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- Completion: The colonoscope is carefully withdrawn, and the removed tissue is sent for histological analysis.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