CPT® Code 43510

1. Indications

The procedure is indicated for patients with advanced esophageal cancer, particularly when there is a failure to pass a tube using a transoral endoscopic approach. This condition typically arises due to esophageal stenosis, which can significantly impede the ability to swallow and maintain nutritional intake.

• Advanced Esophageal Cancer Patients with this condition may experience significant narrowing of the esophagus, leading to difficulties in swallowing.
• Inability to Pass Tube Endoscopically When traditional methods fail, this procedure provides an alternative means to address esophageal obstruction.

2. Procedure

The procedure begins with the patient being placed under appropriate anesthesia. An incision is made in the abdomen to access the stomach. Once the stomach is exposed, it is incised to allow for further intervention. A balloon catheter is then advanced through the incision to the site of the esophageal stenosis. The balloon is inflated at the site of the narrowing, which helps to dilate the esophagus. This inflation may be repeated several times to ensure that the narrowed segment is adequately widened to the desired diameter. In some cases, instead of using a balloon, a series of tubes of increasing diameter may be inserted through the stomach to the stenosis, facilitating the dilation process. Once the esophagus has been dilated sufficiently, a permanent intraluminal tube is inserted at the site of the esophageal stenosis. This tube is crucial for maintaining the patency of the esophagus, allowing for continued passage of food and liquids. After the placement of the tube, the stomach incision is carefully closed, followed by the closure of the abdominal incision in layers to promote optimal healing.

• Step 1: The patient is placed under anesthesia, and an abdominal incision is made to access the stomach.
• Step 2: The stomach is incised to facilitate access to the esophagus.
• Step 3: A balloon catheter is advanced to the site of the esophageal stenosis and inflated to dilate the narrowed segment.
• Step 4: Inflation and deflation of the balloon may be repeated several times to achieve the desired dilation.
• Step 5: Alternatively, a series of tubes of increasing diameter may be inserted to assist in dilation.
• Step 6: A permanent intraluminal tube is placed at the site of the esophageal stenosis to maintain patency.
• Step 7: The stomach incision is closed, followed by the closure of the abdominal incision in layers.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications related to the surgery, such as infection or bleeding. Patients may require nutritional support, as they may have difficulty swallowing until they fully recover. Follow-up appointments are essential to assess the function of the intraluminal tube and ensure that the esophagus remains patent. Additionally, healthcare providers will monitor for any signs of recurrence of esophageal obstruction or other complications related to the underlying condition.