44405 Colonoscopy through stoma; with transendoscopic balloon dilation

Name of the Procedure:

Colonoscopy through stoma with transendoscopic balloon dilation

Common Name(s): Stoma Colonoscopy, Balloon Dilation via Stoma

Summary

In this procedure, a colonoscope (a flexible tube with a camera) is inserted through a stoma (an artificial opening to the colon) to examine the colon's interior. During the examination, a balloon is inflated inside the colon to widen narrowed areas.

Purpose

This procedure addresses narrowing (strictures) within the colon that can cause blockages and discomfort. The goal is to widen these areas to improve intestinal transit and alleviate symptoms such as pain, cramping, and difficulty passing stool.

Indications

• Strictures or narrowing in the colon
• Obstructive symptoms (e.g., constipation, abdominal pain)
• Assessment of colonic disease in patients with a colostomy or ileostomy

Preparation

• Patients may need to follow a clear liquid diet 24 hours before the procedure.
• Patients should avoid eating or drinking after midnight on the night before the procedure.
• Bowel preparation, including laxatives or enemas, may be required to clear the colon.
• Any medications, especially blood thinners, may need to be adjusted or paused.

Procedure Description

1. The patient is positioned laying on their side.
2. Sedation or anesthesia may be administered for comfort.
3. The colonoscope is gently inserted through the stoma.
4. The colonoscope transmits images to a monitor for the physician's examination.
5. If a stricture is identified, a balloon is positioned at the narrowed section.
6. The balloon is inflated to dilate the strictured area.
7. The colonoscope is withdrawn, and the procedure is completed.

Tools and Equipment:

• Colonoscope
• Balloon dilation catheter
• Sedation or anesthesia

Duration

Typically takes about 30-60 minutes.

Setting

Performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Gastroenterologist or colorectal surgeon
• Nurses
• Anesthesiologist (if sedation is used)

Risks and Complications

• Discomfort or cramping during the procedure
• Perforation (tear) of the colon
• Bleeding
• Infection
• Adverse reactions to sedation or anesthesia

Benefits

• Improved colonic passage and relief of obstructive symptoms
• Non-surgical approach to treating strictures
• Immediate visualization and treatment in one session

Recovery

• Patients may be monitored for a few hours post-procedure.
• Mild cramping or bloating may occur.
• Normal activities can often be resumed within 24 hours.
• Follow-up appointments to monitor progress and any recurring symptoms.

Alternatives

• Surgical resection of the stricture
• Medication-based treatments to reduce inflammation
• Non-invasive imaging and monitoring without intervention

Pros and cons of alternatives:

• Surgery is more invasive with longer recovery.
• Medications might not address the mechanical obstruction caused by strictures.

Patient Experience

During the procedure, patients may feel pressure or mild discomfort due to the scope and dilation. Post-procedure, some bloating or gas may be felt, but pain is typically minimal and manageable with over-the-counter pain relievers. Regular follow-up helps ensure the effectiveness of the procedure and the management of any recurring symptoms.