CPT® Code 45327

1. Indications

The procedure of rigid proctosigmoidoscopy with transendoscopic stent placement is indicated for specific clinical scenarios, particularly when addressing intestinal obstructions. The following conditions warrant this procedure:

• Malignant Neoplasm: The primary indication for this procedure is the presence of a malignant tumor causing an obstruction in the intestinal tract, particularly in the rectum or sigmoid colon.
• Intestinal Obstruction: This procedure is performed to relieve symptoms associated with intestinal obstruction, which may include abdominal pain, bloating, and changes in bowel habits.

2. Procedure

The procedure of rigid proctosigmoidoscopy with transendoscopic stent placement involves several critical steps to ensure successful intervention. Each step is designed to facilitate the examination and treatment of the obstruction:

• Step 1: Insertion of the Obturator The procedure begins with the insertion of an obturator into the rigid endoscope. This obturator is crucial for the initial introduction of the scope into the anal canal.
• Step 2: Advancement of the Scope The endoscope is then carefully advanced approximately 5 centimeters into the rectum. This positioning is essential for accessing the lower colon and identifying the site of obstruction.
• Step 3: Removal of the Obturator Once the scope is in place, the obturator is removed, and an eyepiece is attached to the endoscope. This allows the physician to visualize the internal structures during the procedure.
• Step 4: Air Insufflation The endoscope is advanced toward the obstruction while air is insufflated to separate the mucosal folds. This technique enhances visibility and allows for a thorough examination of the affected area.
• Step 5: Mucosal Inspection After reaching the obstruction, the endoscope is withdrawn to inspect the mucosa for any signs of ischemia or necrosis. This assessment is critical to determine the health of the tissue before proceeding with stent placement.
• Step 6: Introduction of the Guidewire If the mucosa appears healthy, a guidewire is introduced through the endoscope and advanced across the lesion. This guidewire serves as a pathway for subsequent interventions.
• Step 7: Predilation (if necessary) If the stricture is significant, a balloon catheter is passed over the guidewire and positioned in the middle of the stricture. The balloon is then inflated to dilate the narrowed area, left in place for a short period, deflated, and subsequently removed.
• Step 8: Stent Placement An appropriately sized stent is selected and passed over the guidewire, crossing the area of obstruction. The stent is deployed under endoscopic vision, ensuring proper placement to maintain patency in the obstructed segment.
• Step 9: Removal of the Scope Finally, the endoscope is removed, completing the procedure. The successful placement of the stent aims to alleviate the obstruction and improve the patient's condition.

3. Post-Procedure

After the completion of the rigid proctosigmoidoscopy with transendoscopic stent placement, patients may require specific post-procedure care. Monitoring for any immediate complications, such as bleeding or perforation, is essential. Patients are typically advised to follow up with their healthcare provider to assess the effectiveness of the stent and to monitor for any recurrence of obstruction. Additionally, instructions regarding dietary modifications and activity restrictions may be provided to ensure optimal recovery. It is important for patients to report any unusual symptoms, such as severe abdominal pain or changes in bowel habits, to their healthcare provider promptly.