How to fill out the protocol of the EGDS examination of the stomach. Efgds: what is it? Esophagogastroduodenoscopy - what is it

Esophagogastroduodenoscopy (EGDS) - a detailed examination of the mucous membrane of the esophagus, stomach and duodenum is carried out using a special gastroscope probe, to which a lamp and a video camera are attached.

With the help of equipment it is possible:

take high quality pictures;
zoom in, remove the image;
do a test for bacteria, the cause of the ulcer duodenum and stomach;
identify inflammation of the mucous membranes at the initial stage;
do a biopsy without causing discomfort;
avoid surgical intervention if any items are swallowed;
remove polyps;
perform a visual inspection of the mucous membrane of the digestive system.

Esophagogastroscopy helps to study in detail the cause of the disease and begin to fight in the near future. This diagnostic procedure has a short name gastroscopy, sometimes called esophagoduodenoscopy.

Gastroscopy shows the peculiarities of the work of the mucous membrane of the digestive organs and reveals changes in organs abdominal cavity. The endoscopist examines the peculiarities of the gastrointestinal tract. Through research, doctors are able to diagnose the slightest change and prevent the development of more serious diseases. After all, a violation of the functioning of the mucous membrane of even one organ leads to a disruption in the work of other digestive organs, to a decrease in efficiency.

During the examination by the EGDS method, diagnoses are studied:

esophagitis (inflammation) of the mucous membrane of the esophagus;
ulcerative lesions of the gastrointestinal tract;
the presence of neoplasms;
enlargement of the veins of the esophagus;
gastritis;
hernia of the esophagus;
achalasia of the cardia, when the upper and lower sphincter does not function properly;
inflammation of the diverticula;
duodeno-gastric reflux (DGR);
Barrett's syndrome;
mucous colitis;
acute pancreatitis.

Methodology for the EGDS procedure

It is carried out as follows:

The procedure to reduce discomfort and gag reflex includes the use of painkillers. Held under the general local anesthesia. This simplifies the examination, the patient does not feel discomfort and does not interfere with the procedure. Anesthesia is prescribed when, in addition to the examination, it is necessary to undergo additional long-term procedures. It is important to take into account the presence allergic reactions in patients on the elements that make up anesthesia. Anesthesia is administered by an anesthesiologist, who is called upon to correctly select the drug and the amount administered. If there are risks associated with the use of anesthetic drugs, the procedure is prohibited.
The patient lies on the left side, a mouthpiece is inserted into the mouth so that the lips do not compress during the procedure.
The endoscopist smoothly inserts the gastroscope and proceeds to examine first the esophagus, then the stomach and its antrum, and lastly the duodenum.
Air is supplied through special equipment to straighten the folds, which makes it easier to inspect.

To reduce the patient's pain, deep respiratory movements. The procedure takes 3 minutes. After esophagogastroduodenoscopy, it is possible discomfort in the throat.

At the end of the study, in the absence negative consequences and biopsies, food is taken after two hours. If complications arise during the procedure, the patient will be given medication and you need to lie down until the condition improves.

Classification of fibrogastroduodenoscopy

The research method of fibrogastroduodenoscopy is divided into areas:

Planned treatment and diagnostics.
Emergency procedure.

Planned treatment includes diagnostics to determine the disease of the gastrointestinal tract.

An emergency procedure includes the removal of foreign bodies from the stomach and abdominal cavity, diagnosis for acute pain.

Factors to be considered for the study

For the study take into account:

mucous membrane of the stomach, intestines;
the presence of erosion, inflammation;
the presence of neoplasms and taking a sample for histological microexamination;
reduced passage of food through the esophagus;
study of ulcerative lesions of the stomach, intestines.

Possible complications after gastroscopy

EGDS is performed by a competent specialist. Otherwise, this leads to deterioration: to microtrauma of the mucosa, to malfunctions vascular system, lungs, to increase pressure.

If food is present in the stomach during the procedure, it will enter the lungs, leading to asphyxia or pneumonia.

Preparation for the study of EGDS

To undergo EFGDS, you need to prepare in advance. The examination is carried out on an empty stomach early in the morning, the last meal is no later than 9 pm. The esophagus, stomach, and duodenum must be empty for examination. The last dinner should not contain dairy products and carbonated drinks, you can not take medications and refrain from smoking, it is recommended to take a sedative medicine. Before the procedure, remove glasses and all accessories from the neck.

During the procedure, do not worry, the anesthetic will muffle the discomfort. If preparation for EGDS study performed according to the requirements, the procedure is smooth and painless.

