Esophagogastroduodenoscopy (EGD) or Endoscopy

An EGD or endoscopy is a test that allows your doctor to see inside the esophagus (ee-SOFF-a-gus), the tube that carries swallowed food to the stomach; the stomach; and the first part of the duodenum (dew-oh-DEEN-um), the beginning of the small intestine. It is used to look for swelling, irritation, ulcers and bleeding that can’t be seen in other tests, such as X-rays. With the endoscope, your doctor also can check for infection and possibly see the cause of swelling or irritation.

• A high-quality video chip works as a camera to send pictures through a soft, bendable tube called an endoscope (END-o-scope). 
• As the endoscope is ­gently passed through the mouth and down through the esophagus, the picture is shown on a small TV screen that allows the doctor to see changes in the esophagus, stomach and upper intestine.

In order to make this test as comfortable as possible for your child, most EGD tests are done with anesthesia (an-es-THEEZ-ya), medicine that will allow your child to sleep through the test. Your doctor will tell you whether you child will have a sedation (se-DAY-shun) anesthesia or general anesthesia for this test. 

Most EGD tests are done while your child is under general anesthesia, meaning that he or she will be sound asleep during the test.

• A pediatric anesthesiologist—a doctor who specializes in anesthesia for children—will give the medications that will make your child sleep during the test. 
• Under general anesthesia, your child will not feel any pain or have any memory of the test.

Occasionally, the EGD may be done while your child is under sedation, meaning that your child will be given medication to make him or her very drowsy and relaxed during the test. Although your child will not be fully asleep, he or she probably will not even remember the test afterwards. If your child receives sedation, the doctor doing your child’s test will give the sedation medication. 

Home Preparation

When sedation or general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the test. One business day before your child’s test, you will receive a phone call from a nurse between the hours of 1 and 9 p.m. (Nurses do not make these calls on weekends or holidays.) Please have paper and a pen ready to write down these important instructions.

• The nurse will give you specific eating and drinking instructions for your child based on your child’s age. Following are the usual instructions given for eating and drinking. No matter what age your child is, you should follow the specific instructions given to you on the phone by the nurse.

For children older than 12 months:

• After midnight the night before the test, do not give any solid food or non-clear liquids. That includes milk, formula, juices with pulp, chewing gum or candy.

For infants under 12 months:

• Up to 6 hours before the scheduled arrival time, formula-fed babies may be given formula. 
• Up to 4 hours before the scheduled arrival time, breastfed babies may nurse.

For all children:

• Up to 2 hours before the scheduled arrival time, give only clear liquids. Clear liquids include water, PedialyteTM, Kool-Aid® and juices you can see through, such as apple or white grape juice.
• In the 2 hours before scheduled arrival time, give nothing to eat or drink. 

Once your child has been registered for the test, a member of the anesthesia staff will meet with you to take your child’s vital signs, weight and medical history. As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given.

• The anesthesiologist will meet with you and your child to review your child’s medical information and decide which kind of sleep medication your child should be given. 
• If your child is very scared or upset, the doctor may give a special medication to help him or her relax. This medication is flavored and takes effect in 10 to 15 minutes. 
• If you wish, you may go with your child to the room where the test will be done and stay as the sleep medication is given. When your child has fallen asleep, you will be taken to the waiting room.
• Younger children will get their sleep medication through a mask that will carry air mixed with medication. Your child may choose a favorite scent to flavor the air flowing through the mask. There are no shots or needles used while your child is still awake. 
• Older children may choose between getting their medication through the mask or directly into a vein through an intravenous (IV) line. 
• When your child has fallen asleep, you will be taken to the waiting room. If it has not already been done, an IV will be started so that medication can be given to keep your child sleeping throughout the test. While your child is asleep, his or her heart rate, blood pressure, temperature and blood oxygen level will be checked continuously.
• Your child may have a breathing tube placed while he or she is asleep. If a breathing tube is used, your child may have a sore throat after the test.
• To keep your child asleep during the test, he or she may be given anesthetic medication by mask, through the IV line or both. When the test is over, the medications will be stopped and your child will begin to wake up.

Once your child has been registered for the test, a nurse will meet with you to take your child’s vital signs, weight and medical ­history. As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given.

• Your child’s doctor will decide which type of sedation medication is right for your child, depending on your child’s age, medical history and the type of test being done. 
• Sedation medication may be given by mouth, through the nose, into the rectum, or directly into a vein through an intravenous (IV) line. There are no inhaled medications given. 
• You may stay with your child until he or she is very drowsy. You will be taken to the waiting room when the test is ready to begin.
• During the test, your child’s heart rate, blood pressure, ­temperature and blood oxygen level will be checked ­continuously. 

We welcome your help and support during this test. One of the most important roles of a parent or guardian is to help your child stay calm and relaxed before and after the test. The easiest way to help your child stay calm is for you to stay calm. 

Your child’s EGD will be scheduled either at UPMC Children's Hospital of Pittsburgh or at Children’s North in Wexford. Your child’s doctor will decide which facility is most appropriate for your child’s test, depending on the type of anesthesia that has been chosen for your child. The location of your child’s test will be confirmed by a phone call from the scheduling nurse.

• Once your child is sedated or asleep, the endoscope will be passed through the mouth, down the esophagus, into the stomach and, finally, the first part of the duodenum. 
• Each area is looked at by the doctor, and pictures are taken for your child’s records. You will get a copy of the pictures. 
• The doctor may take very tiny samples of tissue from each area. 
• Tissue samples will be sent to a laboratory and looked at under a microscope to check for infections or other changes in the tissue that were not seen with the endoscope. 
• The test takes about 20 to 45 minutes. 

• When the test is done, you will be called to the room to be with your child as the medications wear off. The length of time it will take the medications to wear off will vary, as some ­children take longer than ­others to become alert.
• Children coming out of anesthesia may react in different ways. Your child might cry, be fussy or confused, be sick to his or her stomach, or vomit. These reactions are normal and will go away as the anesthesia wears off. 
• When your child is discharged, he or she may still be groggy and should take it easy for the day.  

When the test is done, your doctor will speak with you in the surgical family waiting room. You can join your child in the recovery room when he or she is awake.

• Your child might have a sore throat and stomach gas for several days.
• Your child may seem tired after the test and the next day. 
• Your child should not participate in activities requiring balance or judgment, such as gymnastics, bicycling, or driving, for at least 24 hours, and then only if the effects of the anesthesia or sedation have worn off completely.
• Your child may resume normal activities, eating and drinking at the rate he or she is comfortable with when you get home. 
• Your child’s gastroenterology doctor will call you to discuss the results of the EGD, usually within several days.
• If your child develops a high fever, vomiting, or has visible red blood in his or her stool (bowel movement), please call 412-692-5180 for immediate attention. 

If your child has any special needs or health issues you feel the doctor performing the test needs to know about please call the gastroenterology procedure nurse at Children’s Hospital of Pittsburgh before the test at 412-692-5944. It is important to notify us in advance about any special needs.