DOCSLIB.ORG

Advances in Flexible Endoscopy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Advances in Flexible Endoscopy Advances in Flexible Endoscopy Anant Radhakrishnan, DVM KEYWORDS Flexible endoscopy Minimally invasive procedures Gastroduodenoscopy Minimally invasive surgery KEY POINTS Although some therapeutic uses exist, flexible endoscopy is primarily used as a diagnostic tool. Several novel flexible endoscopic procedures have been studied recently and show prom- ise in veterinary medicine. These procedures provide the clinician with increased diagnostic capability. As the demand for minimally invasive procedures continues to increase, flexible endos- copy is being more readily investigated for therapeutic uses. The utility of flexible endoscopy in small animal practice should increase in the future with development of the advanced procedures summarized herein. INTRODUCTION The demand for minimally invasive therapeutic measures continues to increase in hu- man and veterinary medicine. Pet owners are increasingly aware of technology and diagnostic options and often desire the same care for their pet that they may receive if hospitalized. Certain diseases, such as neoplasia, hepatobiliary disease, pancreatic disease, and gastric dilatation–volvulus, can have significant morbidity associated with them such that aggressive, invasive measures may be deemed unacceptable. Even less severe chronic illnesses such as inflammatory bowel disease can be asso- ciated with frustration for the pet owner such that more immediate and detailed infor- mation regarding their pet’s disease may prove to be beneficial. Minimally invasive procedures that can increase diagnostic and therapeutic capability with reduced pa- tient morbidity will be in demand and are therefore an area of active investigation. The author has nothing to disclose. Department of Internal Medicine, Bluegrass Veterinary Specialists 1 Animal Emergency, 1591 Winchester Road, Suite 106, Lexington, KY 40505, USA E-mail address: [email protected] Vet Clin Small Anim 46 (2016) 85–112 http://dx.doi.org/10.1016/j.cvsm.2015.08.003 vetsmall.theclinics.com 0195-5616/16/$ – see front matter Ó 2016 Elsevier Inc. All rights reserved. 86 Radhakrishnan INDICATIONS Flexible endoscopy is a versatile tool that provides visualization of the gastrointestinal lumen. During the procedure, samples are obtained to provide greater diagnostic infor- mation. Endoscopy is commonly used for the patient with gastrointestinal signs (Box 1), because other diagnostic tests such as complete blood count, serum chemistry, radiography, and ultrasonography may not provide definitive information to diagnose the underlying condition. The typical objectives of the endoscopist include visual evaluation of the mucosal surface of the stomach, small intestine, and large intestine for lesions such as ulcers or masses, and obtaining mucosal samples for histopathology, cytology, or cul- ture. Flexible endoscopy can be of therapeutic value in several situations, such as gastric or esophageal foreign bodies, esophageal strictures, and feeding tube placement. EQUIPMENT Endoscope Components Equipment and routine flexible endoscopic procedures have been described previ- ously and are reviewed.1 The typical flexible endoscope can be divided into 3 compo- nents: the handpiece, the insertion tube, and the umbilical cord (Fig. 1). The handpiece (Fig. 2) contains the main control mechanisms for the endoscope. For a fiberoptic scope, the eyepiece for visualization is on the end of the handpiece. A coupler can be attached to the eyepiece to accept a camera head for viewing on a monitor. For a flex- ible video endoscope, the handpiece does not contain an eyepiece. Control options include deflection of the insertion tube tip, insufflation, water infusion, and suction. The insertion tube is the flexible portion of the endoscope that is inserted into the gastrointestinal tract for examination (Fig. 3). It contains channels for insufflation, water Box 1 Common indications for gastrointestinal endoscopy Abdominal pain Anorexia Diarrhea Dyschesia Dysphagia Hematemesis Hematochezia Hypersalivation Melena Mucoid feces Nausea Regurgitation Retching Tenesmus Vomiting Weight loss Advances in Flexible Endoscopy 87 Fig. 1. Main components of the flexible endoscope. to rinse the lens, and the working channel used for suction and endoscopic instruments. The tip of the endoscope can deflect in 4 directions under control of the 2 dials on the handpiece. Typically the degree