If the preparation is prescribed for the purpose of checking for the presence of oncological diseases, EGDS is combined with a biopsy, material is taken for histological examination. During the procedure, the patient does not experience discomfort.

Take with you:

clean diaper;
change of shoes;
referral to the procedure;
medical card.

It is necessary to warn the patient in advance to come with an escort if help is needed.

Indications and contraindications for the procedure of esophagogastroduodenoscopy

Various doctors offer to undergo an EFGDS examination, but you should not go through it without the need, the procedure is not pleasant. Basically, the problems associated with the stomach and intestines are solved by a gastroenterologist.

Indications for esophagogastroduodenoscopy (EFGDS):

loss of appetite;
nausea and vomiting;
feeling of heaviness, pain and swelling of the abdominal cavity;
difficulty in swallowing;
suspicion of oncological diseases;
control of rehabilitation and recovery.

Contraindications to EFGDS

severe mental disorder;
recent infectious diseases;
angina;
attacks of bronchial asthma;
circulatory disorders.

Deciphering the results of gastroscopy

To decipher the results of the survey, you need to decide what the indicators are in the norm, and make a comparative analysis. For each digestive organ, norms are established.

Indicators of the norm of the digestive system healthy person:

The mucous membrane of the esophagus. Pay attention to color and texture. In a healthy person, the color of the esophagus should be pink or red, and the composition of the structure should be fine-fibered, the length of the esophagus should be 25-30 centimeters.
Stomach. It has a brighter color than the esophagus, usually red. One side of the stomach is smooth, a small amount of mucus is allowed. The other side has a folded appearance.
The mucosa of the duodenum. This is a small tube, with a circumference of up to 3.5 centimeters. Sheath color is light pink. There is one fold, two ducts - bile and pancreatic. The channels are connected to gallbladder and with the pancreatic gland.

Indicators of the organs of the stomach, intestines with pathology

Indicators cause concern if found during the examination.

With gastritis, the mucous membrane of the stomach swells, pinpoint hemorrhages or erosions, a significant amount of mucous substance and an increase in the number of folds on the membrane are found.
With a stomach ulcer, the study immediately reveals ulcerative formations, their shape and color characteristics. Ulcers usually have the form of a convex roller, the bottom of the ulcer contains a white coating.
In the presence of a tumor or cancer of the stomach, longitudinal folding is observed, the color of the mucous membrane becomes white or gray. During the study, if there are neoplasms, they are immediately visible, even small ones up to 1 mm.

It is important to realize that the decoding of the results of gastroscopy is done by a qualified specialist in order to avoid making mistakes. There are many pathological changes seen only by the attending physician.

Advantages of EGDS in comparison with other methods of examination of the gastrointestinal tract

Esophagogastroduodenofibroscopy is one of the effective methods for examining the esophagus, the lining of the stomach and duodenum. There are other methods for examining the mucous membrane, but the difference between them is significant, since they have limited capabilities.

Advantages of gastroscopy:

diagnostics of education at the initial stage;
take pictures and watch videos at the same time;
combine two procedures at the same time: diagnostics and taking material for a biopsy;
identifies difficult-to-diagnose diseases.

Gastroscopy is intended for every person who wants to check the state of health, as this equipment is available in many clinics. This study is also carried out for therapeutic and prophylactic purposes. This method can reveal the most serious illnesses on the early stages development.

Esophagogastroduodenoscopy is one of the modern effective methods for examining the mucous membranes of the upper sections. digestive system person. This diagnostic method allows to identify diseases of the stomach, esophagus, duodenum of various nature. Let's see what it's based on EGDS method how to prepare for the study, and how to interpret the results.

The essence of esophagogastroduodenoscopy

The study can be both planned, recommended in advance by a doctor, and emergency. It is performed using a fiberscope - a flexible probe with a small lamp attached and a video camera.

The main advantage of EGDS over conventional x-ray examination, which was common earlier, is the ability to identify inflammatory processes of the mucous membranes, forming or already scarring ulcers several times more accurately.

If preparation of endoscopy appointed in connection with a suspected oncological disease of the stomach or esophagus, during the procedure, a specialist can also do a biopsy - tissue sampling for subsequent analysis. The biopsy does not cause additional discomfort to the patient.

Also, during the procedure, the doctor has the opportunity to remove polyps, accidentally swallowed small objects, blood clots after bleeding, etc. This makes it possible to exclude abdominal surgery.

