Duodenoscopy

Under duodenoscopy (from the Latin duodenum – duodenum and Greek skopeo – research) in modern medicine is understood the technique of endoscopic superficial examination of the duodenum (its mucous membrane), the head of the pancreas and the choledochus (common bile duct). This procedure can pursue both diagnostic and therapeutic tasks. It gives an idea of ​​the morphological and functional changes of the above organs. With its help, you can remove calculi or stones from the intestinal lumens or lumens of the common bile duct, stop intestinal bleeding, install stents.

The possibility of duodenoscopy appeared after the creation of special devices equipped with fiberglass optics. Duodenoscopy is performed using an endoscope, which is a flexible rubber hose with a small tip-video camera and a lamp. The image read by the endoscope is transmitted by the camera to the screen of a personal computer connected to the device. For the first time, successful duodenoscopy became known in 1958.

Indications and contraindications for the procedure

Duodenoscopy can be prescribed to patients for diagnostic purposes by internists, gastroenterologists, oncologists or surgeons. Duodenoscopy is carried out in private or public medical institutions in endoscopic diagnostic rooms, equipped with the necessary equipment and having qualified specialists.

The indication for this study may be erosive or hemorrhagic duodenitis, various neoplasms in the intestines (benign and malignant), obstructive jaundice, gastric or duodenal ulcers, acute and chronic intestinal bleeding, diverse pains in the abdomen with unclear etiology, suspicion of the presence of parasites.

It is also important to remember that during duodenoscopy, some diagnostic manipulations can be performed, for example, taking a mucosal sample for histology, monitoring the passage of bile or cystic reflex, monitoring the processes of secretion of pancreatic juices, catheterization of the duodenal papilla and subsequent radiopaque examination of the ducts.

Also during duodenoscopy is possible:

• remove foreign bodies from the duodenum;
• produce electrocoagulation;
• perform polypectomy, sphincterotomy.

Sometimes a diagnostic procedure can be used for postoperative therapeutic purposes to remove ligatures, cannulate, and flush the common bile duct.

Among the main contraindications for the use of the duodenoscopy technique, doctors call acute disorders of cardiac or cerebral blood flow, aortic aneurysm, severe cardiopulmonary failure, hypertension, blood clotting disorders (hemorrhagic syndrome), severe mental disorders and diseases (for example, schizophrenia), varicose veins. veins of the esophagus.

A temporary reason for canceling the duodenoscopy procedure may be hypertensive crises, a general deterioration in well-being, exacerbated somatic diseases, acute diseases in the oral cavity, nasopharynx and respiratory tract.

Duodenoscopy technique

On the eve of the duodenoscopy procedure, the patient is not required to comply with any special norms of behavior. 6 hours before the proposed procedure, it is necessary to stop eating, and 2-3 hours – fluid intake to facilitate the passage of the probe and ensure the purity of the resulting biomaterial.

This procedure is performed by a specialist lying on the left side of the patient. Sometimes, during the procedure for a thorough revision of the major papilla in the duodenum or its biopsy, the patient is placed on the right side or abdomen. The patient’s mouth and pharynx are treated with a local anesthetic prior to insertion into the equipment in order to reduce vomiting and organ sensitivity. The doctor can insert a thin hose (endoscope) through the patient’s mouth or nasal passage to the level of the stomach through the esophagus, and then, under visual observation from the camera, advance it to the duodenum, which is to be examined. During this advance, it is important for the doctor to constantly monitor the movement of the endoscope in order to examine the condition of the mucous membranes of the stomach, esophagus and duodenum. The duration of duodenoscopy takes no more than 10 minutes, after which the endoscope is carefully removed.

Side effects, complications and study results

After the end of the study using an endoscope, the patient may feel discomfort in the stomach area as a side effect, this may be pain or discomfort, as well as mild nausea. Vomiting after a competent duodenoscopy will not be observed. All such symptoms pass quite quickly without the use of any special drugs. To weaken the manifestations of side effects after duodenoscopy, food intake is undesirable for some time.

Duodenoscopy is a procedure for examining patients, in which there are practically no complications during the procedure. Sometimes, with very sharp advances of the endoscope inside the esophagus, it is possible to injure the mucous membranes of the internal organs, as well as the occurrence of bleeding during perforation of the digestive tract wall. More often, complications caused by the duodenoscopy procedure are associated with anesthetic, therapeutic or diagnostic manipulations during this period.

After the procedure, the specialist who was involved in the diagnosis gives the patient a written opinion with a full description of the results of the examination and the manipulations performed. These results of duodenoscopy must be provided to the attending physician to clarify the diagnosis, monitor the dynamics of the course of the disease and adjust therapeutic measures aimed at eliminating the disease.

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