Gastroscopy

Gastroscopy is a diagnostic procedure that helps evaluate a variety of symptoms, including persistent epigastric pain, nausea, vomiting, or trouble swallowing, as well as find and treat the cause of upper GI bleeding. Gastroscopy is also a more accurate study than fluoroscopic methods for detecting changes in the mucous membrane of the esophagus, stomach and duodenum, characteristic of inflammation, erosion, ulcers, oncological or other processes. A specialist may perform an upper endoscopy to perform a biopsy (obtaining samples of soft tissue) in the differential diagnosis of benign and malignant neoplasms, as well as to diagnose celiac disease or test for Helicobacter pylori, a bacterium that causes recurrent gastroduodenitis, gastric ulcer or duodenal ulcer. Gastroscopy is also used for medical purposes, to stop bleeding, remove polyps, or apply topical drugs.

How to prepare for the procedure

Preparation for the procedure has specific features, since the procedure is carried out strictly on an empty stomach, because the food eaten will prevent you from seeing all the changes in the mucosa. Therefore, it is recommended not to eat, drink or smoke at least 6 hours before the procedure.

Если все же есть необходимость употребить воду, например, для запивания лекарств, которые жизненного нужны пациенту, то их можно принять, запив небольшими глотками воды, но необходимо сообщить об этом врачу, проводящему исследование. В связи с тем, что процедура проводится натощак, пациентам назначают обследование в первой половине дня.

Patients with asthma are allowed to use an inhaler if indicated. Smokers are advised not to smoke at least 6 hours before the procedure.

Очень важно сообщить врачу за 5 дней до проведения гастроскопии о любых лекарствах, которые пациент принимает, поскольку может потребоваться корректировка дозы, или даже полное прекращение приема определенных лекарств, таких как препараты железа, антациды, антисекреторные и разжижающие кровь препараты. Нужно обсудить с врачом любые аллергии на лекарства, а также сопутствующие заболевания, такие как болезни сердца или легких.

Diet before gastroscopy

On the eve of endoscopy, the diet should be as light as possible throughout the previous day, in the evening a light dinner in the form of stewed vegetables with boiled chicken or fish. In this case, the portion is supposed to be no more than 350 grams. Further, the fasting regime for 12 hours before the study, since during this time the stomach has time to fully digest and evacuate the food eaten.

The volume of liquid drunk on an empty stomach should not exceed 300 ml, its larger amount can cause vomiting during the introduction of the endoscope; only water is allowed to drink, as other liquids can cause the production of hydrochloric acid.

Under these conditions, the gastroscopy procedure will be successful and informative.

Indications for gastroscopy

During gastroscopy, the doctor visualizes the mucous membrane of the upper gastrointestinal tract, including the esophagus. The gastroscopy procedure is safe and effective and in many cases replaces the use of fluoroscopy to detect any abnormalities in the duodenum, stomach, or esophagus.

Through the gastroscope, the doctor can take samples of the mucous membrane for examination and obtain video images using a video sensor installed at the end of the gastroscope. The study can be videotaped and used for subsequent diagnostic comparison.

Patients are often scheduled for a gastroscopic examination because of dyspepsia symptoms, which can usually be treated with medication. Sometimes the cause of dyspepsia is a peptic ulcer, and it is now known that many ulcers are caused by a bacterial infection in the stomach. Biopsy – taking a small section of the mucous membrane with subsequent histological examination and is performed during gastroscopy to determine the presence of an infectious agent or other anomaly. In a very small number of patients with dyspepsia, a biopsy can diagnose upper GI malignancies or conditions that precede malignancy, which is very important for therapeutic and diagnostic purposes. Further research may be planned to ensure the most effective treatment.

Gastroscopy will help:

1. to identify changes in the upper gastrointestinal tract, in particular inflammation of the esophagus (esophagitis) or stomach (gastritis), gastroesophageal reflux disease (GERD), narrowing (stricture) of the esophagus, varicose veins in the esophagus, Barrett’s esophagus, which can significantly increase risk of developing esophageal cancer, hiatal hernia, ulcer, cancer;
2. find the cause of bloody vomiting or hemoptysis;
3. determine the cause of symptoms such as abdominal pain or bloating, trouble swallowing (dysphagia), vomiting, or unexplained weight loss
4. найти причину инфекции;
5. control the healing of ulcers during therapy;
6. view the inside of the stomach and upper small intestine (duodenum) after surgery.

Gastroscopy may also be performed in the following cases:

1. to detect trauma to the esophagus in an emergency (for example, with a chemical burn);
2. for biopsy of tissue samples that need to be subjected to histological examination;
3. to remove polyps from the small intestine, stomach, esophagus;
4. to treat upper GI bleeding, which can cause anemia;
5. для удаления проглоченных инородных предметов.

Седация и анестезия

Before the gastroscopy procedure, the patient’s throat is treated with lidocaine in order to reduce pain and other negative effects that occur during the introduction of the endoscope. At the request of the client, gastroduodenoscopy of the stomach is performed under anesthesia. In this case, intravenous anesthesia is performed, which causes relaxation and light sleep. Patients wake up within an hour, but the effects of the drugs last longer, so it is not safe to drive until the next day. General anesthesia for medical reasons is provided only in special cases (in young children and when planning very complex procedures).

Types of gastroscopy

Modern endoscopes in the lower part of the handle are equipped with an instrument channel through which, if necessary, at any time you can pass an instrument for biopsy, treatment or other manipulation. These replacement tools include:

• flexible forceps, which are used to grasp a tissue sample;
• биопсийные щипцы для удаления образца ткани или подозрительного образования;
• a cytology brush, which is used to take cell samples;
• suture removal forceps.