Indications for EGDS

The study is performed to determine the nature of such symptoms:

loss of appetite;
unexplained weight loss;
chest pain;
pain in the upper part of the stomach;
a feeling of acidity or bitterness in the mouth;
belching;
chronic heartburn;
a quick feeling of fullness in the stomach;
bad breath that is not associated with poor dental health;
causeless vomiting;
diarrhea with black contents;
problems with swallowing food;
violations of the passage of food through the esophagus;
regurgitation of ingested food;
chronic cough;
chronic bowel disease.

Contraindications for carrying out

Esophagogastroduodenoscopy is prohibited in such situations:

serious condition of the patient;
myocardial infarction;
postinfarction state;
infectious and acute surgical diseases;
manifestations of atherosclerosis;
abnormal narrowing of the esophagus;
heart failure;
hemophilia;
varicose veins of the esophagus;
mental disorders.

The procedure is performed only by specially trained endoscopists who have been trained in gastroscopy.

How to prepare for EGDS of the stomach

It is impossible to start the study without special preparation. Improper preparation or its absence can lead to the fact that the results of the procedure will be incorrect and the doctor will not be able to make a correct diagnosis and prescribe the correct treatment.

The main condition for esophagogastroduodenoscopy is the absence of food mass in the stomach and duodenum. That is why the patient must refuse to eat at least 9-12 hours before the procedure.

If the procedure is scheduled for the morning (or the first half of the day), the evening before dinner should take place no later than 20-00. It is advisable to eat only light, quickly digestible food. Boiled egg whites, slimy porridges on the water, chicken broth cooked on the breast are well suited.

You should give up salty, sweet, fatty, pickled, spicy foods, pastries, fast food, flour, citrus fruits, fresh apples, etc. It is unacceptable to drink alcohol and smoke.

In the morning before the procedure, the patient is strictly prohibited from:

there is;
drink;
chew gum;
smoke;
brush your teeth.

If esophagogastroduodenoscopy is scheduled for the afternoon (although this is extremely rare), the patient is allowed a small light breakfast no later than eight o'clock in the morning. The menu is best discussed with the doctor who deals specifically with your treatment.

Also, before EGDS, it is unacceptable to use various medications that prevent blood clotting. This applies not only to oral preparations, but also to those administered intramuscularly, intravenously, subcutaneously, etc.

What to take for the procedure

You need to take with you to the clinic:

a clean sheet or diaper;
shoe covers;
towel;
referral to EGDS;
previous analysis of esophagogastroduodenoscopy (if any);
outpatient card.

Immediately before the EGDS, you need to remove jewelry from the neck, tie, neckerchief, glasses. If the patient has dentures or removable dentures, they should also be removed for a while.

How is EGDS performed?

The research methodology itself is as follows:

For the effectiveness of the procedure and to reduce discomfort, the patient is treated with a pharynx with a local anesthetic spray. Subsequently, for greater relaxation, the patient may be given an additional anesthetic intravenously;
The subject lies on the couch on the left side. In the teeth, he clamps the mouthpiece to prevent uncontrolled clutching of the teeth during the examination;
The doctor gently inserts the fiberscope into the esophagus, then into the stomach and duodenum. Air is introduced through the device in order to straighten the lumen of the organs and thereby facilitate inspection;
The specialist alternately examines the mucous membrane of the esophagus, then the stomach and duodenum.

During the examination, the patient feels vomiting, salivation increases, and belching may occur. Preparation for EGDS is also important in order to exclude vomiting during the procedure.

To reduce discomfort during the examination, the patient is advised to take deep breaths and exhalations.

The duration of this procedure is only 1-3 minutes.

An incorrectly performed EGDS procedure can lead to complications. However, this is quite rare. To possible complications include mechanical injuries of the gastric mucosa and / or esophagus.

There may also be complications from the respiratory and cardiovascular systems. The risk group includes the elderly, as well as patients with lung pathology, heart failure or stenosis.

If food was present in the patient's stomach before esophagogastroduodenoscopy, during the procedure it can get into Airways, and this, in turn, is fraught with asphyxia or subsequent pneumonia.

After the study, a person feels pain or a burning sensation in the larynx. Less commonly, patients experience pain in the stomach. As a rule, these unpleasant symptoms disappear on their own a day after the study.

The patient can drink and eat food after a few hours, but it should be as sparing as possible.

Deciphering the results of esophagogastroduodenoscopy

Analysis of the study is done by a gastroenterologist. Usually, during the procedure itself, the research process is displayed on a computer or TV monitor and recorded. If necessary (at the request of the patient), the data can be printed. This is done in order to be able to take the pictures for reading to another specialist or to conduct a medical consultation.

