Esophageal endoscopy is a modern diagnostic method used to assess the condition of this part of the digestive canal. The procedure is performed using a special device, which is a flexible tube equipped with optical and lighting systems. The method is necessary for the early diagnosis of esophageal pathologies, making a prognosis for the development of the disease, determining treatment tactics and the type of surgical intervention.

Indications for use

Esophageal endoscopy is prescribed:

• for severe pain, heartburn, belching, difficulty swallowing
• inflammation of the esophagus due to thermal or chemical burns
• entry of a foreign object into the esophagus
• bleeding, etc.

When conducting an endoscopic examination, it is possible to detect the presence of polyps, erosions and ulcers in the initial stages of the disease, hernias, pathological changes in the mucous membrane, weakening of tone, etc.

Contraindications

Endoscopy of the esophagus has a number of contraindications, namely:

• the patient is in shock
• epileptic seizures
• acute circulatory disorders
• asthma attack
• myocardial infarction, ischemic disease
• hypertensive crisis
• atlantoaxial subluxation.

Relative contraindications to esophagoscopy include various inflammatory diseases of the respiratory system that prevent the insertion of the instrument. In these cases, endoscopy of the esophagus is performed after recovery. Sometimes the implementation of therapeutic manipulation can be difficult due to the presence of scars or severe injuries to the organ.

Preparation for esophagoscopy

Endoscopic examination of the esophagus requires compliance with a number of simple recommendations. It is usually carried out in the morning on an empty stomach. If the procedure is scheduled in the afternoon, the patient can eat a light breakfast, but no later than 4-5 hours before the procedure. It is recommended to refrain from smoking 2 hours before the examination. For patients with increased anxiety, doctors can prescribe sedatives and muscle relaxants to prevent the development of spasms.

Carrying out the procedure

During the endoscopic examination, the patient is in a lying position on the couch. The head should be thrown back slightly. If the patient has dentures, they must be removed. The subject is asked to open his mouth wide and stick out his tongue as much as possible to treat the back of the throat with anesthetic. This is necessary to prevent the gag reflex.

The doctor inserts an endoscope, simultaneously observing the condition of the mucous membranes of the organ and recording pathological foci. To facilitate the process, the patient is asked to make a swallowing movement. The duration of the procedure does not exceed 15-20 minutes.

Endoscopy of the esophagus, performed by an experienced specialist using modern equipment, does not cause severe discomfort. Minor discomfort does not pose a health hazard and goes away without treatment within 1-2 days. In clinics in Kurkino, Kommunarka and Maryino it is possible to carry out the procedure with sedation, “in your sleep”.

results

When performing an endoscopy and examining its results, the doctor pays attention to the following indicators: the color and structure of the mucous membranes, the diameter and length of the esophagus, vascular pattern, folding, etc. A healthy person has four constrictions ranging from 25 to 30 cm in length. The normal color of the mucous membrane is from pale pink to reddish, structure fine-fibrous. Deviations from the norm are evidence of a disease and require treatment.

Endoscopy in IMMA medical clinics

Are you looking for where you can have an esophagoscopy and quickly get the results of the examination? Contact one of the IMMA medical clinics. We have no queues or long waits for results. Each patient is guaranteed qualified care, comfortable conditions for the procedures and attentive attitude of the medical staff. The procedure performed by an experienced specialist will not cause severe discomfort or pain. We care about your safety and peace of mind during the procedure. In their work, the clinic’s doctors use only modern equipment, which shows accurate results with minimal inconvenience.

Currently, endoscopic research methods are widely used in medical centers, hospitals, clinics and sanatoriums when examining patients with diseases of the digestive system. Endoscopy- a study consisting of direct examination of the internal surface of cavity or tubular organs (esophagus, stomach, duodenum, colon) using special devices - endoscopes.

Modern endoscopes used to examine the gastrointestinal tract are a flexible tube equipped with an optical system in which the image and light beam (to illuminate the organ being examined) are transmitted through fiberglass threads - so-called fiberscopes. The technical excellence of the instruments used for research ensures the absolute safety of diagnostic procedures for the patient.

Endoscopy in gastroenterology is used to examine the esophagus (esophagoscopy), stomach (gastroscopy), duodenum (duodenoscopy), rectum and sigmoid colon (sigmoidoscopy), and the entire colon (colonoscopy).

