Gluing/embolization of gastrostomy tract

kzelaz

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I have an interventional radiologist who was working in conjunction with a surgeon to close a gastrostomy by surgical adhesive & I can't find a code even near this. An unlisted code, perhaps? Any assistance appreciated!

Dictation:
Gastrostomy tract gluing/embolization
Procedure:
1. Removal of gastrostomy catheter
2. Gluing/embolization of gastrostomy tract
Clinical indication: Gastric leak status post distal pancreatectomy
and splenectomy, repaired. A percutaneous drainage catheter had been
placed by an outside institution to drain a collection posterior to
the stomach. Upon further evaluation, drainage catheter was noted to
be within the lumen of the stomach. Patient is here for coordinated
procedure between the surgeon who will perform an
endoscopic repair while the catheter is removed, and radiology is to
glue the tract from the stomach defect to the skin.

Procedure/Findings:
The patient was positively identified on the fluoroscopy table,
supine, already undergoing endoscopy by Dr. ----. Timeout was
performed.
Scout film of the left upper quadrant showed endoscope terminating
over the fundus of the stomach, percutaneous pigtail drainage catheter
which was within the lumen of the stomach, and a left pigtail chest tube.
Existing percutaneous pigtail drainage catheter acting as gastrostomy
and surrounding skin were prepped and draped in the usual sterile
fashion using all elements of maximal sterile barrier technique
including cap, mask, hand hygiene, sterile gloves, sterile gown, 2%
chlorhexidine skin preparation, and large adhesive sterile drape.
Local anesthesia was provided by administration of lidocaine 1%
solution.
The gastrostomy catheter was cut, and a guidewire advanced through the
catheter into the lumen of the stomach. Catheter was gently retracted
until satisfactory visualization of the wire at the defect in the
stomach was achieved by Dr. ---- endoscopically. Dr. ---- then
placed clips at the defect in the stomach around the wire. The
gastrostomy was then completely removed over the wire. A 4 French
angled catheter was advanced over the wire into the lumen of the
stomach, and the wire removed. Access to the stomach was confirmed by
small volume injection of iodinated contrast.
On the back table, a mixture of n-butyl cyanoacrylate and lipiodol was
mixed in a 1-5 ratio. 4 French catheter was flushed with D5. The
cyanoacrylate lipiodol mixture was gently injected under both
fluoroscopic and endoscopic guidance while retracting the catheter to
occlude the remaining defect in the stomach and the tract extending to
the skin.
Procedure was concluded. Sterile dressing was applied.
Complications: None immediate.
Impression: Successful coordinated procedure between surgery and
interventional radiology ending with removal of a percutaneous
gastrostomy, stapling of the gastric defect endoscopically, and
gluing/embolization of the stomach defect and the tract to the skin.

End dictation
 
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