With the help of data obtained on EGDS, the following problems can be identified:

hiatal hernia;
bulk benign or malignant formations(polyps, cancer, papillomas);
the presence of scars, narrowing, strictures of the stomach, esophagus;
obstruction of the esophagus and / or stomach;
protrusion of the muscular walls;
gastritis, peptic ulcer;
gastroesophageal and duodenogastric reflux;
pathological changes in the mucous membrane (erosion, inflammation, ulcers, hypertrophy, atrophy, etc.).

Perform a comparative analysis, focusing on the norms of indicators in the study.

EGDS of the stomach is a diagnostic method that can be used to examine the entire gastrointestinal tract. The second name of this examination is gastroscopy, it is carried out using a probe equipped with a miniature camera.

To date, esophagogastroduodenoscopy is the most effective method diagnostics. It helps to detect the presence of an inflammatory process, the formation of a tumor or erosion. Previously, in order to conduct such an examination, conventional probes were used, which caused a lot of inconvenience and pain to the patient. However, today the diameter of the inserted instrument has significantly decreased in size, making the procedure completely painless.

Indications for EGDS

Absolutely any doctor can refer a patient to gastroscopy, but the main specialists are: a gastroenterologist, a therapist, an oncologist and a surgeon. There are many reasons for performing an EGDS, but since the procedure is extremely unpleasant, they are sent to it only in case of urgent need.

The main indications in which the patient is recommended to conduct esophagogastroduodenoscopy are:

pain in the area chest during a meal;
anemia and weight loss for no apparent reason;
persistent bitter taste in the mouth;
diarrhea;
the presence of a foreign body in the stomach.

In addition, the patient is sent for endoscopy and with such signs as:

severe pain in the abdomen;
frequent or persistent vomiting, nausea, heartburn, acid regurgitation;
a feeling of heaviness in the abdomen, not only after eating, but also in a state of absolute rest;
flatulence.

Oncologists refer the patient to gastroscopy in case of suspicion of cancer of the esophagus or stomach, as well as in order to check for metastases. Gastroenterologist prescribes EGDS in case of peptic ulcer stomach or duodenum, in order to prevent after treatment.

In order for the diagnosis to be more accurate, it is recommended to take a number of additional tests, namely blood, urine and feces, undergo a sound examination and do a test for the presence of the bacterium Helicobacter Pillory.

Existing contraindications

As with any other examination, there are a number of reasons why gastroscopy should not be performed. Contraindications for EGDS include:

varicose veins veins on the walls of the esophagus;
atherosclerosis;
acute heart failure or recent myocardial infarction;
elevated arterial pressure;
swelling or narrowing of the esophagus;
any infectious diseases, hemangiomas.

In addition, gastroscopy is prohibited for patients with mental disabilities due to the fact that it is not known how the patient can behave during the procedure.

Preparation for the examination

Proper preparation for EGDS plays a very important role, because it depends not only on how successfully and accurately the examination will be carried out, but also how the patient will feel during the procedure. To prepare for EGDS, it is necessary not to eat foods that promote gas formation within 12 hours before the start of the procedure, and also not to consume sour-milk and dairy products. It is advisable to use something light during dinner - this is broth, boiled fish or meat, weak tea or jelly.

Do not forget that meat and fish should only be lean varieties. It is advisable to give up alcohol, spicy, salty and fried foods three days before the procedure. On the day of the manipulation, it is necessary to completely exclude food intake. You can drink some water, but no later than 4 hours before the procedure. The procedure is usually scheduled for the first half of the day, but if the EGDS is carried out in the afternoon, then you can have breakfast 8-9 hours before it starts. At the same time, do not forget that you need to take only light food.

The use of drugs that can affect the acidity, enzymes and contraction of the muscles of the intestines and stomach is strictly prohibited. Preparation also includes giving up cigarettes until the examination. Before going to bed, you can take some kind of mild sedative, but only with the permission of a doctor. If there is an allergy to drugs, then it is necessary to warn a specialist about this.

An hour or two before the procedure, you can not take any medications, except for those on which the patient's life depends. If the doctor allows, you can drink a sedative. This completes the preparation for the EGDS.

Directly during the procedure, the patient should try to relax as much as possible and not worry. Before the procedure, the patient is given local anesthesia - lidocaine, which will help smooth out the discomfort and reduce the gag reflex. It is advisable to breathe deeply during the procedure, but a little less than usual.