). In each specific case, endoscopy is carried out using a special endoscope, slightly different in design in accordance with the anatomical and physiological characteristics of the organ being examined. Endoscopes are named according to the organ for which they are intended.

The role of endoscopy in the diagnosis of diseases of the gastrointestinal tract is significantly increasing due to the ability, during the examination of an organ, to take material from the surface of its mucous membrane for cytological analysis(i.e. studying the form and
structure of tissue cells) or pieces of tissue for histological and histochemical examination ( biopsy). During endoscopy, you can also take photographs (using special photo attachments) of areas of interest to document the identified changes, record on a video recorder if necessary, monitor the dynamics of pathological processes or the healing of emerging disorders during repeated endoscopic examinations (for example, the development of polyps, the progress of scarring of a stomach ulcer, etc.) .d.).

Endoscopy is often performed for therapeutic purposes: small polyps are removed through the endoscope, bleeding is stopped, cauterized, sealed, medicated ulcers, erosions, laser therapy is performed, etc.

The most accurate instrumental studies are performed using a videoscope.

Examination of the upper gastrointestinal tract - esophagus, stomach, duodenum ( esophagogastroduodenoscopy , FGDS ) - is usually carried out simultaneously.

Patient preparation. Planned gastroscopy carried out in the morning on an empty stomach. Before the study, patients should not smoke, take medications, or drink liquids. Emergency gastroscopy (for example, for gastric bleeding) is performed at any time
days. To improve the tolerability of endoscopy, immediately before the examination, patients are given pharyngeal irrigation with medications that reduce the sensitivity of the mucous membrane. For patients with allergic reactions to these drugs, esophagogastroduodenoscopy ( FGDS) is performed without medication preparation.

It should be borne in mind that after esophagogastroduodenoscopy, patients are not allowed to eat or drink water for 30-40 minutes.
If a biopsy was done, then only cold food can be taken that day.

Patients scheduled for endoscopy should do the following: rules:
The stomach is examined on an empty stomach. On the eve of the examination, a light dinner can be taken no later than 18:00. On the day of the examination, you should skip breakfast.
Before the examination, patients may be given an injection to facilitate the procedure and prevent discomfort.
An anesthetic helps ensure smooth and painless insertion of the endoscope.
Before the procedure, you should free yourself from restrictive clothing, take off your tie and jacket.
Be sure to take off your glasses and dentures, if you have them.
The procedure should not cause concern to the patient - it lasts several minutes. You need to follow the doctor's instructions and breathe calmly and deeply. Do not worry.
Immediately after the procedure, you should not rinse your mouth, try to make up for missed breakfast - you can eat food an hour after the end of the study and, of course, you should not drive a car - the anesthetic continues to act for another thirty minutes.

Esophagogastroduodenoscopy (FGDS) is contraindicated in patients with severe cardiac and pulmonary heart failure, aortic aneurysm, who suffered a myocardial infarction less than six months ago, stroke, in the presence of mental illness, severe spinal deformity, large goiter, varicose veins of the esophagus, significant esophageal tendons (after surgeries, burns, etc.). If patients referred for esophagogastroduodenoscopy have inflammatory diseases of the upper respiratory tract, coronary heart disease (angina pectoris), hypertension, obesity, large diverticula of the esophagus, the endoscopist must be informed of the existing pathology in order to perform the study with extreme caution and accept all measures to prevent deterioration in the well-being of patients during and after the procedure.

Before sigmoidoscopy the night before and in the morning on the day of the study (no later than 1.5-2 hours before) cleansing enemas are given. No dietary or other restrictions are required.

One of the important diagnostic methods for diseases of the digestive system is endoscopic retrograde cholangiopancreatography (ERCP). ERCP for a number of types of pathology is considered by clinicians as the most informative method for identifying organic changes in the pancreatic and bile ducts. ERCP is especially often used to determine the causes of obstructive jaundice, painful conditions of patients after operations on the extrahepatic bile ducts and pancreas, for diseases such as primary sclerosing cholangitis, internal pancreatic fistulas, etc. ERCP combines endoscopic examination - fibrogastroduodenoscopy and x-ray examination contrasted pancreatic and biliary ducts. Preparing patients for ERCP combines preparation for fibrogastroduodenoscopy and cholecysto-cholangeography (see above).

