CPT® Code 74355

1. Indications

The percutaneous placement of an enteroclysis tube is indicated for several specific clinical scenarios, particularly when there is a need for detailed imaging or intervention involving the small bowel. The following conditions may warrant this procedure:

• Small Bowel Obstruction: When there is a blockage in the small intestine that prevents the normal passage of contents, an enteroclysis tube can help in both diagnosing the obstruction and providing decompression.
• Inflammatory Bowel Disease: Conditions such as Crohn's disease or ulcerative colitis may require evaluation of the small bowel, and the enteroclysis tube can facilitate imaging to assess the extent of inflammation.
• Suspected Tumors: If there is a suspicion of neoplastic growths within the small bowel, the enteroclysis tube allows for enhanced imaging to identify and characterize these lesions.
• Feeding Tube Placement: In patients who are unable to consume food orally, the enteroclysis tube can be used for the placement of a feeding tube to ensure nutritional support.

2. Procedure

The procedure for the percutaneous placement of an enteroclysis tube involves several critical steps to ensure accurate placement and effective imaging. The following procedural steps are performed:

• Step 1: Patient Preparation The patient is positioned appropriately, and the abdominal area is cleaned and prepared for the procedure. A local anesthetic is administered to minimize discomfort at the puncture site.
• Step 2: Skin Puncture and Needle Insertion A skin puncture site is selected, typically in the abdominal region. A large-bore needle or trocar is then inserted through the skin and advanced towards the duodenum under continuous fluoroscopic guidance to ensure correct trajectory.
• Step 3: Tube Placement Once the needle is in the correct position, the enteroclysis tube is threaded through the needle. Contrast dye is infused through the tube to verify that it is properly placed within the small bowel.
• Step 4: Confirmation and Securing the Tube After satisfactory placement is confirmed via imaging, the guide needle is carefully removed. The enteroclysis tube is then secured in place to prevent displacement during subsequent use.

3. Post-Procedure

After the procedure, the patient is monitored for any immediate complications or adverse reactions. It is essential to ensure that the enteroclysis tube remains patent and correctly positioned. Patients may be advised on care instructions for the tube, including how to maintain hygiene and monitor for signs of infection at the insertion site. Follow-up imaging may be required to assess the effectiveness of the procedure and the condition of the small bowel. Additionally, healthcare providers will evaluate the patient's overall recovery and any need for further interventions based on the findings from the enteroclysis procedure.