Before manipulation, the doctor must be informed of factors such as pregnancy, diabetes, stomach surgery. It is best to wear loose, not easily soiled clothes for the procedure, do not use belts. In order to bring yourself back to normal after the examination, you need to bring wet wipes or a towel.

Stages of examination

Before starting the procedure, the patient should lie on his left side. In order to reduce the discomfort that occurs when the probe is inserted, the patient's throat is treated with lidocaine. Modern gastroscopes are very thin, so they can be inserted both through the mouth and through the nose without fear of harming the patient's health, and thanks to a miniature camera at the end of the gastroscope, everything that happens is immediately displayed on the monitor screen.

During the procedure, the doctor carefully examines the patient's gastrointestinal tract, all changes are immediately recorded on video or photo. If necessary, a piece of tissue is removed for a biopsy. During the extraction of tissue for analysis, the patient may experience pain, but this procedure lasts a maximum of 2 minutes, and therefore does not require additional preparation.

In the presence of a foreign body, it is immediately removed by suction, but if the object is large, then it is pulled out with forceps. If polyps are found, they can be removed immediately. After the examination, the gastroscope should be removed as slowly as possible, while the patient should exhale deeply and hold his breath for a while. The entire EGDS procedure can take between 20 and 45 minutes in total.

Discomfort from the EGDS procedure can be minimized, provided that the preparation was carried out on the basis of all the requirements of the doctor, and in addition, so that the patient does not feel any inconvenience, it is recommended to contact highly qualified specialists.

How to behave after the examination

If the examination went according to plan, then there is no need to observe any special regimen. If there was no biopsy, then the patient can eat within 1-2 hours after the examination. The effect of lidocaine usually wears off after 1-2 hours, and with it the feeling of a lump in the throat disappears.

If, during the examination, the patient felt unwell, he began to feel sick, tachycardia began and blood pressure rose, the doctor will give the patient the necessary medicinal product and offer to spend some time in a horizontal position.

Possible Complications

The equipment used for esophagogastroduodenoscopy is equipped with new technologies, so that the risk of any complications is minimized. The only consequence that can occur is perforation of the gastric tissues, which requires surgery to eliminate. However, such complications occur extremely rarely, so you should not worry about this.

Gastroscopy(EGDS, FGDS) is a method of instrumental visualization of the mucous membrane of the esophagus and stomach using a flexible fibroesophagogastroscope. Esophagogastroscopy is indicated for dysphagia, signs of bleeding from the upper gastrointestinal tract, suspected polyps, cancer, ulcers of the stomach or esophagus. Anesthesiological support for gastroscopy is provided by premedication and local anesthesia pharynx or medication sleep. Endoscopy is accompanied by the sampling of material for the determination of acidity and Helicobacter, cytological, histochemical analysis. During therapeutic gastroscopy, strictures are dissected, polyps are removed, ulcers are treated, etc.

During diagnostic gastroscopy, an endoscopic biopsy is usually performed, which allows obtaining samples of altered tissues, followed by a morphological study of the biopsy. Chromoscopy of the esophagus and stomach, carried out as part of gastroscopy, expands the possibilities of detecting small mucosal defects, detailing their prevalence, boundaries and structural characteristics. In some cases, price gastroscopy includes pH determination and Helicobacter pylori.

Gastroscopy is performed using flexible esophagogastroscopes equipped with fiber optics. They are flexible, have clear imaging and recording capabilities, and are less likely to cause injury than their rigid counterparts. With gastroscopy, it is possible to identify various superficial changes that are inaccessible to detection using radiological methods(radiography of the stomach or esophagus). The use of endoscopes with ultrasound and Doppler sensors allows for endoscopic ultrasonography - to assess the degree of damage to the walls of hollow organs and regional lymph nodes.

Indications

to planned diagnostic indications gastroenterology refers to gastroscopy in patients with gastroesophageal reflux, dysphagia, retrosternal pain, nausea, dyspepsia, iron deficiency anemia, and weight loss. Gastroscopy is performed to clarify clinical or radiographic symptoms that are suspicious of cancer. Dynamic gastroscopy is recommended for atrophic gastritis, peptic ulcer, after gastric resection.