Colonoscopy carried out after thorough bowel preparation.
3 days before the colonoscopy, a slag-free diet is prescribed: vegetables, rye bread, as well as coarse wheat bread, legumes, oatmeal, buckwheat, barley, hard meat, etc. are excluded from food. On the eve of the colonoscopy, after the second breakfast, patients are prescribed 40 g of castor or Vaseline oil to obtain a laxative effect, in the evening a cleansing enema is done. At night, patients should take a mild sedative (tincture of valerian or motherwort, seduxen, 1/2 tablet of diphenhydramine). In the morning, 2 hours before the study, a cleansing enema is given again. Patients do not have breakfast on the day of the study.

Colonoscopy is contraindicated (very dangerous) in patients with severe cardiac and pulmonary heart failure, a myocardial infarction or stroke less than 6 months ago, mental illness, or hemophilia. The endoscopist should be warned in advance about the postoperative, postpartum cicatricial narrowing of the rectum, acute inflammatory and purulent lesions of the perineum, cardiovascular failure, hypertension, coronary heart disease (angina pectoris) in patients, so that he can take all necessary measures to prevent possible deterioration of the patient's condition during colonoscopy.

The most common diagnostic method that underlies the diagnosis of almost all diseases of the esophagus, stomach and duodenum is currently the endoscopic method - a method of visual examination of the mucous membrane of these organs. The great advantage of endoscopy is the ability to study those parts of the gastrointestinal tract that are difficult to see radiographically (pyloric canal), or pathological processes (ulcers) that are hidden in the folded structures of the deformed duodenum. In addition, it facilitates the diagnosis of superficial lesions of the mucous membrane with minor changes in relief (complete and simple erosions, small polyps, etc.).

Endoscopic examination of the esophagus, stomach and duodenum is carried out using fiber endoscopes - flexible optical devices with fiber optics (Fig. 5.82). Recently, the video endoscopy method has been widely introduced into endoscopy, the advantage of which is that the entire research process is displayed on a monitor screen with simultaneous video recording.

The most recent achievement in video endoscopic technology was the use of a video endoscopic capsule in diagnosing the condition of the gastrointestinal tract (Fig. 5.83). The creation of capsule endoscopy is based on the most advanced achievements in optics and microelectronics. The endoscopic capsule is a disposable endoscopic capsule measuring 11x26 mm and weighing 4 g. The capsule contains a color video camera, 4 light sources, a radio transmitter and a power source. Before the study, the patient abstains from eating for 8 hours, then takes the capsule with a small amount of water. The capsule taken orally moves through the gastrointestinal tract with peristalsis, and all video information is recorded on a recording device attached to the patient’s belt. Then, at the end of the study, the video capsule leaves the body naturally, and all the resulting material is processed using a special program on a computer workstation.

Using this device, it is possible to diagnose the entire spectrum of gastrointestinal diseases, especially those parts of it that are difficult to reach with traditional endoscopy (small intestine), as well as in cases where a conventional endoscopic procedure is difficult to perform (seriously ill patients). The use of an endoscopic capsule for diagnosing tumor pathology in all three parts of the small intestine - duodenum, jejunum and ileum - is especially promising. This technique allows you to identify hidden sources of bleeding, reveal the cause of periodic abdominal pain syndrome (diverticular disease), and monitor the effectiveness of therapeutic measures.

The endoscopic method of examining the esophagus allows you to directly examine the mucous membrane of the organ, determine the severity of morphological changes in inflammatory, destructive, sclerotic, stenotic, including tumor processes in the esophagus.

Normally, the mucous membrane of the esophagus is pale pink, smooth, shiny, at a distance of 38-40 cm from the incisors it gives way to the brighter mucous membrane of the stomach - the so-called serrated or Z line.

During endoscopy, the condition of the lumen of the esophagus is also assessed, cicatricial narrowings (whitish, compacted areas of narrowings), diverticular enlargements, ulcerative, erosive, tumor processes, their length, affected area, the presence of complications - bleeding, perforation are excluded). With endoscopically positive gastroesophageal reflux disease, especially with pronounced inflammatory changes (erosion, ulcers) (see Fig. 5.8) and the presence of peptic stricture, swelling, hyperemia of the mucous membrane, and fibrin deposits over a fairly large area above the site of narrowing are noted.