of flexion is 90 in 3 planes and 180 in 1 plane (Fig. 4). The umbilical cord connects the endoscope to support items including light source with insufflator, water, and suction (Fig. 5). Air, water, and vacuum are pumped through the umbilical cord for use through the insertion tube and are controlled with the hand- piece buttons. In a video endoscope, electronic signals are transmitted from the video chip in the endoscope to the external processor for image production on a monitor. Support Items A light source (xenon or halogen bulb) with insufflator, water bottle for flush, and suc- tion are used via the umbilical cord. Additional support items include a camera, cap- ture unit, and monitor (Fig. 6A). With a fiberoptic endoscope, a camera head can be Fig. 2. Handpiece components of the flexible endoscope. 88 Radhakrishnan Fig. 3. End-on view of tip of insertion tube. attached to the eyepiece and connected to an external camera for visualization on a monitor (see Fig. 6B). A video endoscope has a video microchip in the handpiece that sends electronic signals to a video processor that is included in the light source to produce an image on a monitor. Endoscope Sizes Endoscopes vary in diameter and length of the insertion tube (Fig. 7). When selecting an endoscope, the application of the scope should be considered. A longer insertion tube is necessary for giant breed dogs, whereas bronchoscopic examination in small dogs and cats will require a narrow insertion tube of 2.5 to 5 mm. Historically, it has been challenging to have 1 endoscope that adequately evaluates the gastrointestinal tract in all dogs and cats owing to the wide range of patient sizes. Bronchoscopy and Fig. 4. (A, B) Flexion of tip of insertion tube. Advances in Flexible Endoscopy 89 Fig. 5. Umbilical cord connected to light source and insufflator. cystourethroscopy in the male dog place further demands on endoscope diversity. With advancement of flexible endoscopy, endoscopes with longer but narrower inser- tion tubes (7–9 mm diameter and 120–160 cm length) are available that also have adequate working channel size. A working channel that is large enough to pass a 2.4-mm (7-Fr) biopsy forceps or larger is recommended to obtain adequate tissue samples for histopathology.2 Endoscopic Instruments Various instruments are available that pass through the working channel (Fig. 8). The most commonly used instruments for general gastrointestinal evaluation are biopsy forceps and grasping forceps for foreign body retrieval. A variety of styles are avail- able. Additional instruments include cytology brushes and injection/aspiration needles. For advanced procedures and the experienced endoscopist, other instru- mentation can be used via the working channel and are referenced in their respective sections elsewhere in this article. Fig. 6. (A) Endoscopic tower, including light source insufflator, camera, capture unit, and monitor. (B) Camera attachment for a fiberoptic endoscope. 90 Radhakrishnan Fig. 7. Different diameter flexible endoscope from left to right: an 11-mm gastroduodeno- scope, an 8-mm gastroduodenoscope, a 5-mm bronchoscope, and a 2.5-mm urethroscope. GENERAL FLEXIBLE ENDOSCOPY Patient Preparation Patients should be fasted for 12 hours before gastroduodenoscopy and 24 to 48 hours for colonoscopy, depending on the patient’s condition and method of cleansing used. Isotonic electrolyte solutions such as GoLYTELY (Braintree Laboratories, Inc, Brain- tree, MA) will cause an osmotic diarrhea and typically provides adequate colon cleansing for endoscopic visualization. Failure to properly cleanse the colon impairs visibility and sample procurement. Fig. 8. Different foreign-body grasping devices: from left to right: basket, loop, wire basket, forceps with alligator jaws, and forceps with 1 2 teeth. (From Sum S, Ward CR. Flexible  endoscopy in small animals. Vet Clin North Am Small Anim Pract 2009;39:886; with permission.) Advances in Flexible Endoscopy 91 Patient Positioning For routine examination, the patient should be induced, intubated with a cuffed endo- tracheal tube to reduce the risk of aspiration, and maintained on inhalant anesthesia. The patient is placed in left lateral recumbency to minimize pressure on the stomach from adjacent organs and allow easier entry into the duodenum. Approach The endoscopist should be positioned in front of the head for gastroduodenoscopy and behind the tail for colonoscopy. If a monitor is used, it should be placed next to or behind the patient (Fig. 9). This positioning allows for direct visualization with coor- dination of the endoscope tip with the image on the screen. The placement of the monitor relative to the endoscopist is also important to minimize strain on the endo- scopist, which can result in musculoskeletal discomfort such as tendinitis that can develop over time owing to compromised posture. Procedure Insufflation with air allows for distension and visualization of the lumen. The endo- scope should only be advanced when the lumen is clearly visible. If visualization is not achieved or if orientation is lost, the insertion tube should be withdrawn slowly until the lumen
