What are the pre-procedure instructions for a patient undergoing an Esophagogastroduodenoscopy (EGD) tomorrow?

Pre-Procedure Instructions for Esophagogastroduodenoscopy (EGD)

For patients undergoing an EGD tomorrow, you should fast from all food and liquids for at least 6-8 hours before the procedure, and follow specific medication management instructions based on your anticoagulation status. 1

General Preparation Instructions

• Fast from all food and liquids for at least 6-8 hours prior to the procedure to ensure an empty stomach for optimal visualization and safety 2, 3
• Remove all removable dental work (dentures, partial plates) before the procedure 4
• Arrange for someone to drive you home after the procedure if sedation will be used 3

Medication Management

Antiplatelet Medications

• For diagnostic EGD (low-risk procedure):

  • Continue aspirin and P2Y12 receptor antagonists (e.g., clopidogrel, prasugrel, ticagrelor) as these do not need to be discontinued 1

• For therapeutic EGD (high-risk procedure):

  • Continue aspirin if you're taking it for secondary prevention 1
  • Discontinue P2Y12 receptor antagonists (e.g., clopidogrel) 5-7 days before the procedure if you're at low thrombotic risk 1
  • If you're at high thrombotic risk (recent coronary stent placement), continue aspirin and consult with your cardiologist about P2Y12 receptor antagonists 1

Anticoagulant Medications

• For diagnostic EGD (low-risk procedure):

  • If on warfarin: Continue your regular dose, but ensure your INR is within therapeutic range 1
  • If on direct oral anticoagulants (DOACs): Omit the morning dose on the day of the procedure 1

• For therapeutic EGD (high-risk procedure):

  • If on warfarin with low thrombotic risk: Discontinue 5 days before the procedure and ensure INR is <1.5 1
  • If on warfarin with high thrombotic risk: Temporarily discontinue and substitute with low molecular weight heparin (LMWH) 1
  • If on DOACs: Take your last dose at least 48-72 hours before the procedure 1
  • For patients on dabigatran with reduced kidney function (CrCl 30-50 mL/min): Take last dose 72 hours before the procedure 1

Risk Assessment

• Diagnostic EGD is considered a low-risk procedure for bleeding 1
• Therapeutic interventions during EGD (such as dilation, polypectomy, therapy of varices, or stenting) are considered high-risk procedures 1
• Be aware that there is an increased risk of post-procedure bleeding if you are on anticoagulants compared to patients not on these medications 1

Special Considerations

• If you have a mechanical heart valve, atrial fibrillation with valvular disease, or other high thrombotic risk conditions, specific bridging anticoagulation may be required 1
• For patients with rapidly deteriorating kidney function who are on DOACs, consultation with a hematologist is recommended 1
• If you're unsure about your medication management, contact your healthcare provider immediately for clarification 5

Post-Procedure Expectations

• Antiplatelet or anticoagulant therapy that was discontinued should typically be resumed 1-3 days after the procedure, depending on bleeding and thrombotic risks 1, 6
• Contact your doctor immediately if you experience any signs of bleeding after the procedure 7, 3