FGDS( Fibrogastroduodenoscopy, FGS of the stomach) - Causes, symptoms and treatment. MF.
Often the patient experiences unreasonable fear at the thought that the doctor assigned him such a study as the EGD.But the experience of doctors shows that using this method of diagnostics can save a person health and save him not only from serious complications of a particular stomach disease, but also from surgical intervention used to treat complications.
FEGS( fibroesophagogastroduodenoscopy) or abbreviated as FGDS( fibrogastroduodenoscopy) or even shorter FGS( fibrogastroskopia) or even gastroscopy is an instrumental examination method conducted with the help of endoscopic equipment and used to diagnose diseases of the esophagus, stomach and duodenum. To conduct it, a thin gastric tube with an optic-fiber system is used, which is inserted through the mouth into the esophagus and stomach with further examination by the doctor of the inner walls of the organ. Inspection is carried out with the help of an eyepiece on the outer end of the gastroscopy, and modern equipment also allows you to display an enlarged image on the TV screen in the office with the preservation of the video protocol in the computer.
The image shows the
gastroscope. The capabilities of the
method The FGD is the "gold standard" in the diagnosis of diseases of the esophagus and stomach. Can be prescribed for diagnostic or therapeutic purposes. The diagnostic value of the method is priceless, since it is possible not only to examine the walls of the stomach from the inside for diseases, but also to biopsy the tissue, that is, "pinch off" a piece of tissue with further examination of the material under the microscope. In addition, when performing gastroscopy, you can perform therapeutic manipulations, for example, stop bleeding or remove a small polyp in the mucosa of the organ.
Advantages of the method:
- high informativity,
- absence of traumatic tissue,
- safety and almost complete absence of complications,
- painlessness,
- possibility of several diagnostic manipulations in one procedure( for example, confirmation of diagnosis of gastric ulcer, acidity analysis, heliobacter pylori test, and biopsy sampling),
- the possibility of carrying out in a polyclinic without hospitalization in the hospital, if there are no emergency indications,
-Semi-equipped with modern medical facilities.
Disadvantages of the FGDS
method The only disadvantages are the presence of a small discomfort when swallowing the probe, but this factor can be omitted in view of how important the information about the state of his stomach the patient will receive in return.
Species of
One of the types of gastroscopy is the video- FGDS, a study in which a doctor examines the cavity of the stomach not only with the help of his eyes, but also with the help of an enlarged image transmitted to the TV in the office. This allows you to better examine the smallest details in the mucosa, and issue a video inspection report on the hard drive to the patient on hand. Currently, each procedure of gastroscopy is recorded by a miniature video camera at the end of the gastroscope.
If for some reason the patient can not be examined through the oral cavity, he may be offered transnasal FGDS - the introduction of the probe through the nose. In this method, the subject does not experience an emetic reflex and can talk with a doctor, which is mainly for patients with pronounced urge to vomit with irritation of the root of the tongue or with neurologic disorders of the swallowing act.
If it is not possible to perform routine gastroscopy in people due to severe fear and discomfort, for example in children or the elderly, who flatly refuse to perform the procedure, it is possible to conduct FGDs under anesthesia. For this purpose, if there are contraindications, the patient is given an intravenous anesthesia with the patient immersed in a drug-induced sleep for several minutes or more.
Indications for gastroscopy
Diagnosis of diseases:
- examination of persons older than 40 years,
- esophagitis - inflammatory process in the esophagus,
- gastroesophageal reflux disease( GERD) - throwing acidic gastric contents into the esophagus,
- varicose veins of the esophagus with cirrhosis,
- Mallory-Weiss syndrome -hemorrhage on the mucosa of the border between the esophagus and stomach due to indomitable vomiting during alcohol poisoning,
- tumors, strictures and adhesions of the esophagus,
- thermal and chemical burns of the esophagus,
- peptic ulcerstomach inflammation,
- symptomatic gastric ulcers with the use of certain drugs( nonsteroidal anti-inflammatory drugs - diclofenac, aspirin, ketorol, nise, steroid hormones - prednisolone, dexamethasone, etc.),
- acute and chronic gastritis,
- stomach tumors and polyps,
- stomach cancer,
- complications of peptic ulcer - gastric bleeding and perforated ulcer,
- pyloric stenosis( pyloric stenosis) - cicatrical narrowing of the outlet stomach,
- ulcer, tumors and cancer of the duodenal bulbshki,
- duodenitis - inflammation bulbs 12 duodenal ulcer,
- papilla of Vater cancer - malignant tumor formation, into which open the bile duct and pancreatic duct at the rear wall 12 - duodenum.