Endoscopy is the main method for diagnosing endoscopically positive GERD; it allows timely detection of complications, performing a targeted biopsy, and monitoring treatment results.

However, with endoscopically negative GERD, which manifests itself only clinically as a symptom of heartburn, it is usually impossible to visually detect metaplasia and dysplasia of the esophageal mucosa (morphological restructuring processes in the esophageal epithelium that threaten the occurrence of tumor processes) during conventional endoscopy. Endoscopic signs of restructuring of the esophageal mucosa may be absent. To accurately diagnose these processes, additional morphological diagnosis using biopsy is necessary. Biopsies are taken from 4 randomly selected points around the circumference of the esophagus, every 2 cm from the esophagogastric junction to the dentate line, as well as from all visually changed areas of the mucosa in this area.

For more accurate diagnosis of the nature of changes, the extent of the process, as well as for targeted biopsy, vital dyes (chromoendoscopy) are used during endoscopic examination. For vital staining of the esophageal mucosa, dyes are used that differ in their mechanism of action: absorbable dyes - methylene blue solution and Lugol's solution, as well as contrast dyes - indigo carmine.

The methylene blue solution is actively absorbed by the cells of intestinal metaplasia, which turns the areas of intestinal metaplasia blue.

Lugol's solution is used to detect minimal changes in the esophageal mucosa. It temporarily stains normal squamous epithelium dark brown. Coloring occurs due to a reaction with glycogen-rich cells. Pathologically altered, glycogen-poor cells of the esophageal mucosa remain unstained, and the extent of its damage becomes clearly visible.

The indigo carmine solution does not stain the cells of the mucous membrane of the esophagus, but, distributed over the surface of the mucous membrane, makes it possible to identify areas with an altered structure in various lesions (scars, polyps, small tumors), including visually identifying areas with intestinal metaplasia and high-grade dysplasia.

To increase the frequency of diagnosis of neoplasia, the method of fluorescent endoscopy has also been proposed. There are two variants of this method. The first is based on the use of the ability of tissues to fluoresce when illuminated with light of a certain wavelength, which occurs due to endogenous tissue fluorophores (healthy tissues and neoplasia have different metabolic levels and, accordingly, different fluorescent spectra). The second option is the systemic or local administration of a sensitizer (5-aminolevulonic acid), which accumulates in tissues that have undergone neoplasia. Fluorescent endoscopy provides more accurate identification of foci of neoplasia for targeted biopsy.

In case of malignant neoplasms of the esophagus, an exophytically growing tumor, a formation can be detected growing into the lumen of the esophagus, blocking it partially or completely (Fig. 5.84). The tumor may have an uneven, bumpy surface, areas of ulceration, necrosis, and blood clots. With endophytic cancer, a pattern of circular narrowing of the esophagus is detected.

With achalasia cardia, especially in advanced cases, a pronounced expansion of the esophagus (up to 10 cm) is detected with an eccentrically located, closed cardiac sphincter and symptoms of esophagitis due to stagnation of the contents.

Endoscopic method for examining the stomach and duodenum. Normally, during endoscopic examination, the normal mucous membrane of the stomach and duodenum is pale pink or red, smooth, shiny with delicate (velvety in the duodenum) folds of the mucous membrane, which expand when inflated with air. In the stomach, during peristalsis, the folds converge well, acquiring a stellate character. The mucous membrane of the bulb has a light pink color, a cellular appearance and a “juicy” character. In the bulb, as already mentioned above, the folds are longitudinal, and in the rest they are circular, more pronounced in the distal sections. The color of the mucous membrane in the distal parts has a yellowish tint due to staining with bile. The lumen of the duodenum in the postbulbar sections has a rounded shape, and the bends of the intestine are clearly contoured.

If the duodenal papilla is covered with duodenal epithelium, then its color does not differ from the surrounding duodenal mucosa, and its opening is poorly contoured. In the case of mixed epithelial coverage of the papilla (partly duodenal epithelium, partly ductal epithelium), its central part has a bright pink color and a fringed appearance.

According to endoscopic signs, inflammatory processes in the stomach and duodenum (gastritis, gastroduodenitis, duodenitis) are divided into superficial, pronounced, pronounced, as well as atrophic and erosive gastritis and duodenitis.

