Informed Consent for Esophagogastroduodenoscopy(EGD)

EGD is a procedure in which your physician can look into your upper GI tract (esophagus, stomach, and duodenum) with an instrument about the size of your index finger.

The instrument is swallowed and goes down the same path as when you swallow a piece of food. A small amount of tissue (a biopsy) may be removed and sent to a pathologist for examination under a microscope.

The benefits of the procedure include the early diagnosis and assistance with treatment of diseases of the upper GI tract such as reflux disease, ulcers, and cancers.

There are risks to this procedure, although we believe that the potential benefits outweigh the risks.

1. Bleeding is very uncommon. With severe bleeding, a blood transfusion and/or surgery may be required.
2. Perforation (a small hole through the bowel wall) is rare, but if it occurs would require hospitalization and surgery.
3. EGD is the most accurate diagnostic test available for the detection of diseases of the upper GI tract, but no test can guarantee 100% accuracy and lesions can be missed in the course of this exam.
4. The medications that we give you to prevent pain and discomfort (Versed and Fentanyl), can cause adverse reactions such as severe allergic reactions, redness and swelling of the arm, suppression of breathing or cardiac arrhythmias.There is also no guarantee that you will be free from pain during the procedure.
5. Serious heart and lung abnormalities may also occur. Although rare, there is a remote risk of heart attack or stroke.

There are alternatives to EGD, including x-ray studies, but they do not allow the physician to biopsy abnormal areas, and they are not as accurate in detecting abnormalities. In the course of the procedure, pictures may be taken to document findings.

If you want more time to consider this procedure or have further questions, please ask us. Please be aware that delaying the procedure can subject you to a delay in the diagnosis of serious conditions.

HAVING READ AND UNDERSTOOD THE ABOVE, I FEEL THAT THE BENEFITS OF THIS PROCEDURE OUTWEIGH THE RISKS. I HAVE DISCUSSED THE RISKS, ALTERNATIVES, AND HAVE BEEN GIVEN AMPLE OPPORTUNITY TO ASK QUESTIONS.

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