CPT® Code 43290

1. Indications

The flexible esophagogastroduodenoscopy with deployment of an intragastric bariatric balloon is indicated for patients who meet specific criteria related to obesity management. The following conditions warrant this procedure:

• Obesity Patients who have not achieved adequate weight loss through dietary modifications or pharmacological interventions.
• Weight Management Individuals seeking a minimally invasive option to assist in weight loss as part of a comprehensive weight management program.
• Assessment of Gastrointestinal Health Patients requiring evaluation of the upper gastrointestinal tract for potential abnormalities that may affect weight loss efforts.

2. Procedure

The procedure involves several critical steps to ensure successful deployment of the intragastric bariatric balloon:

• Step 1: Patient Preparation The patient is placed under appropriate sedation to ensure comfort during the procedure. This is crucial as the procedure involves the insertion of a flexible endoscope through the mouth.
• Step 2: Insertion of the Endoscope A flexible upper endoscope is carefully advanced through the patient's mouth and into the esophagus, reaching the proximal stomach. This allows for direct visualization of the upper gastrointestinal tract.
• Step 3: Stomach Inspection Once in the stomach, any liquid contents are suctioned out to clear the view. The stomach is then insufflated with air to expand it, allowing for thorough inspection of the gastric lining and structures.
• Step 4: Duodenal Examination The endoscope is passed through the pylorus into the duodenum, where it is also inspected for any abnormalities or issues that may be present.
• Step 5: Withdrawal of the Endoscope After the inspection, the endoscope is slowly withdrawn while suctioning out the air. During this process, the esophageal mucosa is examined, and measurements of the gastroesophageal (GE) junction and other anatomical landmarks are taken.
• Step 6: Identification of Abnormalities Any presence of hiatal hernias or other abnormalities is noted. Additionally, brushings or washings may be obtained for further analysis if necessary.
• Step 7: Deployment of the Bariatric Balloon The bariatric balloon delivery catheter is advanced to the stomach at the previously noted locations. The endoscope is then reinserted to the GE junction, and the stiffening wire is removed from the delivery catheter.
• Step 8: Inflation of the Balloon The balloon is inflated with saline to the desired size, which is a critical step in ensuring the effectiveness of the weight loss intervention.
• Step 9: Final Inspection and Removal The catheter is disengaged from the intragastric balloon, and both the stomach and the balloon in situ are inspected before the catheter is finally removed.

3. Post-Procedure

After the procedure, patients are typically monitored for any immediate complications related to the endoscopy or the balloon placement. It is essential to provide post-procedure care instructions, which may include dietary modifications and guidelines for activity levels. Patients may experience some discomfort or nausea as they adjust to the presence of the balloon in their stomach. Follow-up appointments are usually scheduled to monitor the patient's progress and to assess the effectiveness of the bariatric balloon in aiding weight loss. Additionally, healthcare providers may offer support and counseling to help patients adapt to lifestyle changes necessary for successful weight management.