What is gastric EGD? Examination of the gastrointestinal tract using an endoscope: esophagogastroduodenoscopy and gastroscopy

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The gastrointestinal tract is a kind of laboratory, the proper functioning of which determines the saturation of the entire body with substances useful and necessary for life. When a failure occurs, most vital processes are disrupted. Gastroenterological problems plague many people these days.

There are many reasons for the development of such diseases: frequent stress, poor diet, serious psychological disorders and polluted environment. But as a rule, patients are in no hurry to seek help from gastroenterologists. When this does happen, during a comprehensive examination the patient may be prescribed an esophagogastroduodenoscopy.

At the end of the last century they began to practice endoscopic examination internal organs, but the equipment was so imperfect that this method was abandoned for many years. And only in the 60s of the last century they remembered it and began to actively develop it. Patients have heard various terms and they are not always clear to people without medical education. Therefore, the question most often asked is - what is it?

Esophagogastroduodenoscopy (EGD) is an examination of the esophagus, stomach and duodenum using a flexible endoscope. It is more common for many to call such a study gastroscopy EGDS. In fact, we are talking about the same thing diagnostic technique. If during the manipulation the esophagus is not examined, then they talk about fibrogastroduodenoscopy (FGDS).

Gastroenterologists widely practice the use of such endoscopic methods for therapeutic and diagnostic purposes. Modern endoscopes are equipped various types flexible glass fibers and additional devices that allow you to perform the following manipulations during the research process:

• examination with biopsy (biopsy specimen taken for histological examination);
• assessment of urease activity on Helicobacter pylori in vitro in biopsy specimen;
• targeted therapy of parts of the affected organ (ulcer, erosion);
• collection of biomaterial to identify pathogens;
• removal of small foreign bodies;
• cauterization using locally applied electric current;
• stopping bleeding;
• microsurgery (resection of a polyp, small tumor).

Esophagogastroduodenoscopy is performed in the following cases:

• the need to diagnose diseases of the upper digestive tract;
• the patient often experiences chest pain, complains of difficulty swallowing and a burning sensation in the esophagus;
• impaired evacuation of food from the stomach due to scarring of the initial part of the duodenal bulb or the pyloric part of the stomach;
• suspicion of the presence of an oncological process in the upper parts of the digestive tract (the patient is rapidly losing weight, there is a persistent decrease in hemoglobin);
• suspicion of bleeding from the veins of the esophagus due to portal hypertension;
• determining the source of bleeding in the stomach and duodenum;
• diagnosing a through defect of a hollow organ or the spread of a pathological process beyond the organ against the background peptic ulcer;
• diagnosis of traumatic injuries and identification of foreign bodies in the upper parts of the digestive tract.

This method makes it possible to detect diseases at the initial stage of development, whereas other diagnostic methods are not always able to do this.

Preparation

Before going to the endoscopy room for manipulation, you need to understand how to prepare for EGD. It all starts with a conversation with your gastroenterologist, during which various questions that may concern the patient or doctor should be clarified. The patient must tune in psychologically to the procedure, so he has the right to find out in detail what will happen to his body during the diagnostic process, what he will feel how long it will take and what informational value such an examination has.

The patient is obliged to provide the doctor with his medical card, and also report all chronic diseases and any hypersensitivity history, as this may affect the use of medications during the study. Diseases that are potentially dangerous for esophagogastroduodenoscopy must be corrected. Typically, special attention is paid to cardiovascular and respiratory system. Diseases of these organs can lead to serious complications.

Direct preparation is as follows. The patient must adhere to a special diet. Two days before endoscopy, you should exclude foods that can injure the mucous membrane (spicy foods, seeds, nuts), and give preference to gentle, easily digestible foods. You will also have to give up alcoholic drinks. The last meal should take place 12 hours before the scheduled procedure.

Take medications recommended by a gastroenterologist. Espumisan is most often prescribed. This is necessary to reduce gas formation and remove them from the gastrointestinal tract. This technique will not only reduce discomfort during the procedure, but also shorten the examination time. Particular attention should be paid to clothing. It is better to give preference to those wardrobe items that are fastened with buttons rather than pulled over the neck. Clothes should be comfortable and not brand name.

