CPT® Code 45327

A rigid proctosigmoidoscopy is a diagnostic and therapeutic procedure that involves the examination of the rectum and the lower part of the colon (sigmoid) using a rigid endoscope. This procedure is specifically performed with the additional step of transendoscopic stent placement, which is a technique used to alleviate intestinal obstruction caused by malignant neoplasms, such as tumors. The process begins with the insertion of an obturator into the endoscope, which is then introduced into the anus and advanced approximately 5 centimeters into the rectum. Once in position, the obturator is removed, and an eyepiece is attached to allow for visualization. The endoscope is then advanced toward the site of obstruction, utilizing air insufflation to separate the mucosal folds for better visibility. After reaching the obstruction, the endoscope is withdrawn to inspect the mucosa for any signs of ischemia or necrosis, which are critical indicators of tissue health. If the mucosa appears intact and healthy, a guidewire is introduced through the endoscope and advanced across the lesion. In cases where the stricture is significant, predilation may be necessary, which involves the use of a balloon catheter to widen the narrowed area. This balloon is inflated to facilitate the placement of a stent, which is then deployed under direct endoscopic vision to ensure proper positioning. The procedure concludes with the removal of the endoscope, having successfully placed the stent to maintain patency in the obstructed area.