Therapeutic manipulation:
- dilatation( expansion) of cicatrical strictures of the esophagus,
- introduction of sclerosing( "gluing") solution into varicose veins of the esophagus with bleeding from them - sclerotherapy,
- removal of foreign bodies from the esophagus or stomach, and also bezoars from clotshair when eating in large quantities( the disease is called trichophagia), or phytobesoids of small size( food clots from the remains of grapes, used in large quantities, bones of berries, etc.),
- imposition of clips orlektrokoagulyatsiya vessels at the site of gastric bleeding,
- removal of polyps and small tumors,
- monitoring the effectiveness of treatment.
Contraindications for FGDS
The study is not recommended for diseases such as:
- acute myocardial infarction, acute stroke,
- acute heart failure and chronic at a late stage,
- sudden paroxysm of rhythm disturbances,
- aortic aneurysm in the thoracic and abdominaldepartment,
- hemophilia( pathology of the blood coagulation system),
- acute infectious diseases, ENT diseases - tonsillitis, tonsillitis, pharyngitis,
- severe depletion or significant obesityient,
- mental illness in the acute phase, however, FGDS can be carried out on urgent indications with intravenous injection of anesthesia after consultation of a psychiatrist.
Preparing for EGF for the patient
In order to prepare for the procedure, the patient should come to the examination on an empty stomach. The last meal should be no later than 7-8 hours before the study. In the morning on the day of the EGF, do not even drink water.
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 medications, for example, aspirin, non-steroidal drugs or anticoagulants( warfarin, phenylin, etc.), he should discuss with the doctor the possibility of their complete cancellation for several days, due to the fact that "dilution" of blood withWith these drugs, longer bleeding may be possible with a biopsy, if needed.
How is the FGD procedure carried out?
FGDS is possible in a polyclinic or in a hospital. In the department, gastroscopy is prescribed for patients who are already being treated or examined there. That is, there is no need to specifically hospitalize a patient for a gastroscopy for one day. It is possible that hospitalization will be needed after the results of the survey. In addition, the EGD can be paid at private expense in private medical centers that offer the appropriate services.
There are planned and emergency gastroscopy. Planned is carried out in the clinic or in the department of endoscopic methods of diagnosis of the hospital, if the clinic does not have the appropriate equipment. Emergency is usually carried out in the hospital, where the patient is delivered by urgent indications, for example, if there is a suspicion of bleeding or perforation of the stomach ulcer.
After the patient is escorted to the office of the EGDF, he is invited to come in and sign the informed consent. This is a document in which the patient voluntarily agrees to carry out the procedure, and also signs in the box, where it is said that he was notified of the technique and possible complications of manipulation.
Then the nurse suggests to lie patient on the couch on the left side, after which the doctor irrigates the oropharynx with a spray of anesthetic, for example, lidocaine. If the patient has an allergic reaction to anesthetics, he must warn the doctor about this without fail. After a couple of minutes, after the anesthetic has worked, the doctor suggests holding a mouthpiece around the teeth to prevent injury to the teeth and mucous membranes of the lips.
The next step is the introduction of a gastroscope through the oropharynx into the esophagus. It lasts a few seconds and can cause quite a tangible vomiting. The patient at this time should make a swallowing movement, how to swallow the probe, at the doctor's command, and then smoothly, calmly and deeply breathe. Swallowing after this without a doctor's team is not possible, and the accumulated saliva is removed by a nurse with an electro pump.
After the probe enters the stomach, air is supplied to ensure that the folds of the mucosa are straightened and can be better examined. Further, the doctor performs a visual examination, after which he removes the probe from the oral cavity. The duration of the entire procedure is no more than 5 -10 minutes, if no medical manipulations are performed. In these cases, the time of gastroscopy can be up to half an hour.