Refusal of perfume. Even if the patient does not suffer from allergies, you should consider medical personnel or other patients who will also undergo endoscopic examination.
You should not smoke before the diagnosis. Nicotine strengthens the gag reflex and increases the amount of mucus in the stomach, which makes examination difficult.

Conducting research

To decrease discomfort During the procedure, as well as to weaken the gag reflex and the urge to cough, an antiseptic in liquid form is used. When applied to the mucous membrane, its effect begins very quickly, and upon completion of the manipulation it also ceases its effect quite quickly.

A special mouthpiece is inserted into the patient's mouth to protect the teeth and endoscopic equipment from biting. It is recommended to remove removable dentures first. To reduce nervousness and fear, the patient may be offered sedative. Therapeutic and diagnostic esophagogastroduodenoscopy is performed with the patient in the lateral position, preferably the left one.

After the anesthetic begins to act, the procedure is performed according to this plan:

• A flexible endoscope is carefully inserted through the patient's mouth, passing the esophagus, stomach and into the duodenum. Air is supplied to the equipment to facilitate viewing the mucous membrane by straightening the lumen of the organs.
• So as not to interfere with progress endoscopic equipment, the patient must remain absolutely still. At this moment, he needs to concentrate on his breathing, which should be deep and slow.
• The endoscopist's task is to carefully examine the mucous membrane of all the upper organs of the digestive tract. If necessary, a biopsy can be taken for further histological examination.
• If endoscopy is not only diagnostic in nature, then in the process a narrowed section of the esophagus can be expanded, small foreign bodies, polyps, and small tumors can be removed.
• In order not to provoke the urge to vomit, it is better to abstain from food for an hour after the manipulation. The duration of the study ranges from 5 to 20 minutes.

Patient reviews

Before doing such a procedure themselves, people want to know reviews about endoscopy from those who have already experienced it.

When conducting an EGDS study great importance has the quality of equipment and experience as an endoscopist. The technical characteristics of modern endoscopes make it possible to examine all parts of the esophagus, stomach, and duodenum, examining even the most difficult areas. If you put aside all fears, you can diagnose various diseases at an early stage or make sure that everything is in order with the body. And this is worth a lot.

Early diagnosis of diseases of the gastrointestinal tract is an important element in the prevention of oncological pathologies of the stomach and intestines, the prevalence of which reaches approximately 30.1% among all patients with diagnosed malignant tumors. Some diseases of the intestines and stomach, for example, atrophic gastritis or perforated ulcer, are considered precancerous conditions and early detection of these diseases significantly increases the chances of forming a favorable prognosis for future life and health.

There are several methods for diagnosing the digestive tract (radiography, breath tests, ultrasonography, intragastric pH-metry), but the main way to effectively and early diagnosis is esophagogastroduodenoscopy.

EGDS is the most informative method for diagnosing the gastrointestinal tract

Esophagogastroduodenoscopy - what is it?

Esophagogastroduodenoscopy (abbreviated as gastroscopy or EGDS) is an examination of the mucous membranes of the digestive tract, which is carried out using a fiber-optic device in the form of a long flexible tube.

The gastroscope is inserted into gastrointestinal tract the patient through the mouth, so the procedure requires certain preparation, which may also include medication correction. Using fiber or optical gastroscopes, you can obtain data on the condition of the mucous membranes, the presence of erosive lesions and ulcerative defects, and identify signs of inflammatory processes (hyperemia, swelling, the presence of bleeding areas).

With the help of endoscopy it is possible to detect various defects stomach

During the examination, the doctor can also perform a biopsy of pathologically changed areas to eliminate the risk of malignant course of certain diseases, as well as to determine the histological nature of existing formations. Endoscopy allows you to identify the presence of cysts, polyps, tumors, their location, size and shape, which makes it possible to draw up a protocol for primary therapy for various tumor formations.

Using the procedure, it is possible to identify cysts, polyps and tumors

During esophagogastroduodenoscopy, the central parts of the digestive tract are examined, which include the esophagus, the pyloric part of the stomach, as well as the bottom and body of the organ, and the duodenal intestine (duodenum). This type of examination is used not only for diagnostic purposes, but also has many other possibilities, for example:

• local administration of medications;
• removal of foreign bodies;

Removing a foreign body from the stomach

You can monitor the dynamics of ulcer scarring

Important! For some tumors of the gastrointestinal tract, endoscopy allows making a preliminary conclusion about the stage of the cancer (to confirm and clarify the diagnosis, a tissue biopsy is required, followed by histological examination of the biomaterial).

