CPT® Code 43270

Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

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 performed transorally, meaning the endoscope is introduced through the mouth. During the EGD, the physician examines various anatomical structures, including the velopharyngeal closure, the base of the tongue, and the hypopharynx, to assess for any abnormalities. Vocal cord motion is also evaluated, and the pharyngeal musculature is inspected for any signs of dysfunction. As the endoscope is advanced through the esophagus, the physician may ask the patient to swallow or burp to facilitate the passage of the scope past the cricopharyngeus muscle. Once the endoscope reaches the stomach, it is advanced through the pylorus into the duodenum, allowing for a thorough inspection of the mucosal surfaces. Any lesions, such as tumors or polyps, are identified and documented. If there is a narrowing of the esophageal or gastrointestinal lumen at the site of a lesion, dilation may be necessary prior to the ablation procedure. This dilation can be achieved by passing a guidewire through the endoscope, followed by the insertion of a series of rigid tubes of increasing diameter or a balloon catheter to expand the lumen. The ablation of lesions is performed using a laser device, which is introduced through the endoscope. The physician targets the distal margin of the lesion and ablates it as the endoscope is retracted, ensuring complete destruction of the lesion. This process may be repeated for multiple lesions, and if further dilation is required after the ablation, it is performed as previously described. Finally, the upper gastrointestinal tract is re-examined to confirm that all lesions have been successfully destroyed and to check for any procedural injuries.