CPT® Code 74260

Deleted

1. Indications

Duodenography, hypotonic, is indicated for various clinical scenarios where detailed visualization of the duodenum and pancreatic head is necessary. The following conditions may warrant the performance of this procedure:

• Lesions in the Duodenum - The procedure is utilized to identify and characterize any abnormal growths or lesions present in the duodenum.
• Pancreatic Head Evaluation - It is performed to assess the anatomy and function of the pancreatic head, particularly in cases where abnormalities are suspected.
• Gastrointestinal Symptoms - Patients presenting with unexplained gastrointestinal symptoms may undergo this procedure to investigate potential underlying issues related to the duodenum or pancreas.

2. Procedure

The hypotonic duodenography procedure involves several critical steps to ensure accurate imaging of the duodenum and pancreatic head. The following outlines the procedural steps:

• Step 1: Patient Preparation - Prior to the procedure, the patient is prepared by ensuring that they have fasted for a specified period to minimize the presence of food in the gastrointestinal tract, which could interfere with imaging.
• Step 2: Tube Insertion - A tube is carefully inserted through the patient's nose or mouth and advanced into the duodenum. This step is performed under fluoroscopic guidance to ensure proper placement of the tube.
• Step 3: Administration of Medication - Medication is administered to inhibit peristalsis, which helps to stabilize the duodenum and allows for better visualization during imaging.
• Step 4: Contrast Material Infusion - A contrast material, typically barium, is infused through the tube into the duodenum. The infusion is done in a manner that overfills the duodenum, applying pressure against the pancreatic head to enhance imaging quality.
• Step 5: Fluoroscopic Imaging - During the procedure, fluoroscopy is used to visualize the duodenum and pancreatic head in real-time. The radiologist can observe organ function and capture spot films as needed to document findings.
• Step 6: Post-Procedure Medication - At the conclusion of the imaging study, additional medication may be administered to stimulate peristalsis, facilitating the movement of the contrast material through the gastrointestinal tract.

3. Post-Procedure

After the hypotonic duodenography procedure, patients may be monitored for a short period to ensure there are no immediate adverse reactions to the contrast material or medications administered. It is common for patients to experience some transient gastrointestinal discomfort as the contrast material moves through the digestive system. Patients are typically advised to resume normal activities as tolerated, but they may be instructed to follow specific dietary guidelines or restrictions for a short time following the procedure. Additionally, the radiologist will review the images obtained during the procedure and provide a report detailing the findings, which will be communicated to the referring physician for further evaluation and management.