Gastrointestinal Endoscopy deals with the endoscopic examination, therapy or surgery of the gastrointestinal tract. Gastrointestinal Tract generally refers to the digestive structures stretching from the mouth to anus, but does not include the accessory glandular organs such as liver, billary tract, panceras. The gastrointestinal tract is categorized into various sections, these include:
(Source: MeSH Database)
Currently, the most commonly used imaging methods for detection of gastrointestinal disorders, including disorders of the small intestine, are
endoscopy and radiological imaging.
A traditional endoscope is a device consisting of a flexible tube and an optical system. There are several types of endoscopic procedures used to
identify disorders in the gastrointestinal tract. The basic endoscopic procedures available include:
Gastrointestinal endoscopy is undergoing major improvements, which are driven by new available technologies and substantial refinements of optical features. Detection, characterization and confirmation are essential steps required for proper endoscopic diagnosis. Optical and nonoptical methods can help to improve each step; these improvements are likely to increase the detection rate of neoplasias and reduce unnecessary endoscopic treatments. Furthermore, functional and molecular imaging are emerging as new diagnostic tools that could provide an opportunity for personalized medicine, in which endoscopy will define disease outcome or predict the response to targeted therapy.
Several new technologies are now available for each step, some of them include:
Source: Kalorama, Company website, Company SEC filings
The three main areas where GI Endoscopy has considerable applications are Colon/Rectum cancer, Obesity (gastric bypass/gastric banding) and Digestive system disorders.
Tumors or cancer of the colon or the rectum or both. Colorectal cancer starts in the large intestine (colon) or the rectum (end of the colon). Risk factors for colorectal cancer include chronic ulcerative colitis; familial polyposis coli; exposure to asbestos; and irradiation of the cervix uteri. (MeSH) Colorectal cancer is the third most commonly diagnosed cancer in the world, but it is more common in developed countries.
Stages of colon cancer are:
(For more information on colon cancer click here)
(Source: Colorectal cancer association of Canada & American cancer society)
The estimated incidence rate of colorectal cancer in 2007 is expressed geography wise below:
Area | Incidence per 100,000 people |
North America | 17-33.5 |
Europe | 17-33.6 |
Asia | 17-33.7 |
South America | 17-33.4 |
Africa | 3.2-17 |
Source: Kalorama Information Report
The two most common weight-loss surgeries are:
Diseases in any part of the gastrointestinal tract or the accessory organs (liver; biliary tract; pancreas). The digestive system disorders are categorized as:
NOTE: All values for USA and Europe are in 000's. Data includes both in-patient and out-patient surgical procedures in all populations
CPT Code | Procedure | 2008 National Average Medicare Payment Facility |
43250 | Upper GI endoscopy including esophagus, stomach and either duodenum and/or jejunum as appropriate; with removal of tumors, polyps, or other lesions by hot biopsy forceps or bipolar cautery | $172.91 |
43251 | Upper GI endoscopy including esophagus, stomach and either duodenum and/or jejunum as appropriate; with removal of tumors, polyps, or other lesions by snare technique | $199.58 |
43255 | Upper GI endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; diagnostic, with control of bleeding any method | $258.99 |
43256 | Upper GI endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with transendoscopic stent placement (includes predilation) | $233.09 |
43258 | Upper GI endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with ablation of tumors, polyps, or other lesions not amendable by hot biopsy forceps, bipolar cautery or snare technique | $244.14 |
45383 | Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesions(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique | $307.36 |
45384 | Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery | $248.33 |
45385 | Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique | $281.84 |
91110 | Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), esophagus through ileum, with physician interpretation and report (Visualization of the colon is not reported separately) | $944.18 |
APC | APC Description (Hospital Outpatient Dept) | Medicare Payment |
130 | Level I Laparoscopy (CPT 43659) | $2,190.81 |
135 | Level III Skin Repair (CPT 43887) | $288.30 |
137 | Level V Skin Repair (CPT 43886, 43888) | $1,287.06 |
141 | Level I Upper GI Procedure (CPT 43999) | $541.59 |
CPT Code | Procedure | 2008 National Average Medicare Payment Facility |
43886 | Gastric reconstructive procedure, open; revision of subcutaneous port component only | $836.59 |
43888 | Removal and replacement of subcutaneous port component only | $836.59 |
43644 | Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (Roux limb 150 cm or less) | $1,507.10 |
43645 | Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption | $1,615.27 |
43659 | Unlisted laparoscopy procedure, stomach (Removal and replacement of both adjustable gastric band and subcutaneous port component) | Carrier Priced |
43770 | Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components)(use modifier - 52 for individual component placement) | $970.08 |
43771 | Laparoscopy, surgical, gastric restrictive procedure; Revision of adjustable gastric band component only | $1,107.95 |
43772 | Laparoscopy, surgical, gastric restrictive procedure; Removal of adjustable gastric band component only | $833.72 |
43773 | Laparoscopy, surgical, gastric restrictive procedure; Removal and placement of adjustable gastric band component only | $1,107.95 |
43774 | Laparoscopy, surgical, gastric restrictive procedure: Removal of adjustable gastric band and subcutaneous port components | $838.29 |
43842 | Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical banded gastroplasty | $1,071.01 |
43843 | Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical banded gastroplasty | $1,097.67 |
43845 | Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy (50 to 100 cm common channel) to limit absorption (billopancreatic diversion with duodenal switch) | $1,716.20 |
43846 | Gastric restrictive procedure, with gastric bypass, for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy | $1,416.07 |
43847 | Gastric restrictive procedure, with small intestine reconstruction to limit absorption | $1,553.19 |
43848 | Revision of gastric restrictive procedure for morbid obesity (separate procedure), other than adjustable gastric band | $1,680.40 |
43886 | Gastric reconstructive procedure, open; revision of subcutaneous port component only | $287.18 |
43887 | Removal of subcutaneous port component only | $272.32 |
43888 | Removal and replacement of subcutaneous port component only | $387.34 |
43999 | Unlisted procedure, stomach | Carrier Priced |
S2083 | Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline | Carrier Priced |
Areas | Companies Involved |
Enhanced Imaging Modalities | Olympus Medical System Corp. |
Pentax Crop. (Hoya Corporation) | |
Fujinon | |
Mauna Kea Technologies | |
KARL STORZ | |
SpectraScience Inc. | |
Robotic-Assisted Endomicroscope | EndoControl Inc. |
Wireless Biosensors and Polymers for GI bleeding (Hemostasis) | Pluromed Inc. |
Electronic Nose "Smells" Disease | Cyrano Science Inc. |