Endoscopic signs of inflammation are: a) swelling; b) hyperemia; c) mucus; d) point hemorrhages; e) contact bleeding; f) the phenomenon of “semolina” (whitish grains with a diameter of up to 0.8 mm), as well as surface erosions (single and multiple). Typically, the severity of inflammation is assessed visually based on the combination of these signs and their severity (Fig. 5.85).

The presence of atrophic processes in the mucous membrane of the stomach and duodenum, based on visual signs, is judged by the degree of thinning of the mucosa, its pallor, and the degree of transillumination of the vascular network (see Fig. 5.25).

The pre-ulcerative condition (the process of ulcer formation) is characterized by a limited area of ​​hyperemia on the surface of the stomach and duodenum with pinpoint hemorrhages. Then flat (sharp) erosions appear, which, merging, form an ulcer. An inflammatory shaft appears around the formed ulcer (edematous, raised edges of the ulcer). Ulcerative defects often have a round shape (Fig. 5.86), less often (but more often than with gastric ulcers) linear ulcers or defects of irregular outline are found. The edges of the ulcer are slightly vulnerable to endoscopy. The bottom of the ulcer is usually covered with a white or yellowish-white coating of fibrin. The surrounding mucous membrane, as a rule, looks inflamed (edematous, hyperemic, its folds are thickened and difficult to straighten with air. The mucous membrane may bleed upon contact with the device.

When the ulcerative process becomes chronic or inflammation subsides (stage II of the development of an ulcerative defect), the edges of the ulcer become flattened, the defect acquires an irregular shape, and due to non-simultaneous repair processes, convergence of folds of the mucous membrane appears to the edges of the ulcer. The severity of the inflammatory process around the ulcerative defect also subsides (swelling and hyperemia decrease). Stage III of development of the ulcerative process is the stage of scarring of the ulcer. This stage is characterized by the ulcerative defect acquiring a slit-like shape with a shallow bottom. Around the ulcer there remains a slight infiltration of inflammation, focal hyperemia, and isolated erosions may still persist.

The scar phase goes through two stages: a) red scar phase; b) white scar phase. Phase “a” is a bright red area at the site of the former ulcer with convergence of folds of the mucous membrane and a zone of hyperemia around. The shape of the scar is usually linear (Fig. 5.87) or stellate. With deep ulcers, especially chronically recurrent ones, a whitish scar appears in place of the red spot (white scar phase). By this time, the convergence of the folds becomes less pronounced, and the deformation of the organ decreases. In some cases, with complete epithelization of the surface of the ulcer, it is difficult to determine the presence of a former ulcer, and the mucous membrane is straightened.

Repeatedly recurrent ulcers usually leave a pronounced deformation of the organ, an uneven narrowing of its lumen, which is sometimes difficult for the endoscope to pass through (for a duodenal ulcer).

Morphological examination of biopsy samples taken from the area of ​​the ulcerative defect and regions remote from the ulcer (mucosal duodenum and stomach with areas of inflammation, metaplasia, etc.) helps to verify the presence, nature and degree of activity of concomitant duodenitis and gastritis. In addition, it allows you to collect material for testing for H. pylori.

The material obtained by biopsy from the bottom of the ulcer and from its edges reveals structureless detritus (a product of cellular decay), accumulations of mucus, and desquamated epithelium. Necrotic collagen fibers and thrombosed vessels are visible under the detrital masses. In the periulcerogenic zone (zone of hyperemia), edema and congestion of the vessels with mucoid edema and fibrinoid necrosis in their walls, cellular lymphoplasmacytic (round cell) infiltration of the wall are detected. Eosinophils and neutrophils are also detected. You can also detect degeneration and decay of nerve elements, atrophy of glands, proliferation of connective tissue (fibrosis), and in the surrounding tissue with a duodenal ulcer - the phenomenon of gastric (antral type) metaplasia.

At the stage of repair, granulation tissue is detected in the cavity of the ulcer crater, round cell infiltration in the walls decreases, and then disappears. At the same time, the intestinal epithelium “creeps” from the edges of the ulcer.

In combination with an ulcerative process in the mucosa (usually in 100% of cases), the presence of gastroduodenitis is determined endoscopically. Gastroduodenitis can be acute and chronic, erosive and non-erosive, diffuse and limited (focal).

