EGD ( fibrogastroduodenoscopy , stomach EGD ) - Causes, Symptoms and Treatment .MF .
patient often feels an unreasonable fear at the thought that the doctor has ordered him to such research as the EGD.But the experience of doctors shows that the use of the diagnostic method can save a person's health and relieve him not only from serious complications of a disease of the stomach, but also from surgical interventions used to treat complications.
FEGDS (fibroezofagogastroduodenoskopiya) or abbreviated EGD (fibrogastroduodenoscopy) or even shorter FGS (fibrogastroscopy) or gastroscopy - this instrumental method survey, conducted with the help of endoscopic equipment used to diagnose diseases of the esophagus, stomach and duodenum.For his use of a thin gastric tube with a fiber-optic system, which is inserted through the mouth into the esophagus and stomach with a further examination by a doctor of internal organ walls.Inspection is carried out by means of the eyepiece on the external end of the gastroscope, and modern equipment also allows you to display an enlarged image on the TV screen
The picture presented gastroscope
EGD is the "gold standard" in the diagnosis of diseases of the esophagus and stomach.It may be administered for diagnostic or therapeutic purposes.The diagnostic value of the method is priceless, since it is possible to not only inspect the inside of the stomach wall for diseases, but also biopsy tissue, ie, the "pinch off a piece" of the affected tissue with subsequent microscopic examination of the material.In addition, during gastroscopy therapeutic manipulations can be performed, for example, to stop bleeding or remove polyps in the small organ mucosa.
- highly informative,
- the absence of traumatic tissue,
- safety and the almost complete absence of complications,
- the possibility of several diagnostic procedures for one procedure (for example, confirmation of the diagnosis of gastric ulcers,analysis on the acidity in the Helicobacter pylori test and biopsy),
- the possibility of holding in outpatient, without hospitalization, if there is no emergency indications,
- pervasive instrumentation equipment of modern hospitals.
The disadvantage is the presence of only a small discomfort if swallowed probe, however, this factor can be omitted in view of how important information about the state of his stomach the patient will receive in return.
One variety is a gastroscopy video EGD - this study, in which the doctor examines the cavity of the stomach, not only with your eyes, but also with the help of the magnified image transmitted to the TV in his office.This allows a better view of the smallest details in the mucosa, and issue a protocol video survey on the hard disk to a patient on his hands.Currently, each gastroscopy procedure fixed a miniature video camera on the end of the gastroscope.
If due to some reason the patient can not be surveyed through the mouth, it can be offered transnasal EGD - the introduction of a probe through the nose.With this method, the examinee does not feel the gag reflex and can talk to the doctor, that especially for patients with severe urge to vomit during stimulation of the tongue or with neurological disorders act of swallowing.
At impossibility of normal gastroscopy in humans due to the expressed fear and discomfort, such as children or the elderly, flatly refusing to the procedure, the possibility of EGD under anesthesia.To do this, the examinee with contraindications given intravenous anesthesia with the patient's medical immersion in sleep for a few minutes or more.
Indications for gastroscopy
Diagnosis of diseases:
- examination of persons older than 40 years,
- Esophagitis - inflammation of the esophagus,
- gastroesophageal reflux disease (GERD) - a throw of acidic gastric contents into the esophagus,
- varicoseesophageal varices in cirrhosis,
- Mallory syndrome - Weiss - bleeding in the mucosa of the border between the esophagus and the stomach due to uncontrollable vomiting in alcoholic poisoning,
- tumors, strictures (seam) and adhesions of the esophagus,
- esophageal burns thermal and chemical,
- peptic ulcer,
- symptomatic ulcer in the use of certain drugs (NSAIDs - diclofenac, aspirin, ketorol, Nise, steroid hormones - prednisolone, dexamethasone, etc.),
- acute and chronic gastritis,
- tumor andpolyps of the stomach,
- stomach cancer,
- complications of peptic ulcer - gastric bleeding and perforated ulcer,
- stenosis of the pylorus (pyloric stenosis) - cicatricial narrowing of the output of the stomach,
- ulcers, tumors and cancer of the duodenal bulb,
- duodenitis - inflammationbulbs 12 duodenal ulcer,
- Vater nipple cancer - a malignant tumor formation, in which opening the bile ducts and pancreatic duct at the rear of 12 - duodenum.