What does stomach cancer look like when examined by endoscopy?

Indications for use

Esophagogastroduodenoscopy is included in the list of mandatory diagnostic procedures for suspected inflammatory, tumor or destructive pathologies of the gastrointestinal tract. This diagnostic method is also used to identify hidden bleeding in the presence of corresponding symptoms (bloody vomiting, tarry black stools, abdominal pain of high intensity).

The main indications for which a therapist or gastroenterologist prescribes endoscopy are:

• abdominal pain, localized in the upper or central part of the abdomen, of unspecified etiology;
• a quick feeling of fullness after eating or, conversely, a feeling of hunger after eating (a possible symptom of a peptic ulcer);

Sometimes a short period of time after a heavy meal a person feels hungry

In some cases, appetite disappears completely

An unpleasant bitter taste appears in the mouth

There is a feeling that there is some foreign object in the throat

Note! Esophagogastroduodenoscopy can be used as an auxiliary diagnostic method for some pathologies related to gastroenterology, for example, systemic allergies or neurotic disorders. About 35% of gastrointestinal pathologies can develop against the background of a stress factor (gastritis, irritable bowel syndrome, duodenitis, etc.), so gastroscopy can be included in the diagnostic protocol for patients undergoing examination for functional disorders central nervous system.

Stomach pathologies can develop due to stress and excessive nervousness.

How the research works

Gastroscopy can be performed in a 24-hour or day hospital setting in a gastroenterology office equipped with a gastroscope (in accordance with the order of the Ministry of Health, each gastroenterologist’s office must have two fiber or optical devices with biopsy kits).

Gastroscopy is performed by a gastroenterologist using a special device

Before the procedure itself, premedication is carried out (preliminary drug preparation of the patient). It consists of local anesthesia with a 10% lidocaine solution.

Before the procedure local anesthesia lidocaine

Today, this drug is considered the most effective for pain relief for the purpose of diagnostic manipulations in the oral cavity, but if there is an allergy, the doctor can replace it with ultracaine or novocaine.

Sometimes Ultracaine is used for anesthesia

The drugs are sprayed onto the root of the tongue, after which the patient experiences numbness, indicating the “switching off” of the receptors located in the oral cavity. Before starting the procedure, it is important to inform your doctor about allergic reactions to any drugs, since if an allergy develops, serious consequences are possible: laryngeal edema, laryngospasm, asphyxia.

If a person is allergic to any anesthetic drugs, severe swelling of the larynx may develop

Further actions are performed according to the generally accepted algorithm

1. The patient is placed on the couch, and a mouthpiece (a device with a hole in the middle) is placed in the mouth, which must be pressed tightly between the lips.

The doctor gradually inserts the tube into the patient's mouth

Thanks to the air supply during the procedure, pathologies of the esophagus can be clearly seen

During the procedure, pictures are taken for further study.

Esophagogastroduodenoscopy also allows you to measure the acidity of the gastric and duodenal space, which facilitates diagnosis if a peptic ulcer or hyperacid gastritis is suspected.

The measurement is carried out under visual control, using a special probe, which is inserted through the instrumental part of the gastroscope.

What pathologies can be detected

Esophagogastroduodenoscopy is the most informative diagnostic procedure, which allows you to detect a large number of diseases and pathologies at an early stage, so you should not refuse to undergo it.

Table. What pathologies can be diagnosed using gastroscopy?

Foreign bodies in the stomach or esophagus

Gastric atony (impaired motor and evacuation function)

Important! Esophagogastroduodenoscopy can also identify symptoms of certain infectious diseases of the gastrointestinal tract, such as syphilis or tuberculosis. If these pathologies are suspected, a biopsy and histological examination of the biological material must be performed.

Contraindications and risk factors

Endoscopic examination of the gastrointestinal tract cannot be performed on all patients. Although the procedure is considered relatively safe, esophagogastroduodenoscopy may cause complications in a certain group of patients. severe complications, therefore, the restrictions for the procedure are:

• stenosis (narrowing) of the aortic valve;
• severe anemia (hemoglobin level ≤ 80 g/l);

Severe anemia is a contraindication for endoscopy

What is prothrombin time

In case of heart failure, EGD cannot be diagnosed

The high-risk group includes elderly and old age, persons with respiratory diseases, pathologies of the heart and blood vessels, as well as patients with pathologies of the central nervous system.

