CPT® Code 44407

1. Indications

The colonoscopy through stoma with transendoscopic ultrasound-guided fine needle aspiration/biopsy is indicated for various clinical scenarios, particularly when there is a need to evaluate abnormalities within the colon or adjacent structures. The following conditions may warrant this procedure:

• Suspicion of malignancy - When there are signs or symptoms suggesting the presence of cancerous lesions in the colon or surrounding tissues.
• Unexplained gastrointestinal symptoms - Such as persistent abdominal pain, unexplained weight loss, or changes in bowel habits that require further investigation.
• Evaluation of known lesions - For patients with previously identified masses or abnormalities that need to be biopsied for histological examination.
• Assessment of lymphadenopathy - When there are enlarged lymph nodes adjacent to the colon that may require biopsy to determine the underlying cause.

2. Procedure

The procedure for a colonoscopy through stoma with transendoscopic ultrasound-guided fine needle aspiration/biopsy involves several detailed steps to ensure thorough examination and accurate sampling of lesions. The following steps outline the process:

• Step 1: Introduction of the endoscope - The procedure begins with the careful insertion of the endoscope through the colostomy opening. This allows the physician to visualize the mucosal surfaces of the colon, extending from the stoma to the cecum or small intestine anastomosis. The entire circumference of the colon is inspected for any abnormalities.
• Step 2: Use of radial scanning echoendoscope - After the initial inspection, a radial scanning echoendoscope is introduced and advanced under direct visualization to areas of compression in the colon that are external to the colonic mucosa. Continuous ultrasound imaging is performed to identify any masses or lesions that may require further evaluation.
• Step 3: Identification of lesions - During the ultrasound examination, the physician identifies the mass exterior to the colon. Ultrasound images are obtained and evaluated to assess the characteristics of the lesion, including its size and relationship to surrounding structures.
• Step 4: Transition to linear scanning echoendoscope - Once the lesions are identified, the radial scanning echoendoscope is removed and replaced with a linear scanning echoendoscope. This allows for more precise targeting of the biopsy sites.
• Step 5: Fine needle aspiration/biopsy - A fine needle aspiration/biopsy catheter is advanced through the biopsy channel of the echoendoscope. Doppler imaging is utilized to ensure that there are no vascular structures obstructing the planned biopsy route. The needle is then carefully advanced through the colon wall into the lesion or lymph node to obtain a biopsy specimen.
• Step 6: Multiple passes for adequate sampling - Multiple passes are made at each biopsy site to ensure that an adequate specimen is collected. After each pass, the biopsy device is removed, cleaned, and reassembled to maintain sterility and functionality.
• Step 7: Addressing additional biopsy sites - Once an adequate specimen has been obtained from the first biopsy site, the physician proceeds to address the next biopsy site in the same meticulous manner, ensuring comprehensive evaluation and sampling of all identified lesions.

3. Post-Procedure

After the completion of the colonoscopy through stoma with transendoscopic ultrasound-guided fine needle aspiration/biopsy, patients may require specific post-procedure care. It is essential to monitor for any immediate complications, such as bleeding or infection at the biopsy sites. Patients are typically advised to rest and may be instructed to avoid strenuous activities for a short period following the procedure. Additionally, the physician may provide guidance on dietary modifications or medications to manage any discomfort. Follow-up appointments may be scheduled to discuss biopsy results and any further management based on the findings. It is crucial for patients to report any unusual symptoms, such as severe abdominal pain or persistent bleeding, to their healthcare provider promptly.