CPT® Code 44378

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

A small intestinal endoscopy, specifically an enteroscopy beyond the second portion of the duodenum, is a procedure that allows for direct visualization and examination of the small intestine, including the ileum. This procedure is particularly important for diagnosing and managing conditions that may cause gastrointestinal bleeding. During the endoscopy, the patient is typically administered a local anesthetic to numb the mouth and throat, facilitating the insertion of a flexible fiberoptic endoscope. This endoscope is a thin, flexible tube equipped with a light and camera, which is carefully advanced through the digestive tract. The examination begins as the endoscope is swallowed, allowing it to navigate through the esophagus and into the stomach, and subsequently into the duodenum. Once the endoscope reaches the duodenum, the mucosal surfaces of the duodenum, jejunum, and ileum are meticulously inspected for any abnormalities, such as lesions, ulcers, or sources of bleeding. The procedure not only involves visual inspection but also includes therapeutic interventions to control any identified bleeding. Various techniques may be employed, including the use of thermal modalities like bipolar or unipolar cautery, heater probes, or laser devices. These methods apply heat to the bleeding site to promote coagulation and stop the hemorrhage. Additionally, pharmacological agents such as epinephrine may be injected to constrict blood vessels and assist in controlling the bleeding. The procedure may also involve the use of staples or hemoclips to close any tears or lacerations in the intestinal wall. Overall, this endoscopic procedure is a critical tool in the management of gastrointestinal bleeding and other related conditions, providing both diagnostic and therapeutic capabilities.