45389 Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post-dilation and guide wire passage, when performed)

Name of the Procedure

Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post-dilation and guide wire passage, when performed)

Summary

A flexible colonoscopy with endoscopic stent placement involves using a long, flexible tube with a camera (colonoscope) to visualize the colon and rectum. During the procedure, a stent (a small mesh tube) is placed to open up blocked or narrowed areas, which may include pre- and post-dilation and guide wire passage if necessary.

Purpose

This procedure addresses blockages or strictures in the colon that can cause symptoms such as severe constipation, abdominal pain, or even bowel obstruction. The goal is to relieve these symptoms by maintaining an open passage in the colon, allowing for normal bowel function.

Indications

• Symptoms such as severe constipation, abdominal pain, and bloating.
• Diagnosed colonic strictures or obstructions due to cancer, inflammatory bowel disease, or other conditions.
• Patients who are not suitable candidates for surgical intervention.

Preparation

• Patients are usually required to follow a clear liquid diet for 24 hours before the procedure.
• Laxatives or bowel preparation solutions are taken to cleanse the colon.
• Fasting from midnight before the procedure.
• Adjustments to regular medications might be necessary, especially blood thinners.
• A pre-procedure evaluation, including blood tests and potentially imaging studies, may be conducted.

Procedure Description

1. The patient is given sedation or anesthesia to ensure comfort.
2. A colonoscope is inserted through the rectum to navigate the colon.
3. The endoscopist may use a guide wire to assist in targeting the narrowed area.
4. Dilators may be used to widen the area before stent placement.
5. The stent is then positioned and expanded to maintain an open passage.
6. Post-dilation may be performed if necessary to ensure proper stent placement.

Duration

The procedure typically takes between 60 to 90 minutes.

Setting

This procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Gastroenterologist or colorectal surgeon
• Nurses
• Anesthesiologist or nurse anesthetist
• Technicians

Risks and Complications

• Common: Discomfort, bloating, minor bleeding
• Rare: Perforation of the colon, infection, misplacement of the stent, allergic reaction to sedation
• Possible Management: Monitoring, antibiotics, emergency surgery if perforation occurs

Benefits

• Relief from symptoms like pain and constipation
• Improved quality of life
• Potential to avoid more invasive surgical procedures Benefits are often realized immediately with improved bowel function.

Recovery

• Patients are monitored for a few hours post-procedure to ensure recovery from sedation.
• Instructions for care post-procedure include managing discomfort and reporting any unusual symptoms.
• Normal activities can typically be resumed within 24 to 48 hours.
• Follow-up appointments may be necessary to check stent position and function.

Alternatives

• Surgical resection or bypass of the blocked area
• Use of medications or different types of medical devices to manage symptoms Compared to surgery, endoscopic stent placement is less invasive with a shorter recovery time but may need repeat procedures.

Patient Experience

• During: Patients are usually sedated and should feel minimal discomfort.
• After: Some mild bloating and discomfort are expected but generally subside quickly.
• Pain management: Over-the-counter pain relief may be recommended, along with comfort measures such as rest and hydration.

By understanding the process, preparation, and recovery involved in a flexible colonoscopy with endoscopic stent placement, patients can feel more at ease and prepared for the procedure.