What complications may arise?

The risk of complications during EGD is about 1.9-5.4%. This is a low figure, but exclude the possibility severe consequences completely impossible, therefore, during the procedure, as well as during the preparation period, the patient must fully follow the instructions of the doctor and other medical workers.

During the procedure, you must follow all the doctors’ commands to avoid complications.

Table. Possible complications during gastroscopy

Important! There is evidence of mental health problems associated with EGD in children aged 5 to 10 years. There is still no scientific evidence that esophagogastroduodenoscopy can affect the psyche, but this possibility cannot be excluded. For this reason, in the presence of strict indications, in childhood The procedure is performed under sedation or general anesthesia.

For children, EGDS is rarely performed and only under anesthesia.

Preparation rules

The main stage of preparation for the study of the gastrointestinal tract is to follow a diet that excludes foods that can stimulate gas formation or enhance the processes of putrefaction and fermentation. These products include:

• carbonated drinks (including beer and kvass);
• alcohol;

You should stop drinking alcohol a few days before the procedure.

Whole milk may cause unwanted fermentation and bloating

Cakes and pastries contribute to bloating and flatulence

It is better to exclude oatmeal and some other grains from the diet a few days before the endoscopy.

You must follow a diet for 1-2 days before the procedure. The last meal should take place no later than 20 hours on the eve of the procedure, and the food for dinner should be light (the ideal option is cottage cheese casserole with fruit puree or poultry soufflé).

On the eve of the diagnosis, you need to have something light for dinner, for example, cottage cheese casserole

On the day of the study you cannot eat, smoke or chew anything. chewing gum. It is allowed to drink a small amount of water (about 150-250 ml), but no later than 2 hours before endoscopy.

Popular questions about endoscopy

Below are the most popular questions from patients who are indicated for esophagogastroduodenoscopy. Sufficient awareness of the patient about what this procedure is and what to be prepared for is an important element of preparing for the study and obtaining a reliable result, so it is better to find out the answers to them in advance.

Patients have many questions about the course of the EGD procedure.

How long does the procedure take?

For simple studies that do not require additional manipulations (for example, administering drugs or stopping bleeding), the study takes no more than 5 minutes. The same amount of time is required to measure the acidity of the gastrointestinal tract. In cases where more complex diagnostics with elements of therapeutic treatment or sampling of material for biopsy are required, the duration of endoscopy can be up to 15-20 minutes.

Usually the procedure lasts no longer than 10 minutes

Is it possible to do an endoscopy under general anesthesia?

Intravenous (general) anesthesia is practiced in some medical clinics, but there are no objective grounds and indications for its use. For patients with an increased gag reflex, prokinetics may be included in the premedication complex central action, for example, "Cerucal" or "Motilium".

Motilium is used to eliminate the gag reflex

For psychological preparation it is allowed to use sedatives 1-3 days before the procedure. Without consulting a doctor, you can only use herbal sedatives (motherwort, valerian), but they may also have contraindications, so you should carefully read the instructions before using them.

For mild sedation, you can use motherwort tincture

Important! General anesthesia has many contraindications and should be used only in extreme cases. Sedation may be an alternative to intravenous anesthesia, but most gastroenterologists consider local anesthesia with lidocaine to be a sufficient measure of pain relief.

What to do if you start to feel sick during the procedure

To reduce the likelihood of a gag reflex, you should breathe slowly and deeply once the device is in your mouth. To prevent vomiting, you should also not eat or drink 8-10 hours before the test, or smoke or chew chewing gum.

To avoid nausea during endoscopy, you should not smoke before the procedure.

In case of sudden vomiting and ineffectiveness of prokinetic agents, the doctor may cancel the procedure or recommend it be performed under general anesthesia.

Sore throat after endoscopy

Such sensations are normal after gastroscopy, and they are associated with damage to the mucous membranes of the larynx by the elements of the gastroscope. The numbness caused by lidocaine usually goes away within 1-2 hours after the procedure. The pain syndrome, which may intensify while eating and drinking, completely disappears 48 hours after the examination.

Sore throat after the procedure goes away in about 2 days

Is it possible to do esophagogastroduodenoscopy for pregnant women?

