Esophagogastroduodenoscopy (EGD)

Preop diagnosis

Esophageal foreign body, stricture, esophageal varices, enzymatic issues

Brush border enzymes

Digestive enzymes located in the membrane of the brush border (microvilli) on intestinal epithelial cells.

The brush border greatly increases the surface area available for the absorption of digested food.

The enzymes include:

• Aminopeptidases, which break down peptides into amino acids
• Maltase, which hydrolyses maltose into glucose
• Sucrase, which hydrolyses sucrose into glucose and fructose
• Lactase, which hydrolyses lactose into glucose and galactose

The products of these enzymes are then absorbed into the blood.

Procedures

EGD

Common in pediatrics, flexible, diagnostic

• Heavy sedation or GA

Rigid Esophagoscopy

Removal of a foreign body, dilation of esophageal stricture, or injection of varices

• Usually performed with ET intubation
• Risk of compression of trachea distal to the ETT

Radial balloon dilation

Less shear stress, performed under endoscopic and fluoroscopic guidance

Dilation is usually performed on patients with prior tracheoesophageal fistula (TEF) repair, prior ingestion of caustic substances, and those with skin and connective tissue diseases (Epidermolysis bullosa)

Preoperative Considerations

Position

Supine

Duration of surgery

5 min to 2 hrs

EBL

< 5 mL/kg

Morbidity

Risk of esophageal perforation 2-5%

Pain score

2-3

Complications

Esophageal perforation, aspiration, accidental extubation, stridor secondary to subglottic edema

Anesthesia considerations

Treat patients as a full stomach with a risk of aspiration

Evaluate airway, history, and previous size of ETT if applicable

If a TEF patient, consider congenital cardiac anomalies

IV access prior to foreign body removal is optimal

Hand on ETT throughout the procedure to prevent dislodgement of ETT