Endoscopic examination is very important in the diagnosis of ulcer bleeding (see Fig. 5.20).

Endoscopic examination also helps to diagnose duodenal diverticula, which are often localized in the duodenum, usually combined with diverticula in other parts of the gastrointestinal tract (esophagus, small and large intestine). Most often, up to 90% of cases, diverticula in the duodenum are localized in its descending part, next to the head of the pancreas, as well as in the area of ​​its lower horizontal part (see Fig. 5.17).

With endoscopy of the stomach and duodenum, polyps of the mucous membrane (Fig. 5.88) and other tumor neoplasms can be detected. Gastric cancer is most often localized in the antrum of the stomach, on the lesser curvature and, less commonly, in the cardia.

Exophytic tumor growth manifests itself in the form of polypous (a tumor protruding into the lumen of the stomach on a wide base, bright red, gray-yellow, etc. in color) and ulcerated cancer (a saucer-shaped ulcer with undermined edges and a bottom covered with a gray coating, often with blood clots) (Fig. .5.89).

Endophytic cancer (infiltrative-ulcerative cancer) also has the appearance of an ulcerative defect with an uneven, bumpy bottom, but flatter in shape, without a pronounced ridge surrounding the ulcer.

Diffuse (infiltrative) cancer is characterized by the presence of rigid, immobile folds of the mucous membrane of the organ, and a pale gray color of the mucous membrane.

Endoscopic examination of the colon. Endoscopic examination of the large intestine - colonoscopy is carried out with a special endoscope (colonoscope) 185 cm long. This device, with adequate preparation of the patient and the absence of obstacles to the procedure (tumors, strictures, etc.), allows you to examine the entire large intestine up to the ileocecal sphincter.

The mucous membrane of the colon normally looks pale with clearly visible blood vessels, shiny, covered with a thin layer of mucus, haustration is pronounced, and the circular folds are high, especially in the areas of physiological sphincters, where the tone of the circular muscles of the intestine is especially high (Fig. 5.90). Along the colon, you can see hemispherical formations up to 0.5 cm in size - submucosal lymphoid follicles.

Using colonoscopy, the main visual and morphological (biopsy) diagnosis of diseases of the colon, inflammatory, erosive-ulcerative and tumor diseases is carried out (see Fig. 5. 30).

During inflammatory processes in the colon, especially with ulcerative colitis, changes in the mucous membrane can vary from moderate hyperemia, petechiae and moderate bleeding to severe pathological changes (looseness, bleeding, swelling, mucopurulent discharge, fibrin deposits, erosions, ulcers, scar changes, pseudopolyps – ulcerative destructive colitis) (see Fig. 5.22). Sometimes narrowing of the intestinal lumen and pseudopolyps are difficult to distinguish from tumor lesions. In such cases, a biopsy is necessary.

Modern medical equipment allows doctors to examine internal organs, diagnose and treat without surgery. The endoscopic research method is widely used in gastroenterology, surgery, pulmonology, gynecology and complements other methods of analyzing the condition of patients. The procedure is carried out using a special device equipped with a video camera.

Modern technology is a device with a flexible fiber tube with optics that allows you to illuminate and image the cavity during the examination. Endoscopy is prescribed as a separate or preliminary diagnosis, before an X-ray with barium. The standard procedure lasts about three minutes and includes the following steps:

1. Endoscopy of the stomach and intestines is done in the supine position. Preparation consists of the patient lying on a couch or manipulation table on his left side, bending his right leg at the knee and pulling it towards his stomach. There is a diaper under the head.

2. The patient is reminded not to interfere with excessive salivation; a spitting tray is placed nearby. There are times when using a saliva ejector is necessary.

3. A thin part of the tube is inserted into the esophagus, the doctor gives a signal for the person to swallow, avoiding the tip entering the trachea. If an obstacle arises, you should not apply force to the device; the physician calms the patient, moves the tube back half a centimeter and continues after a few minutes. During this period, you need to breathe deeply through your nose while the doctor examines the internal organs. After examining the gastric mucosa, the endoscope is rotated around its axis and advanced to the duodenum. To improve visibility, air is supplied into the tube. In each position, the examination is carried out from four sides.

4. After completing the diagnosis, the physician carefully removes the device from the esophagus, once again examining all cavities along the way.