- dilation (widening) of cicatricial esophageal strictures,
- introduction of sclerosing ( "glue") solution in the varicose veins of the esophagus for bleeding of them - sclerotherapy,
- removal of foreign bodies from the esophagus or stomach, andas bezoar clots of hair when eating in a large number (disease called trichophagia) or phytobezoars small size (bolus of grape residues, are used in large quantities, seeds and berries, etc.),
- overlay clips or electrocautery vesselsplace of gastric bleeding,
- removal of polyps, small tumors,
- monitoring the effectiveness of treatment.
Study is not recommended in such diseases as:
- acute myocardial infarction, acute stroke,
- acute heart failure and chronic at the later stage,
- a sudden paroxysm of rhythm disorders,
- aortic aneurysm in the thoracicand abdomen,
- hemophilia (pathology of blood coagulation),
- acute infectious diseases, ENT diseases - sore throat, tonsillitis, pharyngitis,
- pronounced depletion or significant patient obesity,
- mental disease in the acute phase, however,EGD can be carried out on time indications with intravenous anesthesia after consulting a psychiatrist.
Preparing for EGD for patients
To prepare for the procedure, the patient should go for a check on an empty stomach.The last meal should be at least 7-8 hours prior to the study.On the morning of EGD should not even drink water.
just a few days before the procedure, the patient should stop using spicy food and alcohol, and stop smoking, as this has an irritating effect on the gastric mucosa.If the patient is constantly taking any medicines, such as aspirin, non-steroidal inflammatory drugs or anticoagulants (warfarin, fenilin, etc.), he should discuss with your doctor the possibility of the complete abolition of a few days, due to the fact that the "dilution" of blood tousing these products as possible prolonged bleeding during the biopsy, if needed.
EGD How is the procedure?
Carrying EGD possible in the clinic or in a hospital.The gastroscopy department assigned to patients who have treated or examined there.That is especially hospitalized patients for gastroscopy for a day is not necessary.It is possible that hospitalization is required after the test results.In addition, at its own expense EGD can be held in private medical centers, offering appropriate services.
There are planned and emergency gastroscopy.Planned carried out in a clinic or hospital in the department of endoscopic methods of diagnosis, when health center does not have the appropriate equipment.Emergency carried out, usually in a hospital, where the patient is delivered on time indications, for example, in cases of suspected bleeding or perforation (perforation) of the stomach ulcers.
After the patient was escorted to the office of EGD, he was invited to come and sign the informed consent.It is a document in which the patient voluntarily consents to the procedure, as well as the signs in the box, where it is said that it alerted about the technique of manipulation and possible complications.
Next nurse offers the patient to lie down on the couch on the left side, after which the doctor irrigates oropharynx spray anesthetic, such as lidocaine.If a patient has an allergic reaction to anesthetics, it should alert the physician about it without fail.A few minutes later, after the anesthetic will work, the doctor offers to clasp dental mouthpiece to prevent injury to the teeth and the mucous membranes of the lips.
next stage - the introduction of a gastroscope through the oropharynx into the esophagus.It lasts a few seconds and can cause quite tangible retching.The patient at this time should be to make swallowing motion as if to swallow the probe, according to the team doctor, and then smoothly, quietly and breathe deeply.Swallow then no team doctor is impossible, but accumulates saliva nurse removes electric pumps.
After contact probe into the stomach carried the air supply to the mucous folds of violence, and it could get a better look.Next, the doctor conducts a visual inspection, and then extracts the probe from the oral cavity.The duration of the procedure is no more than 5 to 10 minutes, if not carried out therapeutic manipulation.In these cases, gastroscopy time can be up to an hour.