Load more

Recommended publications
  • Laparoscopic Gastropexy As a Preventative Measure for Gastric Dilation Volvulus in Canines
    Laparoscopic Gastropexy as a Preventative Measure for Gastric Dilation Volvulus in Canines By: Erin O’Brien Advisors: Dr. Kimberly Boswell Board Certified Surgeon Southwest Michigan Animal Emergency Hospital Kalamazoo, MI Dr. Diane R. Kiino Ph.D. Kalamazoo College Health Science A paper submitted in partial fulfillment of the requirements for the degree of Bachelor of Arts at Kalamazoo College. 2010 ii ACKNOWLEDGEMENTS Over the summer I was able to intern at the Southwest Michigan Animal Emergency Hospital in Kalamazoo, MI. It was there that I was exposed to the emergency setting in veterinary medicine but also had the chance to observe surgeries done by Board Certified Surgeon, Dr. Kimberly Boswell. I would like to thank the entire staff at SWMAEH for teaching me a tremendous amount about veterinary medicine and allowing me to get as much hands on experience as possible. It was such a privilege to complete my internship at a hospital where I was able to learn so much about veterinary medicine in only ten weeks. I would also like to thank Dr. Boswell in particular, it was a gastropexy surgery I saw her perform during my internship that inspired the topic of this paper. Additionally I would like to acknowledge my advisor Dr. Diane Kiino for providing the direction I needed in choosing my paper topic. iii ABSTRACT Gastric Dilation Volvulus (GDV) is a fatal condition in canines especially those that are large or giant breeds. GDV results from the stomach distending and twisting on itself which when left untreated causes shock and ultimately death. The only method of prevention for GDV is a gastropexy, a surgical procedure that sutures the stomach to the abdominal wall to prevent volvulus or twisting.
    [Show full text]
  • Laparoscopic Fundoplication with Double Sided Posterior Gastropexy: a Different Surgical Technique
    View metadata, citation and similar papers at core.ac.uk ORIGINAL RESEARCH brought to you by CORE provided by Elsevier - Publisher Connector International Journal of Surgery 10 (2012) 532e536 Contents lists available at SciVerse ScienceDirect International Journal of Surgery journal homepage: www.theijs.com Original research Laparoscopic fundoplication with double sided posterior gastropexy: A different surgical technique Fahri Yetis¸ira,*, A. Ebru Salman b,Dogukan Durak a, Mehmet Kiliç c a Ataturk Research and Training Hospital, General Surgery Department, Turkey b Ataturk Research and Training Hospital, Anesthesiology and Reanimation Department, Turkey c Yildirim Beyazit University, General Surgery Department, Turkey article info abstract Article history: Background: Laparoscopic Nissen Fundoplication has become the gold standard surgical procedure for Received 18 April 2012 management of gastroesophageal reflux disease. Nissen fundoplication provides an effective barrier Received in revised form against reflux. The aim of this study was to evaluate early postoperative outcomes of a different surgical 3 August 2012 technique, laparoscopic fundoplication with double sided posterior gastropexy. Accepted 6 August 2012 Methods: Data of 46 patients who underwent laparoscopic fundoplication with double sided posterior Available online 21 August 2012 gastropexy between February 2010 and December 2011 were collected. Surgically, after Nissen fundoplication was completed, 2e4 sutures were passed through the uppermost parts of the posterior Keywords: Gastropexy and anterior wall of the gastric wrap and then passed gently 1 cm above the celiac artery from the denser fi Nissen fundoplication bers of uppermost part of the arcuate ligament. Demographic data, preoperative and postoperative Gastroesophageal reflux assesments of sympthomatic and functional outcomes of patients were recorded.