After the procedure, there may be unpleasant grinding sensations in the oropharynx, which independently pass through a couple of hours.
Transnasal gastroscopy is performed according to the same procedure, with the difference that the probe is inserted through the nose without causing discomfort and vomiting.
After the patient is allowed to get up from the couch, he is escorted back to the department if he is already hospitalized, or asked to wait near the office if the study is conducted in a polyclinic. Then the conclusion is given to the attending physician or given to the patient in his arms.
If, as a result of the survey, there are no diseases requiring emergency care and hospitalization, such as bleeding, the patient is allowed to go home. In case of detection of any diseases that allow to be treated on a routine basis in a polyclinic or on a scheduled basis in a hospital, treatment questions and further pre-examinations are decided by the attending physician who directed to gastroscopy.
Decoding of the results of the
gastroscopy. It is not necessary to understand the patient's medical terms independently, as all results should be interpreted only by the doctor who conducted the study and by the attending physician. But below will be given some of the indicators obtained during the gastroscopy.
So, on the form after the name of the institution, the research number and patient data, the following results will be presented:
- Esophagus - the permeability and color of the mucosa is assessed, the esophagus is passed normally, and the mucosa is pink in color. The presence or absence of strictures, adhesions, tumors, ulcers and other elements that should not normally be assessed is assessed.
- Cardia( the place of passage of the esophagus into the stomach) - is closed or not, normally should close. The incomplete( gaping) cardia can speak of gastroesophageal reflux.
- Stomach - Normally the folds of the mucous membrane are straightened, the pink mucosa, without ulcers and tumor-like formations. In the presence of a source of bleeding, an ulcer or a tumor, their localization and size are assessed. The peristalsis is also evaluated( muscle contractions promoting the progression of the food lump), normally normal. Can be raised or lowered.
- The contents of the stomach - normally transparent, there may be a small amount of mucus. With a bleeding, there is a build-up of a liquid of a dark or scarlet color. When casting bile( duodenogastric reflux), the contents are represented by dark green bile.
- Pyloric department( gatekeeper) - is not normally changed and pass, with scar or tumor lesion their nature and size are described.
Photo of the pyloric part of the stomach through the gastroscope
- Duodenum - normal is not changed, with pathological elements are also given their main characteristics.
Are complications possible with gastroscopy?
Complications of the procedure are extremely rare, less than 0.07% of patients. These include:
Allergic reaction of immediate type ( urticaria, Quincke's edema, anaphylactic shock) to an anesthetic drug.
Prevention is the careful collection of allergic anamnesis, and notification of the doctor by the patient that he previously had similar cases.
Treatment is the provision of emergency care according to the standards of using anti-shock kit, which is included in the configuration of each FGDS cabinet.
Perforation( perforation) of the esophagus is an extremely rare but extremely dangerous condition that can be fatal if diagnosed after 24 hours. Therefore, each patient should know the symptoms, which include hoarseness, subcutaneous emphysema( accumulation of air under the skin) on the face and neck, atypical pain for the patient in the neck, chest and back, violation of swallowing and breathing.
Prevention - extremely careful introduction of the gastroscope into the esophagus. If there is a suspicion of a burn or scarring of the esophagus, the doctor should stop trying to continue the gastroscopy if the first time there is a significant obstruction to the route of administration.
Treatment - surgical, adequate analgesia, antibiotic therapy, parenteral nutrition( using intravenous nutrient solutions).
Bleeding from the vessels of formation during its biopsy - can develop with an increase in clotting time caused by the use of anticoagulants, aspirin, paracetamol and other drugs.
Prophylaxis - timely cancellation of drugs for a few days before the procedure only in consultation with the attending physician.
Treatment - hemostatic therapy( vikasol, aminocaproic acid, askorutin) only as directed by a doctor.
In conclusion, it must be said that the reluctance of patients to undergo such a survey is often caused by a false idea that the procedure is rather painful and causes 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 a doctor is assigned to the patient, it should be performed, because gastroscopy is of great benefit for the timely diagnosis of dangerous diseases of the gastrointestinal tract.
Doctor therapist Sazykina O.Yu.