CPT® Code 44403

1. Indications

The colonoscopy through stoma with endoscopic mucosal resection is indicated for various conditions and symptoms that necessitate direct visualization and intervention within the colon. The following are explicitly provided indications for this procedure:

• Suspicion of Colonic Lesions - This procedure is performed when there is a need to investigate suspected lesions within the colon that may require removal or further evaluation.
• Abnormal Findings on Imaging - If imaging studies, such as CT scans or X-rays, reveal abnormalities in the colon, a colonoscopy through stoma may be indicated to assess these findings directly.
• Surveillance of Known Conditions - Patients with a history of polyps or colorectal cancer may require regular surveillance through colonoscopy to monitor for new lesions or changes in existing ones.
• Management of Colonic Obstruction - In cases where there is a suspected obstruction, this procedure can help identify the cause and allow for therapeutic intervention.

2. Procedure

The procedure for a colonoscopy through stoma with endoscopic mucosal resection involves several critical steps to ensure effective examination and treatment of the colon. The following procedural steps are outlined:

• Step 1: Introduction of the Endoscope - The procedure begins with the careful introduction of the endoscope through the colostomy opening. This allows the physician to access the colon directly and visualize the mucosal surfaces from the stoma to the cecum or small intestine anastomosis.
• Step 2: Inspection of the Colon - Once the endoscope is in place, the physician inspects the entire circumference of the colon for any abnormalities, such as lesions, ulcerations, or strictures. This thorough examination is crucial for identifying areas that may require further intervention.
• Step 3: Identification of Mucosal Lesions - During the inspection, any mucosal lesions are identified. The physician notes the characteristics and locations of these lesions for subsequent treatment.
• Step 4: Marking the Lesion - In CPT® Code 44403, the borders of the identified lesion are marked using electrocautery. This step is essential for delineating the area to be excised and ensuring precision during the resection.
• Step 5: Injection of Diluted Adrenaline - Diluted adrenaline is injected into the submucosal layer surrounding the lesion. This injection helps to separate the mucosal layer containing the lesion from the underlying muscle, facilitating easier removal.
• Step 6: Use of Snare for Resection - A snare with a suction cup is employed to further separate the mucosal lesion from the underlying tissue. The lesion is then excised and captured using the snare, allowing for its removal from the colon.
• Step 7: Withdrawal of the Endoscope - After the lesion has been excised, the endoscope is carefully withdrawn. The physician may perform a final inspection of the mucosal surfaces to check for any additional abnormalities or complications.

3. Post-Procedure

Post-procedure care following a colonoscopy through stoma with endoscopic mucosal resection involves monitoring the patient for any immediate complications, such as bleeding or perforation. Patients may experience some discomfort or cramping following the procedure, which is typically managed with standard analgesics. It is essential to provide instructions regarding signs of complications, such as excessive bleeding, severe pain, or fever, which would require prompt medical attention. Follow-up appointments may be scheduled to discuss pathology results from the excised tissue and to plan any further management if necessary. Additionally, patients may need to adhere to specific dietary recommendations and activity restrictions during the recovery period to ensure optimal healing.