    [Show full text]
  • Modified Heller´S Esophageal Myotomy Associated with Dor's
    Crimson Publishers Research Article Wings to the Research Modified Heller´s Esophageal Myotomy Associated with Dor’s Fundoplication A Surgical Alternative for the Treatment of Dolico Megaesophagus Fernando Athayde Veloso Madureira*, Francisco Alberto Vela Cabrera, Vernaza ISSN: 2637-7632 Monsalve M, Moreno Cando J, Charuri Furtado L and Isis Wanderley De Sena Schramm Department of General Surgery, Brazil Abstracts The most performed surgery for the treatment of achalasia is Heller´s esophageal myotomy associated or no with anti-reflux fundoplication. We propose in cases of advanced megaesophagus, specifically in the dolico megaesophagus, a technical variation. The aim of this study was to describe Heller´s myotomy modified by Madureira associated with Dor´s fundoplication as an alternative for the treatment of dolico megaesophagus,Materials and methods: assessing its effectiveness at through dysphagia scores and quality of life questionnaires. *Corresponding author: proposes the dissection ofTechnical the esophagus Note describing intrathoracic, the withsurgical circumferential procedure and release presenting of it, in the the results most of three patients with advanced dolico megaesophagus, operated from 2014 to 2017. The technique A. V. Madureira F, MsC, Phd. Americas Medical City Department of General extensive possible by trans hiatal route. Then the esophagus is retracted and fixed circumferentially in the Surgery, Full Professor of General pillars of the diaphragm with six or seven point. The goal is at least on the third part of the esophagus, to achieveResults: its broad mobilization and rectification of it; then is added a traditional Heller myotomy. Submission:Surgery At UNIRIO and PUC- Rio, Brazil Published: The mean dysphagia score in pre-op was 10points and in the post- op was 1.3 points (maximum October 09, 2019 of 10 points being observed each between the pre and postoperative 8.67 points, 86.7%) The mean October 24, 2019 hospitalization time was one day.
    [Show full text]
  • The Practice of Gastrointestinal Motility Laboratory During COVID-19 Pandemic
    J Neurogastroenterol Motil, Vol. 26 No. 3 July, 2020 pISSN: 2093-0879 eISSN: 2093-0887 https://doi.org/10.5056/jnm20107 JNM Journal of Neurogastroenterology and Motility Review The Practice of Gastrointestinal Motility Laboratory During COVID-19 Pandemic: Position Statements of the Asian Neurogastroenterology and Motility Association (ANMA-GML-COVID-19 Position Statements) Kewin T H Siah,1,2* M Masudur Rahman,3 Andrew M L Ong,4,5 Alex Y S Soh,1,2 Yeong Yeh Lee,6,7 Yinglian Xiao,8 Sanjeev Sachdeva,9 Kee Wook Jung,10 Yen-Po Wang,11 Tadayuki Oshima,12 Tanisa Patcharatrakul,13,14 Ping-Huei Tseng,15 Omesh Goyal,16 Junxiong Pang,17 Christopher K C Lai,18 Jung Ho Park,19 Sanjiv Mahadeva,20 Yu Kyung Cho,21 Justin C Y Wu,22 Uday C Ghoshal,23 and Hiroto Miwa12 1Department of Medicine, Yong Loo Lin School of Medicine, The National University of Singapore, Singapore; 2Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; 3Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh; 4Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; 5Duke-NUS Medical School, Singapore; 6School of Medical Sciences, Universiti Sains Malaysia, Malaysia; 7St George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW, Australia; 8Department of Gastroenterology and Hepatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; 9Department of Gastroenterology, GB Pant Hospital, New Delhi, India;
    [Show full text]
  • The Short Esophagus—Lengthening Techniques
    10 Review Article Page 1 of 10 The short esophagus—lengthening techniques Reginald C. W. Bell, Katherine Freeman Institute of Esophageal and Reflux Surgery, Englewood, CO, USA Contributions: (I) Conception and design: RCW Bell; (II) Administrative support: RCW Bell; (III) Provision of the article study materials or patients: RCW Bell; (IV) Collection and assembly of data: RCW Bell; (V) Data analysis and interpretation: RCW Bell; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Reginald C. W. Bell. Institute of Esophageal and Reflux Surgery, 499 E Hampden Ave., Suite 400, Englewood, CO 80113, USA. Email: [email protected]. Abstract: Conditions resulting in esophageal damage and hiatal hernia may pull the esophagogastric junction up into the mediastinum. During surgery to treat gastroesophageal reflux or hiatal hernia, routine mobilization of the esophagus may not bring the esophagogastric junction sufficiently below the diaphragm to provide adequate repair of the hernia or to enable adequate control of gastroesophageal reflux. This ‘short esophagus’ was first described in 1900, gained attention in the 1950 where various methods to treat it were developed, and remains a potential challenge for the contemporary foregut surgeon. Despite frequent discussion in current literature of the need to obtain ‘3 or more centimeters of intra-abdominal esophageal length’, the normal anatomy of the phrenoesophageal membrane, the manner in which length of the mobilized esophagus is measured, as well as the degree to which additional length is required by the bulk of an antireflux procedure are rarely discussed. Understanding of these issues as well as the extent to which esophageal shortening is due to factors such as congenital abnormality, transmural fibrosis, fibrosis limited to the esophageal adventitia, and mediastinal fixation are needed to apply precise surgical technique.
