CPT® Code 43206

1. Indications

The procedure of flexible esophagoscopy with optical endomicroscopy is indicated for various clinical scenarios where detailed visualization of the esophageal mucosa is necessary. The following conditions may warrant this procedure:

• Evaluation of Esophageal Abnormalities This procedure is performed to investigate any abnormalities detected during previous examinations or imaging studies, such as strictures, lesions, or tumors.
• Assessment of Esophagitis It is indicated for patients with suspected esophagitis, allowing for direct visualization of inflammation or damage to the esophageal lining.
• Monitoring of Barrett's Esophagus Patients with Barrett's esophagus may require regular surveillance to detect dysplasia or early signs of esophageal cancer.
• Biopsy of Suspicious Lesions The procedure is utilized to obtain targeted biopsies from areas of the esophagus that exhibit abnormal microscopic changes, facilitating accurate diagnosis.
• Investigation of Dysphagia It is indicated for patients experiencing difficulty swallowing (dysphagia) to identify any underlying structural or functional issues.

2. Procedure

The procedure of flexible esophagoscopy with optical endomicroscopy involves several critical steps to ensure thorough examination and accurate diagnosis. The following procedural steps are performed:

• Step 1: Preparation and Anesthesia The patient is prepared for the procedure, which may include fasting for a specified period. Sedation or local anesthesia may be administered to ensure patient comfort during the examination.
• Step 2: Insertion of the Endoscope A flexible endoscope is carefully introduced through the patient's mouth and advanced into the esophagus. The physician ensures that the endoscope is positioned correctly to visualize the esophageal structures.
• Step 3: Examination of the Esophagus The physician examines the velopharyngeal closure, base of the tongue, and hypopharynx. Vocal cord motion is observed, and the pharyngeal musculature is evaluated for any abnormalities.
• Step 4: Advancement to the Gastroesophageal Junction As the endoscope reaches the cricopharyngeus, the patient may be asked to burp or swallow to facilitate the passage of the scope. The endoscope is then advanced along the entire length of the esophagus to the gastroesophageal junction.
• Step 5: Withdrawal and Circumferential Examination After reaching the gastroesophageal junction, the endoscope is withdrawn while the physician examines the entire circumference of the esophagus for any abnormalities.
• Step 6: Application of Contrast Agent A contrast agent is applied to enhance visualization of the esophageal mucosa during the endomicroscopy phase of the procedure.
• Step 7: Endomicroscopy The miniaturized endomicroscope is either integrated into or inserted through the flexible endoscope. Using a blue laser light, the endomicroscope scans the esophageal mucosa from the surface to the deepest mucosal layer, allowing for detailed assessment.
• Step 8: Targeted Biopsy If any areas with microscopic changes are identified, targeted biopsies are obtained, providing instant histological information for immediate treatment decisions.

3. Post-Procedure

After the completion of the flexible esophagoscopy with optical endomicroscopy, the patient is monitored for any immediate complications related to the procedure. It is common for patients to experience a sore throat or mild discomfort following the examination, which typically resolves within a short period. The physician may provide specific post-procedure care instructions, including dietary recommendations and activity restrictions. Patients are usually advised to avoid eating or drinking until the effects of sedation have worn off and swallowing is comfortable. Follow-up appointments may be scheduled to discuss biopsy results and any necessary further management based on the findings from the procedure. It is essential for patients to report any unusual symptoms, such as severe pain, bleeding, or difficulty swallowing, to their healthcare provider promptly.