CPT® Code 44406

1. Indications

The colonoscopy through stoma with endoscopic ultrasound examination is indicated for various clinical scenarios, particularly when there is a need to assess the colon and adjacent structures for abnormalities. The following conditions may warrant this procedure:

• Evaluation of Colonic Lesions This procedure is performed to investigate suspected lesions within the colon, which may include polyps, tumors, or other abnormal growths that require further examination.
• Assessment of Inflammatory Bowel Disease Patients with conditions such as Crohn's disease or ulcerative colitis may require this procedure to evaluate the extent of disease and monitor for complications.
• Staging of Colorectal Cancer For patients diagnosed with colorectal cancer, this procedure can assist in staging the disease by providing detailed imaging of the tumor and surrounding lymph nodes.
• Follow-Up of Previous Findings This procedure may be indicated for patients who have had previous abnormal findings during colonoscopy or imaging studies, necessitating further evaluation.

2. Procedure

The procedure involves several key steps to ensure a thorough examination of the colon and adjacent structures. Each step is critical for achieving accurate diagnostic results.

• Step 1: Preparation and Anesthesia Prior to the procedure, the patient is prepared, which may include fasting and bowel cleansing. Sedation or anesthesia is administered to ensure patient comfort during the examination.
• Step 2: Insertion of the Colonoscope The colonoscope is carefully inserted through the stoma, allowing access to the colon. The physician navigates the scope through the colostomy opening to reach the cecum or small intestine anastomosis.
• Step 3: Visual Inspection The mucosal surfaces of the colon are inspected as the scope is advanced. The physician looks for any abnormalities, such as polyps or lesions, and documents findings for further evaluation.
• Step 4: Withdrawal of the Colonoscope After the thorough examination of the colon's circumference, the colonoscope is withdrawn, allowing for a complete assessment of the mucosal surfaces.
• Step 5: Introduction of the Echoendoscope An echoendoscope is then introduced under direct visualization to the area of concern. This specialized scope is equipped with ultrasound capabilities to provide detailed imaging.
• Step 6: Ultrasound Imaging The balloon covering the transducer housing is filled with water to enhance acoustic coupling. Continuous ultrasound imaging is performed, allowing visualization of lesions and the walls of the colon, as well as pericolonic structures such as lymph nodes.
• Step 7: Completion of the Procedure Upon completion of the ultrasound examination, the echoendoscope is withdrawn, followed by the removal of the colonoscope. The findings are documented for further analysis and management.

3. Post-Procedure

After the procedure, patients are typically monitored in a recovery area until the effects of sedation wear off. It is common for patients to experience some discomfort or cramping, which usually resolves quickly. The physician will provide post-procedure instructions, which may include dietary recommendations and activity restrictions. Patients are advised to report any unusual symptoms, such as severe abdominal pain, fever, or rectal bleeding, to their healthcare provider. Follow-up appointments may be scheduled to discuss findings and any necessary further interventions based on the results of the colonoscopy and endoscopic ultrasound examination.