Emergency gastroscopy is indicated for emergency conditions: suspicion of foreign bodies esophagus or stomach, gastroduodenal bleeding, perforation of the esophageal tube or stomach wall. In addition to its diagnostic value, gastroscopy has a lot of therapeutic possibilities, allowing in some cases to perform endoscopic removal foreign bodies of the esophagus and stomach, ligation and sclerosis of varicose veins, dissection of cicatricial strictures, clipping and coagulation of bleeding vessels in gastroduodenal bleeding, removal of polyps and many others. others

Contraindications

Circumstances excluding gastroscopy are the presence of critical stenosis of the esophagus, which does not allow the introduction of an endoscope, chemical burns of the esophagus, phlegmonous esophagitis, mediastinitis, dissecting aortic aneurysm, hemorrhagic diathesis, acute periods of myocardial infarction or stroke, requiring rest. Among the relative contraindications to gastroscopy, severe spinal deformity, large goiter, severe cardiopulmonary insufficiency, mental disorders, hemophilia are distinguished.

Preparation for gastroscopy

To increase the information content, it is advisable to carry out the procedure on an empty stomach, 8-12 hours after the last meal and water. Before an emergency gastroscopy, a tube emptying of the stomach is performed. After radiopaque examination of the gastrointestinal tract (radiography of the stomach, esophagus, passage of barium along small intestine) the interval before performing gastroscopy should be 2-3 days.

Preparation for gastroscopy consists in the psychological mood of the patient (clarification of the objectives of the study and the rules of conduct), as well as medication (sedation, anesthesia, prevention of pathological reflux). In addition, before gastroscopy, an endoscopist consultation is appointed, who evaluates the indications and risks of the study and explains to the patient the features of the procedure.

Methodology

Before gastroscopy, the patient is given premedication and aerosol anesthesia of the oropharynx with lidocaine or xylocaine. In a number of clinics, during gastroscopy, short-term medical sleep is used. During gastroscopy, the patient lies on the left side. Through a mouthpiece clamped in the mouth, the endoscopist, under visual control, passes the endoscope into the pharynx, esophagus and further into the stomach. When passing the mouth of the esophagus to overcome the spasm of the sphincter of the pharynx, the patient is asked to make a swallowing movement.

To inspect the mucosa and straighten the folds, air is supplied in small portions to the stomach, mucus is sucked off and gastric juice. Starting from the subcardiac section, the internal surfaces of the walls of the stomach are sequentially examined, while the gastroscope is advanced forward, slightly removed outward, rotated around the axis. If necessary, during gastroscopy, an endoscopic biopsy is performed from various pathological areas, chromoscopy, pH-metry, and other studies and manipulations. When using additional diagnostic methods, the price of gastroscopy increases. After examining all parts of the stomach, the fibrogastroscope is removed. After gastroscopy, it is recommended to refrain from eating for 1.5-2 hours.

Interpretation of results

Normal gastroscopy visualizes the gastric mucosa of a pale pink or pink color. The anterior wall has a shiny smooth surface, contains some mucus, the mucosa of the posterior wall has a folded structure. The gatekeeper is cone-shaped, freely passable. With the contraction of the walls of the pylorus, the folds acquire a stellate appearance. With gastritis, edematous, hyperemic mucosa, submucosal hemorrhages, thickened folds, and an increased amount of mucus are visible. With atrophic gastritis, a pale color of the mucosa, smoothness and thinning of the folds are determined.

A sign of a stomach ulcer, determined during gastroscopy, is an ulcerative crater, limited on the sides by a roller. The bottom and edges of the crater are bright red, the surface is covered with mucous, fibrinous or purulent plaque. The ulcer after scarring has the appearance of a whitish spot. A malignant ulcer has irregularities, nodularity and tuberosity of the edges. With stomach cancer, the folds are smoothed out, the mucosa acquires a grayish-white color. With gastroscopy, a decaying or mushroom-shaped tumor of the stomach can be determined.

Complications

Complications of gastroscopy may be associated with anesthesia or research technique. In the first case, side effects usually occur as a result of intolerance to anesthetic drugs, aspiration of stomach contents, and severe concomitant background. These include allergies, anaphylaxis, aspiration pneumonia, respiratory and circulatory disorders.

Complications of technical gastroscopy are more often caused by rough, forced insertion of the endoscope or inappropriate behavior of the patient during the procedure. Forced introduction of a fibrogastroscope or anxiety of the patient during gastroscopy can lead to wounds in the pharynx, rupture of the esophagus in the thoracic or abdominal regions, and gastric perforation. With such complications, the patient needs an emergency surgical aid. With cracks and abrasions of the mucosa, conservative measures are taken: diet, rest, drug treatment of defects. In some cases, gastroscopy can cause bleeding.

