Gastroscopy 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, ulcerative lesions of the stomach or esophagus. Anesthetic aid for gastroscopy is provided by premedication and local anesthesia of the pharynx or drug sleep. EGD is accompanied by the collection of material for the determination of acidity and helicobacter, cytological, histochemical analysis. During therapeutic gastroscopy, strictures are dissected, polyps are removed, ulcerative defects are treated, etc.
During diagnostic gastroscopy, an endoscopic biopsy is usually performed, which allows obtaining samples of altered tissues with subsequent morphological examination of the biopsy. Chromoscopy of the esophagus and stomach, performed as part of gastroscopy, expands the possibilities of detecting small mucosal defects, detailing their prevalence, boundaries and structural characteristics. In some cases, gastroscopy of the price includes the determination of pH and helicobacter.
Gastroscopy is performed using flexible esophagogastroscopes equipped with fiber optics. They are characterized by elasticity, clear visualization and image recording capabilities, and a lower risk of injury compared to their rigid counterparts. During gastroscopy, it is possible to detect various surface changes that are not detectable using radiological methods (stomach or esophageal radiography). 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.
Gastroenterology includes the presence of gastroesophageal reflux, dysphagia, retrosternal pain, nausea, dyspepsia, iron deficiency anemia, and weight loss in patients as planned diagnostic indications for gastroscopy. Gastroscopy is performed to clarify clinical or radiological symptoms suspected of cancer. Dynamic gastroscopy is recommended for atrophic gastritis, peptic ulcer disease, after gastric resection.
Emergency gastroscopy is indicated for urgent conditions: suspected foreign bodies of the esophagus or stomach, gastroduodenal bleeding, perforation of the esophageal tube or stomach wall. In addition to the diagnostic value, gastroscopy has a lot of therapeutic possibilities, allowing in some cases to perform endoscopic removal of 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, etc.
The circumstances precluding gastroscopy are the presence of critical esophageal stenosis that does not allow the introduction of an endoscope, chemical burns of the esophagus, phlegmonous esophagitis, mediastinitis, delaminating aortic aneurysm, hemorrhagic diathesis, acute periods of myocardial infarction or stroke that require rest. Among the relative contraindications to gastroscopy, there are pronounced spinal deformity, large goiter, severe cardiopulmonary insufficiency, mental disorders, hemophilia.
To increase the information content, it is advisable to carry out the procedure on an empty stomach, 8-12 hours after the last use of food and water. Before emergency gastroscopy, a probe emptying of the stomach is performed. After radiopaque examination of the gastrointestinal tract (radiography of the stomach, esophagus, passage of barium through the small intestine), the interval before performing gastroscopy should be 2-3 days.
Preparation consists in the psychological mood of the patient (clarification of the objectives of the study and the rules of conduct), as well as drug effects (sedation, anesthesia, prevention of pathological reflux). In addition, before gastroscopy, a consultation with an endoscopist is prescribed, who assesses the indications and risks of the study and explains to the patient the specifics of the procedure.
Methodology of conducting
Before gastroscopy, the patient undergoes premedication and aerosol anesthesia of the oropharynx with lidocaine or xylocaine. In a number of clinics, short-term drug sleep is used during gastroscopy. During gastroscopy, the patient lies on his left side. Through a mouthpiece clamped in the mouth, an endoscopist under visual control conducts an endoscope into the pharynx, esophagus and further into the stomach. When passing the mouth of the esophagus to overcome the spasm of the pharyngeal sphincter, the patient is asked to make a swallowing movement.
To inspect the mucosa and straighten the folds, air is supplied to the stomach in small portions, mucus and gastric juice are sucked out. Starting from the subcardial part, the internal surfaces of the stomach walls are examined sequentially, while the gastroscope is pushed forward, slightly removed outward, rotated around the axis. If necessary, endoscopic biopsy from various pathological sites, chromoscopy, pH-metry, other studies and manipulations are performed during gastroscopy. When using additional diagnostic techniques, 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
Normally, the gastric mucosa of pale pink or pink color is visualized during gastroscopy. The front wall has a shiny smooth surface, contains a little mucus, the mucosa of the back wall has a folded structure. The gatekeeper is cone-shaped, we pass freely. When the walls of the gatekeeper are reduced, the folds acquire a stellate appearance. With gastritis, edematous, hyperemic mucosa, submucosal hemorrhages, thickened folds, increased amount of mucus are visible. With atrophic gastritis, the pale color of the mucosa, smoothness and thinness of the folds are determined.
A sign of a stomach ulcer, determined by gastroscopy, is an ulcerative crater, bounded on the sides by a roller. The bottom and edges of the crater are bright red in color, the surface is covered with a mucous, fibrinous or purulent coating. The ulcer after scarring has the appearance of a whitish spot. A malignated ulcer has irregularities, nodularity and lumpiness of the edges. With stomach cancer, the folds are smoothed out, the mucosa acquires a grayish-white color. During gastroscopy, a decaying or mushroom-shaped tumor of the stomach can be determined.
Complications of gastroscopy may be associated with anesthesia or the technique of conducting the study. In the first case, side effects usually occur as a result of intolerance to anesthetic drugs, aspiration of stomach contents, severe concomitant background. These include allergies, anaphylaxis, aspiration pneumonia, respiratory and circulatory disorders.
Complications of gastroscopy of a technical order are more often caused by rough, forced introduction of an endoscope or inadequate behavior of the patient during the procedure. Forced introduction of a fibrogastroscope or anxiety of the patient during gastroscopy can lead to wounds of the pharynx, rupture of the esophagus in the thoracic or abdominal sections, perforation of the stomach. With such complications, the patient needs an emergency surgical aid. In case of cracks and abrasions of the mucous membrane, conservative measures are taken: diet, rest, medical treatment of defects. In some cases, gastroscopy can provoke bleeding.