    [Show full text]
  • Spleen Rupture Complicating Upper Endoscopy in the Medical Literature [3–5]
    E206 UCTN – Unusual cases and technical notes following gastroscopy [3]. To our knowl- edge, only few cases have been reported Spleen rupture complicating upper endoscopy in the medical literature [3–5]. We think that the excessive stretching of spleno-diaphragmatic ligaments and of spleno-peritoneal lateral attachments Fig. 1 Computed during endoscopy and possibly the loca- tomography (CT) scan of abdomen in an 81- tion of most of the stomach in the thoracic year-old woman with cavity had contributed to the spleen rup- generalized weakness, ture [5,6]. Rapid diagnosis in the presence persistent nausea, and of suggestive symptoms of hemodynamic difficulty swallowing, instability and abdominal pain following showing hemoperito- upper endoscopy is life-saving. neum, subcapsular spleen hematoma, and blood around the liver. Endoscopy_UCTN_Code_CPL_1AH_2AJ Competing interests: None F. Jabr1, N. Skeik2 1 Hospital Medicine, Horizon Medical Center, Tennessee, USA 2 Vascular Medicine, Abott Northwestern An 81-year-old woman with history of peritoneum with subcapsular hematoma Hospital, Minneapolis, USA chronic lymphocytic leukemia and recent on the spleen (●" Fig. 1). The patient was diagnosis of Clostridium difficile colitis, diagnosed as having splenic rupture. Ex- and maintained on oral vancomycin, pre- ploratory laparotomy showed large he- References sented for generalized weakness, persis- moperitoneum (about 1500 mL blood), 1 Lopez-Tomassetti Fernandez EM, Delgado Plasencia L, Arteaga González IJ et al. Atrau- tent nausea, and a long history of difficulty subcapsular hematoma of the lateral in- matic rupture of the spleen: experience of swallowing (food hangs in her chest and ferior portion of the spleen, as well as a 10 cases.
    [Show full text]
  • Biodegradable Esophageal Stents for the Treatment of Refractory Benign Esophageal Strictures
    INVITED REVIEW Annals of Gastroenterology (2020) 33, 1-8 Biodegradable esophageal stents for the treatment of refractory benign esophageal strictures Paraskevas Gkolfakisa, Peter D. Siersemab, Georgios Tziatziosc, Konstantinos Triantafyllouc, Ioannis S. Papanikolaouc Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium; Radboud University Medical Center, Nijmegen, The Netherlands; “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece Abstract This review attempts to present the available evidence regarding the use of biodegradable stents in refractory benign esophageal strictures, especially highlighting their impact on clinical success and complications. A comprehensive literature search was conducted in PubMed, using the terms “biodegradable” and “benign”; evidence from cohort and comparative studies, as well as data from one pooled analysis and one meta-analysis are presented. In summary, the results from these studies indicate that the effectiveness of biodegradable stents ranges from more than one third to a quarter of cases, fairly similar to other types of stents used for the same indication. However, their implementation may reduce the need for re-intervention during follow up. Biodegradable stents also seem to reduce the need for additional types of endoscopic therapeutic modalities, mostly balloon or bougie dilations. Results from pooled data are consistent, showing moderate efficacy along with a higher complication rate. Nonetheless, the validity of these results is questionable, given the heterogeneity of the studies included. Finally, adverse events may occur at a higher rate but are most often minor. The lack of high-quality studies with sufficient patient numbers mandates further studies, preferably randomized, to elucidate the exact role of biodegradable stents in the treatment of refractory benign esophageal strictures.
