# EGD w/clip placement and loop placement



## busydawnis (May 7, 2009)

I am having trouble coding an EGD with clip placement and loop placement in an effort to close an esophageal fistual.  Does anyone have any suggestions?
Thanks,


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## aguelfi (May 8, 2009)

can you post the report?


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## busydawnis (May 8, 2009)

*EGD w/ clip and loop placement for esoph fistula*

Here is the op report.

The endoscope was advanced through the orpharynx and the area of the anastomosis was well visualized.  It is improved significantly.  It is now probably now on the order of 3 to 4 millimeters across.  A series of Endoclips were placed on the edges. The granulation tissue around is exceptionally hard and it is difficult to get the clips to hold on.  Towards the center where the actual opening is, I placed single clips on each side and then pulled them together with the Endoloops.  Prior to doing this the tissue was abraded with a gold probe at 10 watts.  After completion, the area was injected with normal saline to develop enough edema to help push close the fistula as well.  The endoscope was removed from the patient.  

Monica


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