The cost of gastroscopy in Moscow

AT last years gastroscopy is an extremely popular procedure. The study is widely used in the process of diagnosing and treating diseases of the stomach, and is performed in many private and public clinics in the capital. Diagnostic gastroscopy has the lowest cost. When carrying out therapeutic measures or taking tissue for histological examination, the price of gastroscopy in Moscow increases. The same thing happens when performing a procedure under anesthesia. Pricing takes into account the qualifications of the specialist, location and reputation medical organization availability of additional services.

Esophagogastroduodenoscopy (EGDS) allows you to examine the mucous membrane of the esophagus, stomach and proximal duodenum using a flexible fiber or video endoscope. It is indicated for gastrointestinal bleeding, bloody vomiting, tarry stools, chest pain or epigastric pain, reflux esophagitis, dysphagia, anemia, esophageal and gastric outlet strictures, gastric ulcer and duodenal ulcer; it is also performed to remove foreign bodies of the esophagus and stomach and in case of postoperative relapses of diseases of these organs. Endoscopy often eliminates the need for exploratory thoracotomy or laparotomy and reveals small or superficial lesions that cannot be seen on x-ray. In addition, EGDS, due to the possibility of performing a pinch and brush biopsy, makes it possible to clarify the nature of the lesion detected by X-ray examination. With the help of EGDS, it is also possible to remove foreign bodies, both small and soft by suction, and large and hard with the help of a coagulation loop and forceps.

Target

Diagnostics inflammatory diseases, malignant and benign tumors, peptic ulcer, Mallory-Weiss syndrome.
Assessment of the state of the stomach and duodenum after surgery.
Urgent diagnosis of peptic ulcer and damage to the esophagus (for example, with a chemical burn).

Training

The patient should be explained that EGDS will allow you to examine the mucous membrane of the esophagus, stomach and duodenum.
It should be found out if the patient is allergic to the drugs that are supposed to be used for anesthesia, what drugs he takes, clarify and detail his complaints.
The patient should refrain from eating for 6-12 hours before the study.
It is necessary to warn the patient that during the examination, an endoscope with a camera mounted at the end will be inserted through his mouth, and also to inform who and where the examination will be carried out and that it will last approximately 30 minutes.
When performing emergency EGDS, the patient should be warned about the need for aspiration through nasogastric tube stomach contents.
The patient should be warned that to suppress the gag reflex, the cavity of his mouth and pharynx will be treated with a solution local anesthetic, which has a bitter taste and creates a feeling of swelling of the pharynx and tongue; it is necessary that the patient does not interfere with the outflow of saliva, which, if necessary, is evacuated using an electric suction.
The patient should be explained that a mouthpiece will be inserted to protect the teeth and the endoscope, which, however, will not interfere with breathing.
Before the start of the study, an intravenous infusion system is set up through which sedative drugs are administered that cause relaxation. If the procedure is performed on an outpatient basis, then it is necessary for the patient to be accompanied home after it, since the introduction of a sedative drug will make him drowsy. In some cases, they resort to the introduction of sedatives that inhibit intestinal motility.
The patient is warned that he may experience a feeling of pressure in the abdomen during manipulation of the endoscope inserted into the stomach and a feeling of fullness when air or carbon dioxide is insufflated. Anxious patients are given intravenous meperidine or some analgesic 30 minutes before the study, and atropine is administered subcutaneously to suppress gastric secretion, which can make the study difficult.
It is necessary to ensure that the patient or his relatives give written consent to the study.
Before the examination, the patient must remove dentures, contact lenses and restrictive underwear.

Procedure and aftercare

The main physiological indicators of the patient are determined and a tonometer cuff is fixed on the shoulder to monitor blood pressure during the procedure.
In patients with heart disease, ECG monitoring is performed, and it is also advisable to perform pulse oximetry from time to time, especially in patients with respiratory failure.
When treating the oral cavity and pharynx with a local anesthetic spray, the patient, at the request of the doctor, must hold his breath.
The patient is reminded not to obstruct the flow of saliva from the corner of the mouth. A basin is installed next to the patient for spitting saliva and dropping napkins, if necessary, saliva is evacuated with an electric suction.

The patient is laid on his left side, his head is tilted forward and asked to open his mouth. The doctor passes the end of the endoscope through the mouth into the throat. When the endoscope passes the posterior pharyngeal wall and its inferior constrictor, the patient is asked to slightly straighten the neck, while the chin should not deviate from the midline. Then, under visual control, an endoscope is passed through the esophagus.