Endoscopy can be not only a diagnostic procedure, but also a therapeutic one, it can be used to carry out:

1. surgical laparoscopic surgery, performing only small incisions on the skin;
2. laser endoscopic therapy using laser radiation delivered from the laser device to the site of exposure through the light guide, which is passed through the working channel of the device ^[1];
3. microwave ablation, which uses hyperthermic technologies of interstitial thermal ablation of tumors for their destruction and subsequent necrosis;
4. surgical endoscopic resection of the mucosa;
5. photodynamic therapy, in which, after an injection of a photosensitive drug into the tissues, the destruction of the tumor is performed using a laser;
6. administration of medications.

Трансназальная гастроскопия

Трансназальная гастроскопия выполняется через нос и гораздо легче переносится, чем традиционный метод, потому что интраназальный путь введения не вызывает рвотного рефлекса. Этот метод в основном используется у пожилых пациентов с комплексом сопутствующих заболеваний. Пациенты могут говорить, если это необходимо во время процедуры. Это означает, что меньшее количество пациентов нуждается в седации они могут продолжать свою повседневную деятельность после процедуры.

Capsular gastroscopy

Capsule gastroscopy is a procedure that uses a tiny wireless video camera mounted inside a small capsule that the patient swallows. During the passage of the capsule through the digestive tract, the video camera captures an image at a frequency of 2 frames per second and transfers it to an external medium, after which the doctor views and analyzes the images using a special program. This method is performed without swallowing the probe, as in traditional gastroscopy. The procedure is considered completed after the capsule leaves the body naturally. This method does not completely replace endoscopic gastroscopy, since many of its functions are inaccessible to the capsule, for example, it is impossible to control the movement of the capsule, therefore, once in the stomach, it can take a picture of only part of one of the walls of the stomach, by which it will not be possible to judge its condition. . With capsule endoscopy, the large intestine is not straightened, and the capsule moves uncontrollably along the large intestine, which is large enough to view, the images that it transmits from this part of the intestine are completely uninformative and cannot be analyzed by the doctor. Capsule endoscopy is only for examining the small intestine.

Гастроскопия и колоноскопия в один день

Эффективность гастроскопии и колоноскопии в течение одного дня имеет много потенциальных преимуществ, так как это может снизить затраты, сократить пребывание в больнице и ускорить уход за пациентами. Общими показаниями к данным методам эндоскопии являются скрытые или явные желудочно-кишечные кровотечения, наличие в анамнезе соответствующей патологии (полипы, язвы), неуточненные боли в животе и анемия, диарея или другие симптомы, радиологические исследования. Практика гастроскопии и колоноскопии в один день диагностически более информативна, процедуры могут выполняться даже у пациентов пожилого возраста и не несет повышенных рисков, поэтому предлагается при наличии показаний.

Выполнение процедуры гастроскопии

Перед проведением гастроскопии ротовая полость и горло анестезируются с помощью аэрозоля. Перед процедурой необходимо удалить все съемные протезы. Пациенту может потребоваться седативное средство. Время проведения гастроскопии около 5-10 минут, может быть больше, в зависимости от цели данной процедуры. Обычно процедуру проводят в положении лежа на левом боку, в некоторых исключительных случаях гастроскопию проводят стоя. Между зубами помещается небольшая трубка или защитное кольцо, вследствии этого рот остается открытым, пациента просят сделать глоток, чтобы гастроскоп мог войти в пищевод, а затем его медленно продвигают в желудок и вниз ко входу в двенадцатиперстную кишку.

Using video images, the doctor controls the progress of the probe and visualizes the area under study. When gastroscopy on the monitor, bleeding, varicose veins, unusually narrow passages and stomach ulcers are detected. If necessary, a tissue sample is taken for subsequent histological examination, which is not painful for the patient.

Побочные эффекты и осложнения гастроскопии

Most gastroscopy is carried out without any problems and complications, it is rarely possible to develop moderate inflammation of the pharyngeal mucosa during the day.

The patient may feel tired or sleepy for several hours if a sedative was used during the procedure. There is a slightly increased risk of developing an upper respiratory tract infection or pneumonia after gastroscopy.

Damage to the duodenal mucosa is possible, followed by bleeding, infection, and, very rarely, a hole (perforation). If any of the following symptoms develop within 48 hours after gastroscopy, you should immediately consult a doctor:

• pain after the procedure in the abdomen (in particular, if the pain gradually increases and differs in intensity from any “normal” pain in the stomach);
• повышенная температура (лихорадка);
• labored breathing;
• vomiting blood.

A small number of people have reported a heart attack or stroke during or shortly after gastroscopy. It tends to occur in older people with underlying heart or lung problems.

An allergic reaction to the anesthetic is possible, but according to the rules, this is negotiated before the procedure.

Гастроскопия у детей

У детей данный метод эндоскопического исследования выполняется, в целом, точно так же, как и у взрослых. Очень важным моментом является психологическая подготовка ребенка к процедуре, нужно объяснить, что будет происходить с ним, и чего бояться не стоит. Как и взрослому, ребенку нельзя есть и пить перед процедурой. У детей гастроскопия проводится с использованием местного анестетика, или внутривенной анестезии.

Gastroscopy is a safe and effective way to examine a child’s digestive system, but each procedure has its own risks and possible complications. Children may develop complications after anesthesia, and perforation of the stomach, small intestine, or esophagus has been reported very rarely.

Если во время гастроскопии делалась биопсия, возможно возникновение кровотечения, которое само останавливается. Также у детей может возникать смещение, или повреждение сменных зубов, если согласно возраста такие у него имеются, поэтому очень важно сообщить об этом врачу перед процедурой.

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