UPPER ENDOSCOPY PREP SHEET
Patient: _____________________________________________ Procedure Date: ______________________
Please check with your insurance company about preauthorization. The phone number will be located on the back of your
PHYSICIAN: Harsha Jayawardena, M.D. PLACE OF PROCEDURE: Franklin General Hospital Outpatient Surgery Dept. 641-456-5032 TIME OF PROCEDURE:
The surgery department will call you one or two days prior to your procedure with the time.
EGD – esophagogastroduodenoscopy is a test to examine the lining of the esophagus (the tube that connects your throat to your stomach), stomach, and first part of the small intestine. It is done with a small camera (flexible endoscope) that is inserted down the throat. PREPARATION INSTRUCTIONS FOUR DAYS BEFORE YOUR PROCEDURE: STOP
taking proton inhibitors such as Prilosec, Nexium, Prevacid, Protonix, etc. You may take Pepcid or Zantac, two tablets if needed.
TWO DAYS BEFORE YOUR PROCEDURE: STOP
taking blood thinners such as Aspirin, Coumadin, anti-inflamatory medications, etc. unless instructed by your physician.
NOTHING TO EAT OR DRINK INCLUDING CANDY AND GUM AFTER MIDNIGHT THE NIGHT BEFORE YOUR PROCEDURE. NO SMOKING. DAY OF PROCEDURE:
1. TAKE your heart, blood pressure and/or thyroid medications with a SIP of water. Do not take other medications unless
2. Please have a list of allergies and medications (prescription, over the counter, and herbs) with you. 3. A consent will be obtained and a needle (IV) will be inserted into a vein in your arm to give you medications during the
4. You will receive a sedative and a painkiller (analgesic). A local anesthetic may be sprayed into your mouth to prevent you from
coughing or gagging when the endoscope is inserted. A mouth guard will be inserted to protect your teeth and the endoscope. Dentures must be removed. You will be instructed to lie on your left side. After the sedatives have taken effect: a. The endoscope is inserted through the esophagus (food pipe) to the stomach and duodenum. Air is put into the endoscope to
b. The lining of the esophagus, stomach, and upper duodenum is examined. Biopsies can be taken through the endoscope.
Biopsies are tissue samples that are looked at under the microscope.
c. Different treatments may be done, such as stretching or widening a narrowed area of the esophagus. After the test is finished, you will not be able to have foods and liquids until your gag reflex returns (so you don’t choke). The test lasts about 5 – 20 minutes.
5. Because of the medications given, YOU MUST HAVE SOMEONE TO DRIVE YOU HOME. You may feel gas and/or the
sensation of fullness in your abdomen. You will not be able to feel the biopsy. Because of the sedation, you may not feel any discomfort and have no memory of the test.
If you have any questions regarding your procedure, please feel free to call Franklin General Hospital Surgery Dept (641)456-5032 or Mason City Clinic 1(800)622-1411 ext. 5260.
W:\AZ\FGH\Templates & Various Docs\Surgery forms\UPPER ENDOSCOPY PREP SHEET.doc Created on 04/25/2013 9:08:00 AM
Critical Value Table The University of Michigan Health System (UMHS) has established critical values for the following tests; this Critical Value policy is approved by the UMHS Executive Committee on Clinical Affairs. MLabs will notify the client by telephone of results that are less than the specified Lower Limit or greater than the specified Upper Limit, immediately upon verificat
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