Despite the fact that pregnancy is not included in the list of contraindications for EGD, this type examinations are only possible if there are serious indications, life-threatening woman or fetal health. This is due not only to a possible increase in the symptoms of toxicosis, but also to possible infection, which is caused by poor-quality treatment of the room or insufficient sterilization of instruments. It should also be taken into account that the introduction of a gastroscope can provoke an increase in uterine tone, therefore, EGD during pregnancy is contraindicated due to uterine hypertonicity, the threat of premature birth or spontaneous termination of pregnancy. In other cases, the procedure can be carried out if the benefits significantly outweigh the possible risks.

EGDS is not prescribed for pregnant women, as this may cause uterine tone

Esophagogastroduodenoscopy is not very pleasant, but in most cases necessary procedure for the diagnosis of diseases of the esophagus, stomach and duodenum. If you properly prepare for the examination, the risk of discomfort, discomfort and possible complications will be minimal, therefore patients who are indicated for an endoscopy should follow the instructions and prescriptions of the doctor who will conduct the examination.

Video - Esophagogastroduodenoscopy: what is it

Esophagogastroduodenoscopy is an endoscopic examination that evaluates the condition of the esophagus, stomach, and duodenum. During the procedure, an endoscope (flexible hose) is used, which is inserted into the gastrointestinal tract through the oral cavity.

Esophagogastroduodenoscopy is superior to radiography in the accuracy of the information obtained in diagnosing the following diseases:

• inflammatory processes in the mucous membrane;
• ulcerative lesions;
• neoplasms.

EGD helps to identify pathological processes in the area of ​​the stomach, duodenum. The specialist also has the opportunity to identify deviations in the functioning of these organs. Using esophagogastroduodenoscopy, you can take a biopsy to clarify the form of the pathology and its etiology. Also, this procedure is used not only to diagnose the disease, but also for other medical purposes.

Esophagogastroduodenoscopy is carried out if it is necessary to introduce medications into the cavity of a certain organ, to urgently stop bleeding, or eliminate small foreign bodies. In most cases, this research method is prescribed for primary diagnosis pathology, as well as for regular monitoring of the effectiveness of the prescribed course of treatment.

Attention! Esophagogastroduodenoscopy allows you to accurately identify ulcerative defects, the exact location of damaged areas, and the degree of the pathological process.

This research method helps to perform the following activities:

1. To clarify the quantity, intensity of ulcerative lesions, exact location, parameters, presence or absence of inflammation in the area of ​​the affected mucosa.
2. Treatment by insertion with various instruments medications, and laser irradiation affected area.

Indications for the procedure

Typically, esophagogastroduodenoscopy is prescribed to people when they go to the doctor with complaints of abdominal pain, frequent nausea, attacks of vomiting, heartburn, as well as problems associated with swallowing food. This diagnostic study is the most optimal way to identify the causes of hemorrhage from the upper gastrointestinal tract.

Often, EGD is performed after surgical operations on the gastrointestinal tract to quickly identify possible complications resulting from intervention in the structure of the affected mucosa. This method is much more effective than radiography, as it allows not only to visually examine the mucous membrane, but also to take a biopsy. If the doctor has to take a biopsy, a special tip is put on the endoscope in advance. The patient does not experience any discomfort.

When performing the procedure, a flexible endoscope must be used. Additional instruments are used if it is necessary to remove polyps, remove foreign bodies, and also stop bleeding. Due to the fact that these measures can be carried out using an endoscope, the patient avoids surgical operations. When carrying out certain manipulations, for example, expanding narrowed areas, patents may experience unpleasant sensations.

Attention! To prevent the onset pain syndrome Drug pain relief is applied in advance.

Deviations that may require EGD:

Pathologies	Peculiarities
Pain syndrome of unknown etiology, frequent occurrence of heartburn, vomiting	If using less radical methods it was not possible to find out the cause constant nausea, belching after eating, the doctor may also recommend this test
Chronic heaviness in the stomach, feeling of fullness in the abdomen	Immediately after eating or regardless of eating
Decreased appetite, which causes a person to lose weight	An examination is necessary if you have lost more than 2 sizes.
The patient cannot swallow correctly, experiences discomfort, and the dependence of the problem on brain function has not been established	It is important to conduct research if a person indicates problems with the passage of contents through the esophagus
Pain behind the sternum or in the upper abdomen	May indicate chronic pathological processes in the gastrointestinal tract
Frequent foreign taste in the mouth, unusual odor	Symptoms are felt when breathing or talking
Diarrhea, other stool disorders	Caused by constant intake of poor quality food
Cough	In the absence of respiratory problems

A person can receive results within 20-25 minutes after the examination, which is necessary for early appointment effective therapy. In most cases, doctors are able to conduct an examination without damaging the walls of the stomach. The decision to administer an anesthetic during the examination is made extremely rarely.

