Procedure: EGD with Biopsy
Indications: A 60 year-old male presents with severe epigastric pain with
radiation to the back. An abdominal ultrasound shows a normal gallbladder
without stones and normal gallbladder wall thickness. An abdominal computed
tomographic scan reveals a markedly dilated pancreatic duct at 1 cm in diameter
and a normal biliary tree. An ERCP reveals an enlarged ampulla of Vater with a
markedly dilated opening and mucin in the orifice. Pancreatoscopy is performed
to evaluate a presumed intraductal papillary mucinous neoplasms.
Procedure: After informed consent is obtained, the patient is brought to the
therapeutic endoscopy suite. Sedation is administered intravenously, and the
duodenoscope is introduced through the mouth with inspection of the esophagus,
stomach and duodenum. Selective cannulation of the bile duct is obtained
followed by multiple views of the cholangiogram under fluoroscopy. A guidewire
is passed such that the tip is in the proximal biliary tree, and a standard biliary
sphincterotomy is performed.
The cholangioscope is passed through the duodenoscope and into the biliary
tree. Direct visualization is performed with careful inspection of the biliary and
pancreatic epithelium. The mass lesion is identified and multiple biopsies are
taken. The right and left intrahepatic biliary tree, common hepatic duct and
common bile duct are all viewed. The cholangioscope is then withdrawn and
then passed into the pancreatic duct. At the conclusion of the procedure, the
cholangioscope is withdrawn and the physician proceeds with the remainder of
the ERCP procedure. The ERCP procedure is completed and the patient is
moved to the recovery room in good condition.

I coded 52353rt,52353rt,52310-59
DX codes 592.1,590.80