CPT® Code 43204

1. Indications

Esophagoscopy, flexible, transoral, with injection sclerosis of esophageal varices is indicated for the following conditions:

• Esophageal Varices - These are dilated blood vessels within the esophagus that can lead to serious complications, including bleeding, particularly in patients with portal hypertension due to liver cirrhosis.

2. Procedure

The procedure of esophagoscopy with injection sclerosis involves several key steps:

• Step 1: Preparation and Anesthesia - The patient is positioned appropriately, and local anesthesia may be administered to minimize discomfort during the procedure. Sedation may also be provided to ensure the patient remains relaxed and still.
• Step 2: Introduction of the Endoscope - A flexible endoscope is carefully inserted through the patient's mouth. The clinician advances the endoscope through the oropharynx and into the esophagus, ensuring that the anatomical structures are visualized clearly.
• Step 3: Examination of the Esophagus - As the endoscope is advanced, the clinician examines the velopharyngeal closure, the base of the tongue, and the hypopharynx. Vocal cord motion is assessed, and the pharyngeal musculature is evaluated for any abnormalities.
• Step 4: Navigating the Esophagus - Upon reaching the cricopharyngeus muscle, the clinician may ask the patient to perform a burp or swallow to facilitate the passage of the endoscope. The scope is then advanced through the entire length of the esophagus to the gastroesophageal junction.
• Step 5: Injection of Sclerosing Solution - Once the varices are identified, a sclerosing solution is injected directly into the esophageal varices. This solution works to shrink the varices, reducing the risk of bleeding and other complications associated with these dilated vessels.
• Step 6: Withdrawal of the Endoscope - After the injection, the endoscope is carefully withdrawn, allowing for a final examination of the entire circumference of the esophagus to ensure no additional abnormalities are present.

3. Post-Procedure

After the esophagoscopy with injection sclerosis, patients are typically monitored for any immediate complications, such as bleeding or adverse reactions to the sclerosing agent. It is common for patients to experience some throat discomfort or soreness following the procedure. Recovery time may vary, but patients are usually advised to refrain from eating or drinking until the effects of sedation have worn off and they can swallow safely. Follow-up appointments may be scheduled to assess the effectiveness of the treatment and to monitor for any recurrence of varices.