5. Endoscopic examination is quite difficult for young children, so the capsule technique is more suitable for them.

During the examination, it is possible to take tissue for cytological analysis or biopsy, and the physician also takes photographs for the purpose of documenting the condition and further comparison. A targeted method is used, if it is necessary to confirm formations, or a search method to detect new tumors at an early stage. The procedure is absolutely painless, the patient does not feel the manipulation of the forceps. The samples are placed in a formaldehyde solution, labeled and sent to the laboratory.

When is it appointed?

During endoscopy of the duodenum and stomach, specialists assess the condition of the digestive system. If a number of diseases are suspected, the following procedure is recommended:

1. Identify pathologies of the stomach and intestines at the stage of diagnosis, especially during the preclinical development of gastritis, colitis or ulcers.

2. Determination of the exact area and distribution of the inflammatory process.

3. Conducting an analysis to determine the effectiveness of the prescribed treatment.

4. In case of suspected oncological manifestations, a biopsy of the affected tissues.

5. Diagnosis of the consequences of peptic ulcer and identification of scar-inflammatory changes in the stomach in the pyloric region, which causes difficulty in the passage of food.

6. As a therapeutic measure, endoscopy is performed when removing a foreign body.

7. Determining the source and stopping bleeding.

8. Patients with unclear causes of anemia.

9. When administering certain medications and as preparation before surgery.

10. If it is necessary to remove polyps in the cavities of the digestive organs.

Preparation and performance of gastric endoscopy is not prescribed for the following contraindications:

• Heart and pulmonary failure of the first and second degrees.
• Atherosclerosis, stroke, heart attack.
• Cancer, narrowing and ulcer of the esophagus.
• Hemorrhagic diathesis.
• Internal varicose veins.
• Mental disorders in the patient.
• Obesity and pronounced weakness of the body.

Gastric endoscopy is performed with restrictions in the following cases:

1. Third degree hypertension and angina pectoris. The doctor is obliged to correct disorders in the cardiac and vascular systems by prescribing a medication complex.

2. Inflammation of the larynx, tonsils and pharynx.

3. Ulcer with threat of perforation and gastritis in a severe acute stage.

4. Presence of chronic asthma.

What do you need to know before endoscopy?

Preparation for gastric endoscopy includes a number of activities. The doctor conducts psychological training, during which the person is explained the goals and objectives for making the correct diagnosis. A special approach is applied to patients with unstable behavior and nervousness. Patients should be familiar with the rules before and after endoscopy:

1. It is necessary to inform the doctor about the presence of allergies to drugs, including anesthetics. It is also important to warn about existing serious diseases, previous illnesses and the current prescription and use of medications.

2. Manipulations are carried out only on an empty stomach. The patient should not eat for 10 hours before the endoscopy to provide the doctor with an overview and to prevent vomiting.

3. Consumption of still water is allowed, no more than 100 g.

5. Half an hour before the patient is given atropine sulfate; for highly excitable patients, an injection of sedatives such as promedol is prescribed.

6. It is necessary to attend the endoscopy in clothes that do not restrict movement, so it is better to take a home suit with you.

7. Discomfort when inserting the tube is eliminated by using an anesthetic. In most cases, during preparation, the oral cavity and the entrance to the esophagus are irrigated with ice-caine spray. Patients who have difficulty swallowing the endoscope are prescribed intramuscular injections of sedatives. General anesthesia is used for patients in serious condition.

8. To prevent the tube from being crushed by the teeth, use a special plastic mouth guard.

9. After completing the study, the patient should rest for half an hour, then for one and a half hours the person is in a supine position. After this, he is sent home and allowed to take food and water.

Complications after endoscopy of the esophagus and stomach are observed only when the device is roughly inserted or the patient behaves inappropriately. In such a situation, there may be damage to the back of the pharynx and the thoracic internal organs. For small abrasions on the mucous membrane, rinsing with a solution of silver nitrate and a diet are prescribed. In the description of the study, the doctor records the following points:

• The condition of the walls and cavities of all organs that were analyzed.
• Appearance and nature of the stomach contents.
• The degree of elasticity and the presence or absence of defects in fabrics.
• Description of the motor activity of the digestive system.
• Tumors and focal lesions, if necessary.