After the procedure may cause unpleasant burning sensation in the oropharynx, which are independently run through a couple of hours.
transnasal gastroscopy is carried out according to the same procedure, with the difference that the probe is inserted through the nose without causing discomfort and retching.
Once the patient is allowed to get up from the couch, he was escorted back to the office, if it is already hospitalized, or asked to wait outside the office, if the research is carried out in the clinic.Then conclude transmit doctor or give the patient at hand.
If the examination revealed no diseases that require emergency treatment and hospitalization, such as bleeding, the patient is allowed to go home.In case of any - any disease, allowing treatment planning in the clinic or in the hospital planning, management issues and further resolved doobsledovanija doctor, right at gastroscopy.
Decoding results gastroscopy
disassemble in medical terms the patient is not necessary, since all the results should be interpreted by a doctor who carried out the study, and the attending physician.But below are are some of the indicators obtained during gastroscopy.
So on the form after the name of the medical institution, the patient rooms research and data, will be presented the following results:
- Esophagus - estimated throughput and the color of the mucous membrane in the esophagus normally pass and mucous pink color.Evaluated presence or absence of strictures, adhesions, tumors, ulcers, and other elements that normally should not be.
- cardia (the place of transition of the esophagus into the stomach) - joins or not, should normally interlock.Nesmykanie (dehiscence) cardia may indicate gastroesophageal reflux.
- Stomach - normal mucosal folds are straightened, mucous pink color, without ulceration and tumor formation.In the presence of the source of bleeding, ulceration or tumor localization and their estimated sizes.peristalsis (muscle contractions that contribute to the promotion of food bolus) is also assessed in the usual norm.It may be raised or lowered.
- The contents of the stomach - normally transparent, can be a small amount of mucus.When bleeding occurs, or the accumulation of dark crimson liquid.When casting of bile (duodenal reflux) content represented dark - green bile.
- pylorus (gatekeeper) - normally not changed, and pass at cicatricial and neoplastic lesions described by their nature and extent.
Photo pyloric part of the stomach through a gastroscope
- duodenum - normally not changed, pathological elements as are their main characteristics.
whether complications are possible during a gastroscopy?
Complications during the procedure are extremely rare, less than the 0.07% of patients.These include:
immediate type allergic reactions (urticaria, angioedema, anaphylactic shock) to the anesthetic drug.
Prevention - allergoanamneza thorough collection, and alerting the physician by the patient that previously had been similar cases.
treatment - emergency care according to the use of standards antishock set Bundled each EGD study.
perforation (perforation) esophagus - an extremely rare, but extremely dangerous condition that can be fatal if diagnosed within 24 hours.Therefore, every patient should be aware of the symptoms, which include hoarseness, subcutaneous emphysema (air pockets under the skin) on the face and neck, not typical for the patient's pain in the neck, chest and back, violation of swallowing and breathing.
Prevention - extremely cautious introduction gastroscope into the esophagus.If you suspect a burn or scar fusion esophageal wall physician should stop trying to further the introduction of gastroscope, if the first time there is a significant obstacle to the route of administration.
treatment - surgery, adequate analgesia, antibiotic therapy, parenteral nutrition (via intravenous nutrient solutions).
bleeding vessel formation when biopsy - can develop with an increase in blood clotting time, conditioned by the reception of anticoagulants, aspirin, acetaminophen and other drugs.
Prevention - timely removal of the drug for a few days before the procedure only in agreement with the attending physician.
Treatment - Hemostatic therapy (menadione, aminocaproic acid, Ascorutinum) only on prescription.
In conclusion, it must be said that the reluctance of patients to undergo such testing is often caused by the false notion that the procedure is quite painful and cause considerable discomfort.In fact, this method of diagnosis is one of the most informative and unpleasant sensations are forgotten within a few hours after the procedure.Therefore, if the patient is assigned to examination by a doctor, it should be performed, as gastroscopy carries enormous benefits for the timely diagnosis of dangerous diseases of the gastrointestinal tract.
therapists Sazykina OJ