CPT® Code 43205

1. Indications

Esophagoscopy with band ligation of esophageal varices is indicated for the treatment of patients with esophageal varices, which are dilated blood vessels in the esophagus that pose a risk of bleeding. This procedure is typically performed in cases where the patient has been diagnosed with portal hypertension, often due to liver cirrhosis, and is at risk for variceal hemorrhage. The primary goal of the procedure is to prevent potential life-threatening bleeding from these varices.

• Esophageal Varices The presence of dilated blood vessels in the esophagus that can lead to significant bleeding.
• Portal Hypertension A condition commonly associated with liver cirrhosis that increases pressure in the portal venous system, leading to the development of varices.
• Risk of Variceal Hemorrhage Patients who are at high risk for bleeding due to the size and location of the varices.

2. Procedure

The procedure begins with the patient being positioned appropriately to facilitate the insertion of the flexible endoscope. The endoscope is then introduced transorally, meaning it is passed through the mouth. Once the endoscope is in place, it is carefully advanced through the esophagus. During this process, the physician examines the velopharyngeal closure, the base of the tongue, and the hypopharynx to assess any abnormalities. Vocal cord motion is also observed, and the pharyngeal musculature is evaluated for any issues. As the endoscope reaches the cricopharyngeus, the physician may ask the patient to swallow or burp, which helps in maneuvering the scope past this area. The endoscope is then advanced along the entire length of the esophagus until it reaches the gastroesophageal junction. At this point, any abnormalities, including the presence of esophageal varices, are noted. After the thorough examination, the endoscope is withdrawn, allowing for a complete assessment of the esophagus. For the treatment of the identified esophageal varices, a snare is introduced through the endoscope. An elastic band is then placed around each varix, effectively tying off the vein to prevent further bleeding.

• Step 1: Position the patient appropriately for the procedure.
• Step 2: Introduce the flexible endoscope transorally through the mouth.
• Step 3: Advance the endoscope through the esophagus while examining the velopharyngeal closure, base of the tongue, and hypopharynx.
• Step 4: Observe vocal cord motion and evaluate pharyngeal musculature.
• Step 5: Ask the patient to swallow or burp to facilitate the passage of the scope past the cricopharyngeus.
• Step 6: Continue advancing the endoscope to the gastroesophageal junction, noting any abnormalities.
• Step 7: Withdraw the endoscope after a complete examination of the esophagus.
• Step 8: Introduce a snare through the endoscope and place an elastic band around each varix to tie off the vein.

3. Post-Procedure

After the esophagoscopy with band ligation of esophageal varices, patients are typically monitored for any immediate complications, such as bleeding or perforation. It is essential to observe the patient for signs of discomfort or adverse reactions to sedation, if used. Patients may experience a sore throat or mild discomfort following the procedure, which usually resolves within a few days. Instructions regarding diet and activity levels may be provided, and follow-up appointments are often scheduled to assess the effectiveness of the treatment and monitor for any recurrence of varices. Additionally, patients may be advised on the importance of managing underlying conditions, such as liver disease, to prevent the development of new varices.