EGD (Esophagogastroduodenoscopy)What to Expect

 

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Judy J. Davis, M.D., F.A.A.P.

1095 E Warner Ave #102

Fresno, CA 93710

Phone (559) 412-8184 Fax (559) 438‑1174


ESOPHAGOGASTRODUODENOSCOPY


Esophagogastroduodenoscopy is the examination of the upper gastrointestinal tract, which includes the esophagus, stomach, and duodenum (the first part of the small intestine). A flexible tube attached to a powerful light source is passed into the mouth and guided through the esophagus, stomach and duodenum for direct observation of the lining of these areas. The endoscopist is a specially trained physician who uses esophagogastroduodenoscopy (EGD) to help diagnose inflammation, polyps, ulcers, esophagitis, cancer, causes of bleeding and pain, causes of abnormal or questionable x‑ray findings, to remove polyps (abnormal tissue mass), take biopsies of abnormal tissue (small samples of tissue are obtained by a forcep that goes through the endoscope), stop active or impending bleeding by an electric current or injection of a chemical into the tissue, or dilate narrowing (strictures), or put rubber bands or special chemicals around or in varices (dilated blood vessels).


PREPARATION FOR EGD:


Preparation for your child's procedure is individually based on age. Your child will receive a preparation specific for him or her. Please read the instructions at least two days before the procedure.


WHAT HAPPENS DURING THE EGD


*An IV will be started in your child's arm or hand. Cream will be put on the skin to decrease the amount of pain associated with the IV insertion. The child will most likely have the hand and arm placed on a board to help prevent dislodgment of the IV. If general anesthesia is used, your child will have an IV

placed after your child has been put to sleep with gas.

*Your child will be put in a gown and vital signs will be taken. Questions will be asked about the health of your child recently and whether or not the preparation for the endoscopy could be followed. Medication may be given through the IV, nose, or mouth to make your child sleepy and less anxious.           Your child won’t remember anything about the procedure.

*Your child then will be taken from the room that you are in, into the procedure room and the EGD will be done. The scope is inserted by the physician into the mouth and advanced through the esophagus, stomach and duodenum. If there are biopsies to be taken, polyps to be removed, strictures to be dilated, varices to be banded or active bleeding to be stopped, it will be done at this time.

*The procedure is very well tolerated with little or no discomfort. When the procedure is finished your child will go to the recovery room and rest until the sedation wears off. Your child's pulse, respirations, blood pressure and oxygen saturation will be monitored during and after the EGD. You can be with your child once the procedure is over and your child is stable. After the procedure your child can eat anything and do any activity that he or she feels like doing unless the doctor prescribes otherwise.



POSSIBLE COMPLICATIONS OF EGD


*EGD, with biopsy, polypectomy, dilatation, banding or other hemostatic techniques, is a safe procedure and is associated with very little risk.

*One possible complication is perforation, which is a tear through the wall of the gastrointestinal tract and may allow leakage of fluid and bacteria from the gastrointestinal tract into the chest or abdominal cavity, which can cause infection and pain. Perforation of the esophagus can also cause air to leak into the chest and breathing difficulties (i.e., pneumothorax). The complication of perforation usually requires surgery but sometimes can be managed with antibiotics and intravenous fluids and sometimes a chest tube is necessary.




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*Bleeding can occur from the site of a biopsy, polyp removal, dilation or failed hemostasis, (failure to stop bleeding). Bleeding is usually minor and stops on its own, but occasionally repeat EGD evaluation may be necessary and cauterization (application of electric current) or injection of a specialized fluid may be necessary to stop the bleeding. Rarely transfusion or surgery is required. Bright red blood in the child's emesis is fairly common within the first 24 hours of procedure. Also coffee ground material, if the child throws up, is common in the first 24 hours. If the stool is black or if there is bright red blood or clots in the stool, this is an abnormal complication and you should notify your doctor. Also if bright red blood clots are vomited, this is an unusual complication and your doctor should be notified.

*Local irritation of the vein may occur at the site of the medication injection but it usually subsides in 2‑3 days. Elevating the extremity and putting hot compresses on the affected area will be helpful. Tylenol or ibuprofen is often helpful for the discomfort.

*Other risks include drug reaction, i.e., slowing of the heart rate or respiratory rate or possible allergic reaction to the medication or depression of the blood pressure.

*Abdominal bloating or crampy abdominal pain due to the air injected into the gastrointestinal tract can occur and this subsides by the next morning. Again the use of Tylenol or ibuprofen and walking are good measures to alleviate this discomfort.

*Rarely a narrowing or stricture can be due to dilating a narrowed area or after varicele banding or injection of varices. Death is extremely rare, but remains a remote possibility.


TELL YOUR DOCTOR IF:


*Your child is allergic to medications.

*Your child takes any medications.

*Your child has any lung problems or a loose tooth.

*Your child is pregnant.


HOW LONG DOES THE PROCEDURE TAKE:


*EGD takes up to 30 minutes depending on whether other procedures are being done with it, i.e., stricture dilatation, banding or polyp removal etc.

*You need to arrive at least 1hour prior to the scheduled procedure in order to have the IV placed and your child sedated in time for the procedure.

*Recovery time after the procedure is between one and three hours. Usually it takes four hours from the time you enter the endoscopy unit to the time you leave.



SPECIAL NOTES


*Please advise your doctor before the procedure if your child becomes ill before the procedure, as it may need to be canceled for the safety of your child.

*Sometime the medications that are given for sedation can cause nausea and vomiting for the first 24 hours after the procedure.


RESULTS:


You will be given the results of the EGD after the procedure has been completed. Biopsy results usually take a week and the physician will call these to you when they are available.

If you have questions prior to the procedure please don't hesitate to call (559) 438‑8400.


Judy J. Davis, M.D., F.A.A.P.

Fellow American Academy of Pediatrics

Fellow Sub‑Board American Academy of Pediatric Gastroenterology

American Board of Nutrition

Clinical Professor, Department of Pediatrics, University of California, San Francisco

(revised 6/17)

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