    [Show full text]
  • 1 Dr. Melody Joy V. Mique Biochemistry of Digestion 2
    DR. MELODY JOY V. MIQUE BIOCHEMISTRY OF DIGESTION 2 UNIT IV BIOCHEMISTRY OF DIGESTION 2 OBJECTIVE: 1. Explain the chemical reactions involved in the process of digestion. 2. Analyze certain basic biochemical processes to explain commonly occurring health- related problems in digestion 3. Discuss the digestion of complex biomolecules in the body; TOPICS Unit 4: BIOCHEMISTRY OF DIGESTION 3. Chemical changes in the 1. Definition and factors affecting Digestion large intestines and feces 2. Phases of Digestion a. Fermentation a. Salivary Digestion b. Putrefaction b. Gastric Digestion c. Deamination c. Intestinal Digestion d. Decarboxylation d. Pancreatic Juice e. Detoxification e. Intestinal Juice 4. Feces and its Chemical Composition f. Bile CHEMICAL CHANGES IN THE LARGE INTESTINE AND FECES, CHEMICAL COMPOSITION OF FECES The large intestine, also known as colon or the the large bowel, is the last part of the gastrointestinal tract and of the digestive system in vertebrates. The digestive tract includes the mouth, esophagus, stomach, small intestine, large intestine and the rectum. There are 4 major functions of the large intestine: 1. recovery of water and electrolytes (Na, Cl etc) 2. formation and temporary storage of feces 3. maintaining a resident population of over 500 species of bacteria 3. fermentation of some of the indigestible food matter by bacteria. By the time partially digested foodstuffs reach the end of the small intestine (ileum), about 80% of the water content will be absorbed by the large intestine. The colon absorbs most of the remaining water. As the remnant food material moves through the colon, it is mixed with bacteria and mucus, and formed into feces for temporary storage before being eliminated by defecation In humans, the large intestine begins in the right iliac region of the pelvis, just at or below the waist, where it is joined to the end of the small intestine at the cecum, via the ileocecal valve.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • 1 Annex 2. AHRQ ICD-9 Procedure Codes 0044 PROC-VESSEL
    Annex 2. AHRQ ICD-9 Procedure Codes 0044 PROC-VESSEL BIFURCATION OCT06- 0201 LINEAR CRANIECTOMY 0050 IMPL CRT PACEMAKER SYS 0202 ELEVATE SKULL FX FRAGMNT 0051 IMPL CRT DEFIBRILLAT SYS 0203 SKULL FLAP FORMATION 0052 IMP/REP LEAD LF VEN SYS 0204 BONE GRAFT TO SKULL 0053 IMP/REP CRT PACEMAKR GEN 0205 SKULL PLATE INSERTION 0054 IMP/REP CRT DEFIB GENAT 0206 CRANIAL OSTEOPLASTY NEC 0056 INS/REP IMPL SENSOR LEAD OCT06- 0207 SKULL PLATE REMOVAL 0057 IMP/REP SUBCUE CARD DEV OCT06- 0211 SIMPLE SUTURE OF DURA 0061 PERC ANGIO PRECEREB VES (OCT 04) 0212 BRAIN MENINGE REPAIR NEC 0062 PERC ANGIO INTRACRAN VES (OCT 04) 0213 MENINGE VESSEL LIGATION 0066 PTCA OR CORONARY ATHER OCT05- 0214 CHOROID PLEXECTOMY 0070 REV HIP REPL-ACETAB/FEM OCT05- 022 VENTRICULOSTOMY 0071 REV HIP REPL-ACETAB COMP OCT05- 0231 VENTRICL SHUNT-HEAD/NECK 0072 REV HIP REPL-FEM COMP OCT05- 0232 VENTRI SHUNT-CIRCULA SYS 0073 REV HIP REPL-LINER/HEAD OCT05- 0233 VENTRICL SHUNT-THORAX 0074 HIP REPL SURF-METAL/POLY OCT05- 0234 VENTRICL SHUNT-ABDOMEN 0075 HIP REP SURF-METAL/METAL OCT05- 0235 VENTRI SHUNT-UNINARY SYS 0076 HIP REP SURF-CERMC/CERMC OCT05- 0239 OTHER VENTRICULAR SHUNT 0077 HIP REPL SURF-CERMC/POLY OCT06- 0242 REPLACE VENTRICLE SHUNT 0080 REV KNEE REPLACEMT-TOTAL OCT05- 0243 REMOVE VENTRICLE SHUNT 0081 REV KNEE REPL-TIBIA COMP OCT05- 0291 LYSIS CORTICAL ADHESION 0082 REV KNEE REPL-FEMUR COMP OCT05- 0292 BRAIN REPAIR 0083 REV KNEE REPLACE-PATELLA OCT05- 0293 IMPLANT BRAIN STIMULATOR 0084 REV KNEE REPL-TIBIA LIN OCT05- 0294 INSERT/REPLAC SKULL TONG 0085 RESRF HIPTOTAL-ACET/FEM
    [Show full text]