After receiving the results of gastric endoscopy, the patient is sent to a specialized specialist who prescribes optimal treatment or further examination. Despite the discomfort during manipulation, every person should undergo the procedure not only for diagnostic, but also for preventive purposes once a year. Based on the results of such a study, the doctor can get a complete picture and give a detailed conclusion, and, upon special request, the photographs necessary for a comparative analysis.

Medicine offers a large selection of methods that help to examine all organs (stomach, heart, kidneys, etc.), and endoscopy of the esophagus is one of them. With its help, you can get complete information about diseases, because endoscopy allows you to examine them in close proximity. This operation is performed through the mouth with a special device called an endoscope. The device consists of a flexible tube, plastic or metal, at one end of which there is a lighting device, a magnifying lens and a transmitter that displays the image on the screen. The other side has a handle for controlling the device, i.e. turning it in the required direction. To carry out such an operation, the diameter of the tube is no more than three centimeters, which guarantees painlessness, but does not exclude discomfort.

Indications for the procedure

Endoscopic examination is used in such fields of medicine as surgery and gastroenterology. I have two purposes for it:

1. Diagnostic:
   • designation of the exact localization of the process;
   • visual examination of suspected pathologies to specify their prevalence;
   • identification of neoplasms, developmental anomalies, narrowing or expansion, diverticula and other diseases of the esophagus;
   • treatment control.
2. Medicinal:
   • expansion of narrowings of the esophagus formed as a result of burns or injuries;
   • performing a biopsy;
   • removal of foreign bodies and subsequent extraction;
   • stopping severe bleeding;
   • elimination of food debris;
   • sclerosis.

Possible contraindications

This procedure is not recommended for liver cirrhosis.

Endoscopic operations have some contraindications:

1. Absolute, which are caused by the following diseases of the patient:
   • acute circulatory disorders;
   • , cicatricial stricture and other diseases of the esophagus that make it difficult to pass the endoscope or can lead to perforation;
   • exacerbation of bronchial asthma;
   • state of shock;
   • epilepsy attacks;
   • atlantoaxial subluxation;
   • cirrhosis of the liver with concomitant dilation of the veins in the lower segment of the esophagus.
2. Relative:
   • patient's reluctance;
   • coma in the absence of intubation;
   • thoracic aortic aneurysm;
   • coagulopathy;
   • acute myocardial infarction;
   • ischemic disease;
   • inflammatory processes of the respiratory system, oro- and nasopharynx;
   • hypertensive crisis.

Preparation for endoscopic examination of the esophagus

Endoscopic examination is performed on an empty stomach.

Both the patient and the doctor performing it should prepare for an endoscopic examination. After all, each of them strives to obtain accurate and truthful results. To achieve this goal, the patient must:

1. Do not eat anything before the procedure, as it is performed on an empty stomach to reduce the gag reflex.
2. Take laboratory blood and urine tests.
3. Undergo an examination of the cardiovascular system to identify abnormalities that may become a contraindication.
4. Take x-rays of organs to identify certain pathologies.
5. Maintain hygiene of all parts of the body.
6. Preparation includes rinsing the mouth with an antiseptic.
7. If you have dentures, they must be removed.

The doctor’s preparation for this operation is as follows:

1. Disinfection of esophagoscope devices by boiling them.
2. Arrangement of disinfected instruments as needed.
3. Tidying up your appearance with a special robe, gloves, etc.
4. Prepare the necessary medications, without which the endoscopic procedure is impossible.
5. Set up appropriate lighting for the room where the study will be conducted.

Technique

An endoscopic examination of the esophagus can be performed while lying on your side, on your stomach, lying down and sitting.

This method is similar to gastroscopic, the only difference is the object of study: the esophagus is examined by endoscopy, and gastroscopy examines the entire upper gastrointestinal tract (stomach, esophagus, duodenum). Endoscopists work with extreme caution due to the proximity of the esophagus to vital organs. The procedure can be performed in several positions of the patient: sitting, lying, on his side, on his stomach. More often, a person sits on the right side with the right leg bent at the knee and the left leg extended.

Pain relief is required, sometimes local or general anesthesia is used. If necessary, the use of auxiliary devices (for example, bougies for expansion) is allowed. Next, an endoscope is inserted, allowing the doctor to examine the esophagus twice:

1. when moving to the upper part of the stomach;
2. upon direct extraction.