CPT® Code 43253

Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substance(s) (eg, anesthetic, neurolytic agent) or fiducial marker(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis)

Esophagogastroduodenoscopy (EGD) is a diagnostic and therapeutic procedure that involves the use of a flexible endoscope to visualize the upper gastrointestinal tract, which includes the esophagus, stomach, and duodenum. This procedure is particularly significant when combined with transendoscopic ultrasound (EUS) for the purpose of performing transmural injections of various substances or placing fiducial markers. The term "transmural" refers to the injection of substances through the wall of the gastrointestinal tract, which can be crucial for treating conditions such as pancreatic cancer or pancreatitis. The procedure allows for the direct delivery of therapeutic agents, such as chemotherapeutic drugs, to tumors located in the pancreas or liver, or for neurolysis of the celiac plexus to alleviate pain. Additionally, fiducial markers are strategically placed to delineate tumor borders for future radiotherapy, enhancing the precision of treatment. The procedure begins with the introduction of the endoscope through the mouth, allowing for a thorough examination of the oropharynx and hypopharynx, and continues through the esophagus into the stomach and duodenum. The use of ultrasound imaging during the procedure aids in assessing the gastrointestinal wall and surrounding structures, ensuring accurate identification of tumors and their relationship to vital organs. This comprehensive approach not only facilitates diagnosis but also enables targeted therapeutic interventions, making it a vital tool in the management of gastrointestinal malignancies.