  • DIGESTIVE DISEASE CENTER University Hospital of Brooklyn • Long Island College Hospital • SUNY Downstate Bay Ridge
    SUNY DowNState MeDical ceNter DIGESTIVE DISEASE CENTER University Hospital of Brooklyn • long island college Hospital • SUNY Downstate Bay ridge 2012-13 comPreHensiVe Gi serVices GENERAL ADVANCED ENDOSCOPY The Digestive Disease Center at SUNY Downstate GASTROENTEROLOGY Endoscopy allows for direct internal examination and much more accurate diagnosis and treatment of digestive and liver Medical Center provides expertise in all aspects of problems, without invasive surgical procedures. At our state-of-the-art Endoscopy Center, patients have access to virtually gastrointestinal disease management, including: In addition to routine colorectal screenings, we provide every available endoscopic, manometric and treatment option—plus some investigational diagnostic and therapeutic diagnoses and treatment for a wide range of medical procedures not available elsewhere. Medical Director Frank Gress is one of the pioneers of endoscopic ultrasound and General Gastroenterology problems related to the stomach, intestinal tract, biliary literally wrote a textbook on the procedure. tract, gallbladder, bowel and liver, including: Colorectal Cancer Screening Full range of advanced diagnostic and therapeutic endoscopic services: I Colon polyps and colon cancer Advanced Endoscopy I Endoscopic retrograde cholangiopancreatography (ERCP). I Constipation I Sphincter of Oddi manometry (SOD). Pancreaticobiliary Disease I GI bleeding I Endoscopic ultrasound with fine-needle aspiration (EUS FNA). Esophageal and Motility Disorders I Hemorrhoids I I Colonic stents, esophageal stents, small bowel stents and other stent placement Inflammatory Bowel Disease Irritable bowel syndrome for palliative purposes. I Hepatitis & Other Liver Diseases Chronic diarrheal disorder I Small bowel enteroscopy to evaluate gastrointestinal bleeding. I Peptic ulcer disease Pediatric Gastroenterology I Video capsule endoscopy. I Rectal incontinence I Gastrointestinal Radiology EMR, BARRx and photodynamic therapy.
    [Show full text]
  • IQI 24 Incidental Appendectomy in the Elderly Rate
    AHRQ QI, Inpatient Quality Indicators #24, Technical Specifications, Incidental Appendectomy in the Elderly Rate www.qualityindicators.ahrq.gov Incidental Appendectomy in the Elderly Rate Inpatient Quality Indicators #24 Technical Specifications Provider-Level Indicator Procedure Utilization Indicator AHRQ Quality Indicators, Version 4.4, March 2012 Numerator Number of incidental appendectomies (procedures) among cases meeting the inclusion and exclusion rules for the denominator. ICD-9-CM Incidental appendectomy procedure codes1,2: 4382 LAP VERTICAL GASTRECTOMY 4711 LAP INCID APPENDECTOMY 471 INCIDENTAL APPENDECTOMY 4719 OTHER INCID APPENDECTOMY 1 Bolded codes are new to the current fiscal year. 2 Italicized codes are not active in the current fiscal year. Denominator All discharges, age 65 years and older, with ICD-9-CM codes for abdominal and pelvic surgery. ICD-9-CM Abdominal and pelvic surgery procedure codes1: 1711 LAP DIR ING HERN-GRAFT 4342 LOCAL GASTR EXCISION NEC 1712 LAP INDIR ING HERN-GRAFT 4349 LOCAL GASTR DESTRUCT NEC 1713 LAP ING HERN-GRAFT NOS 435 PROXIMAL GASTRECTOMY 1721 LAP BIL DIR ING HRN-GRFT 436 DISTAL GASTRECTOMY 1722 LAP BI INDIR ING HRN-GRF 437 PART GASTREC W JEJ ANAST 1723 LAP BI DR/IND ING HRN-GR 4381 PART GAST W JEJ TRANSPOS 1724 LAP BIL ING HERN-GRF NOS 4389 OPN/OTH PART GASTRECTOMY 412 SPLENOTOMY 4391 TOT GAST W INTES INTERPO 4133 OPEN SPLEEN BIOPSY 4399 TOTAL GASTRECTOMY NEC 4141 SPLENIC CYST MARSUPIAL 4400 VAGOTOMY NOS 4142 EXC SPLENIC LESION/TISS 4401 TRUNCAL VAGOTOMY 4143 PARTIAL SPLENECTOMY 4402 HIGHLY
    [Show full text]