Can a patient undergo Esophagogastroduodenoscopy (EGD) and dialysis on the same day?

Performing EGD and Dialysis on the Same Day

Yes, patients can safely undergo esophagogastroduodenoscopy (EGD) and dialysis on the same day, with dialysis optimally scheduled after the EGD procedure.

Timing Considerations

• When scheduling both procedures on the same day, EGD should ideally be performed first, with dialysis following afterward 1
• For patients already on dialysis, the regularly scheduled dialysis session should be maintained rather than rescheduling or adding additional sessions 1
• There is no evidence supporting the need for additional or more frequent dialysis sessions after EGD procedures 1

Safety Considerations for EGD

• EGD is generally safe with a low risk of complications (perforation rate of only 0.033%) 2
• The American Society of Anesthesiologists recommends that patients may consume clear liquids up to 2 hours before procedural sedation 1, 3
• Studies of patients undergoing both EGD and colonoscopy have demonstrated no excess gastric volumes when comparing split-dose bowel preparations and day-prior preparations 1
• In fact, residual gastric fluid volume has been shown to be significantly lower in patients using split-dose preparation compared to day-before preparation 1

Dialysis Scheduling Considerations

• For patients already on maintenance hemodialysis, it's important to maintain their regular dialysis schedule to avoid complications 4, 5
• Patients on thrice-weekly hemodialysis have higher rates of emergency department visits and hospitalizations after the 3-day interdialytic interval 4
• Time from last dialysis >48 hours is strongly associated with the need for urgent dialysis (OR: 9.22) 5
• Maintaining the regular dialysis schedule helps prevent complications related to extended intervals between dialysis sessions 4, 5

Special Considerations for Contrast Use During EGD

• If gadolinium-based contrast media (GBCM) is used during imaging associated with the EGD, no special dialysis scheduling is required 1
• For patients already on dialysis who receive GBCM, the contrast administration should optimally be timed before a regularly scheduled dialysis session 1
• If optimal timing is not feasible, dialysis should still be conducted at its regularly scheduled day and time 1
• Daily dialysis or multiple per-day dialysis sessions are not considered necessary after GBCM administration 1

Practical Approach to Same-Day Scheduling

1. Schedule the EGD procedure first in the day
2. Allow adequate recovery time from sedation (typically 2-4 hours)
3. Proceed with regularly scheduled dialysis afterward
4. For patients who are not yet on dialysis but have advanced kidney disease, the decision to initiate dialysis should not be based solely on the EGD procedure 6

Potential Complications to Monitor

• Monitor for signs of bleeding after EGD, especially if biopsies or interventions were performed 7
• Early, accurate EGD with appropriate therapeutic intervention is associated with improved outcomes for patients with upper GI hemorrhage 7
• Patients with cirrhosis and portal hypertension may require special consideration due to increased risk of variceal bleeding 1

By following these guidelines, both EGD and dialysis can be safely performed on the same day with minimal risk to the patient.