When the endoscope is inserted into the esophagus to a sufficient depth (30 cm), the patient's head is tilted to the table to drain saliva from the oral cavity. After examining the mucous membrane of the esophagus and cardiac sphincter, the endoscope is rotated clockwise and advanced further to examine the mucous membrane of the stomach and duodenum. To improve the view during the examination, you can insufflate air into the stomach and irrigate the mucous membrane with water and suck out the secret.

You can install a camera on the endoscope to take pictures, if necessary, measure the size of the changed area, insert a measuring tube.

By inserting biopsy forceps or a brush, it is possible to obtain material for histological or cytological examination. The endoscope is slowly removed, re-examining suspicious areas. The resulting tissue samples are immediately placed in a 10% formalin solution, smears are prepared from the cellular material and placed in a Coplin vessel containing 96% ethanol.

Warning. When monitoring a patient Special attention should be given to symptoms of perforation. When perforated cervical pain in the esophagus when swallowing and moving the head. Perforation thoracic the esophagus causes pain behind the sternum or in the epigastrium, aggravated by breathing and movements of the body; perforation of the diaphragm is manifested by pain and dyspnea; gastric perforation causes abdominal and back pain, cyanosis, fever, and fluid accumulation in the pleural cavity.

Be aware of the danger of aspiration of gastric contents, which can cause aspiration pneumonia.
It is necessary to periodically determine the main physiological indicators.
The appearance of a gag reflex is checked by touching the back wall of the pharynx with a spatula.
Eating and liquids can be allowed only after the restoration of the gag reflex (usually 1 hour after the study). You should start by drinking water, then light food.
The patient should be warned about the possibility of belching with insufflated air and sore throat for 3-4 hours. Throat tablets and gargling with warm 0.9% sodium chloride solution can alleviate sore throat.
If pain occurs at the point of connection of the dropper, warm compresses are prescribed.
Due to the administration of sedatives, patients should refrain from drinking alcohol for 24 hours and from driving a car for 12 hours. When performing the study on an outpatient basis, it is necessary to ensure that patients are taken home.
The patient should be warned that if there is difficulty in swallowing, pain, fever, tarry stools or bloody vomiting, he should immediately inform the doctor.

Precautionary measures

When taking tissue samples, they should be labeled immediately and sent to the laboratory.
EGDS regarding safe method studies, perforation of the esophagus, stomach or duodenum is sometimes possible, especially if the patient is restless or does not obey the doctor's instructions.
EGDS is generally contraindicated in patients with Zenker's diverticulum, large aortic aneurysm, recent ulcer perforation or suspected perforation of a hollow organ, as well as in unstable hemodynamics and severe violation breathing.
EGDS can be performed only 2 days after X-ray contrast examination of the gastrointestinal tract.
It is advisable for patients with carious teeth to administer antibiotics before the study.

Warning. Careful consideration should be given to possible side effects sedative drugs (respiratory depression, apnea, hypotension, sweating, bradycardia, laryngospasm). It is necessary to have at the ready equipment for resuscitation, as well as antagonists narcotic analgesics especially naloxone.

Normal picture

Normally, the mucous membrane of the esophagus has a yellowish-pink color and a delicate vascular network. The pulsation of its anterior wall at the level of 20.5-25.5 cm from the incisors is due to the proximity of the aortic arch. The mucous membrane of the esophagus at the level of the esophageal-gastric junction passes into the mucous membrane of the stomach, which has an orange color. The transition line has irregular shape. Unlike the esophagus, the gastric mucosa has a pronounced folded structure and the vascular network is not visible in it. The duodenal bulb is recognized by the reddish color of its mucous membrane and several low longitudinal folds. The distal duodenum has a velvety appearance and pronounced circular folds.

Deviation from the norm

EGDS in combination with histological and cytological examination allows the diagnosis of acute or chronic ulcers, benign or malignant tumors, inflammatory process(esophagitis, gastritis, duodenitis), as well as diverticula, varicose veins, Mallory-Weiss syndrome, esophageal rings, stenosis of the esophagus and pylorus, hiatal hernia. EGDS also reveals gross violations of esophageal motility, for example, with achalasia, but in this respect, manometry is a more accurate research method.

Factors affecting the result of the study

Patient taking anticoagulants (increased risk of bleeding).
Failure to comply with study requirements.
Late sending of tissue samples to the laboratory.
Lack of proper contact with the patient complicates the study.

B.H. Titova

"What is esophagogastroduodenoscopy" and others