risks and Complications

  • Common Risks: Abdominal discomfort, bloating, minor bleeding.
  • Rare Complications: Perforation of the colon, significant bleeding requiring intervention, adverse reactions to sedation or anesthesia.
  • Management: Prompt medical care and sometimes surgical intervention are required in case of severe complications.

Benefits

  • Early detection and removal of potentially cancerous lesions.
  • Symptom relief from bleeding or obstructive lesions.
  • Minimized risk of colorectal cancer with early intervention.

Recovery

  • Post-procedure monitoring for 1-2 hours, especially if sedation was used.
  • Patients may experience mild cramping or bloating, which usually resolves quickly.
  • Instructions include: avoiding certain foods, resting, and watching for signs of complications like fever or severe pain.
  • A follow-up appointment is typically scheduled to discuss pathology results and any further treatment.

Alternatives

  • Non-Invasive: Surveillance with regular imaging or stool tests (less definitive but lower risk).
  • Surgical: Traditional surgery for lesion removal, which is more invasive and has a longer recovery time.

Patient Experience

  • During: Little to no discomfort due to sedation.
  • After: Potential mild cramping or bloating; normal activities can usually resume within a day.
  • Pain Management: Minor discomfort is managed with over-the-counter pain medications; more intensive pain is uncommon.

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Medical Policies and Guidelines for Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

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