Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids)
CPT4 code
Name of the Procedure:
Colonoscopy, Flexible; with Band Ligation(s) (e.g., Hemorrhoids)
Summary
A flexible colonoscopy with band ligation is a medical procedure where a doctor uses a flexible tube with a camera to view the inside of the colon and rectum. During the same procedure, rubber bands are placed around internal hemorrhoids to cut off their blood supply, causing them to shrink and fall off.
Purpose
This procedure addresses hemorrhoids, which are swollen blood vessels in the rectum that can cause discomfort, bleeding, and other symptoms. The goal is to remove the hemorrhoids, alleviate symptoms, and prevent future problems.
Indications
- Persistent or severe hemorrhoidal symptoms such as bleeding, pain, or prolapse.
- Failure of conservative treatments like dietary changes, topical medications, or non-invasive procedures.
- Patients with a history of recurrent hemorrhoids.
Preparation
- Fasting for at least 6-8 hours before the procedure.
- Bowel preparation, which may involve taking a special laxative solution to clear the colon.
- Adjusting or stopping certain medications as advised by the doctor.
- Undergoing a physical examination and possibly blood tests to ensure suitability for the procedure.
Procedure Description
- The patient is sedated or given anesthesia for comfort.
- A flexible colonoscope, equipped with a light and camera, is gently inserted through the anus and advanced through the rectum into the colon.
- The doctor inspects the colon for hemorrhoids and other conditions.
- If hemorrhoids are found, a special device is used to place one or more rubber bands around the base of each hemorrhoid, cutting off their blood supply.
- The colonoscope is then withdrawn.
- The banded hemorrhoids will eventually shrink and fall off within a few days to a week.
Duration
The procedure typically takes about 30-60 minutes.
Setting
The procedure is usually performed in a hospital, outpatient clinic, or surgical center.
Personnel
- Gastroenterologist or colorectal surgeon to perform the procedure.
- Nurses to assist with preparation and monitoring.
- Anesthesiologist or sedation nurse to manage sedation and patient comfort.
Risks and Complications
- Pain or discomfort during or after the procedure.
- Bleeding, which is usually minor but can be more severe in some cases.
- Infection at the site of banding.
- Rarely, perforation of the colon.
- Delayed complications such as stricture formation or thrombosed hemorrhoids.
Benefits
- Relief from hemorrhoidal symptoms such as pain, bleeding, and prolapse.
- Minimal recovery time compared to more invasive surgical procedures.
- High success rate with low recurrence of treated hemorrhoids.
Recovery
- Patients are usually able to go home the same day.
- Mild discomfort or a feeling of fullness may be experienced for a few days.
- Avoid heavy lifting, straining, or vigorous exercise for a few days to prevent complications.
- Follow-up appointment may be scheduled to ensure proper healing and to check for recurrence.
Alternatives
- Conservative treatments: High-fiber diet, topical treatments, stool softeners.
- Minimally invasive procedures: Sclerotherapy, infrared coagulation.
- Surgical options: Hemorrhoidectomy for more severe cases.
Patient Experience
- Patients may feel mild discomfort or pressure during the procedure, but sedation or anesthesia usually makes the process tolerable.
- Post-procedure discomfort is generally managed with over-the-counter pain relievers.
- Patients should communicate any severe pain, fever, or significant bleeding to their healthcare provider immediately.
By adhering to these guidelines, patients can anticipate a smooth procedure and gradual but effective relief of hemorrhoidal symptoms.