CPT® Code 45347

Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)

A flexible sigmoidoscopy is a diagnostic and therapeutic procedure that involves the examination of the sigmoid colon using a flexible endoscope. This procedure is specifically performed with the placement of an endoscopic stent, which is a tube-like device used to keep a narrowed segment of the colon open. The process begins with the introduction of a standard flexible sigmoidoscope into the anus, which is then advanced through the rectum and into the sigmoid colon. During this advancement, air insufflation is utilized to separate the mucosal folds, enhancing the visualization of the colon's inner lining. Once the scope reaches the area of stenosis, the physician assesses the position and length of the narrowing. If the examination indicates that pre-dilation is necessary to facilitate stent placement, a guidewire is inserted through the scope. Following this, a series of rigid tubes with increasing diameters may be passed over the guidewire to dilate the stricture, or alternatively, a balloon catheter may be used to inflate the stricture directly. After the stricture has been adequately dilated, the stent placement procedure commences. A guidewire is again passed through the scope, followed by the stent delivery system, which is carefully positioned in the narrowed segment of the colon. The appropriate size of the stent is selected and introduced through the scope, where it is then deployed or expanded within the stricture. To ensure the stent is correctly positioned and properly deployed, a balloon catheter may be inserted and inflated to secure the stent in place. Finally, the endoscope is advanced through the stent to verify its correct positioning before the scope is withdrawn, completing the procedure.