Attention! With the help of EGD, doctors can not only detect ulcerative lesions of the mucous membrane, polyposis, but also oncological diseases located on the early stages development.

The most common indications for EGD:

1. Differential diagnosis of gastrointestinal diseases. With the help of this diagnostic study, it is possible to identify not only ulcerative lesions, but also diverticulitis, pyloric stenosis, and other abnormalities that can become chronic and cause significant harm to the entire body.
2. Determination of effectiveness various methods treatment, monitoring of therapy.
3. Regular examinations carried out as planned. FGDS is often performed to monitor changes in the condition of the mucous membrane in chronic organ pathologies digestive system.
4. Lack of appetite, pallor skin, other symptoms indicating the presence of bleeding in the stomach.
5. Risk assessment possible development complications after surgery on the stomach, esophagus or other organs of the gastrointestinal tract.

To obtain maximum efficiency when performing EGD, it is necessary to properly prepare for the procedure, and also come to an appointment with a specialist who will perform the examination efficiently and identify any pathological abnormalities in the structure of the mucosa.

For whom is EGDS contraindicated?

Deviations in which it is desirable to postpone the procedure or completely abandon it:

1. General serious condition of the patient, malfunction of vital organs.
2. Atherosclerosis in acute form.
3. A heart attack that occurred recently, heart failure in the acute stage.
4. Disorders requiring surgical treatment.
5. Infectious diseases in the active phase.
6. Tumors big size in the structure of the gastrointestinal tract, severe narrowing of the esophagus.
7. Hemophilia.
8. Varicose veins in the gastrointestinal tract.
9. Hypertension occurring in acute form.
10. Psychical deviations.

How to prepare for the procedure?

In order for EGD to be carried out successfully, it is necessary to perform standard measures the day before the procedure, as well as in the morning.

Preliminary preparation

The day before the examination, it is necessary to adjust your daily routine. Do not have even small meals later than 20:00. During the day, consume only those foods that are easily digested and eliminated quickly. Avoid dairy products completely.

What to do in the morning?

Do not eat breakfast, and smoking is also completely prohibited. If you are very thirsty, drink water in minimal quantities. To avoid complications, the procedure is performed exclusively on an empty stomach. Usually a trip to the doctor is planned for the morning. If the examination is scheduled after 14:00, you can have a small breakfast, but only if the procedure will take place in 8-10 hours.

Diet

For 3 days before the test, you must adhere to a slag-free diet. It is advisable to consult your doctor in advance to choose the exact menu. You can adjust your diet yourself. It is necessary to give up black bread, various greens, legumes, mushrooms, seeds, in particular, products that contain them in the structure, for example, kiwi, grapes.

Attention! You should not take medications that contain iron, and also avoid activated charcoal. Watch your diet carefully to avoid causing indigestion.

Among the priority dishes are broth, boiled chicken, and fish. It is advisable to eat cheese, white bread, butter. You can eat cookies in moderation. If you suffer from constipation, use laxatives, e.g. Duphalac, Forlax, Microlax.

How is EGDS performed?

Sometimes before the procedure, doctors suggest numbing the throat. For this, local anesthetics are used. In order not to experience discomfort during the examination, as well as for relaxation, the specialist may suggest administering an anesthetic intravenously. Medicine and the dosage is selected exclusively by the doctor; usually an anesthesiologist is invited for these purposes.

The patient must move to a special couch. Doctors often advise turning on your left side. The endoscope does not interfere with breathing movements.

Attention! Usually the procedure can be completed in a maximum of 2 minutes.

If the examination was carried out with the use of an anesthetic, the patient remains in the office for up to half an hour, since it is necessary to wait until the effect of the anesthetic wears off. Sometimes there is a feeling of bloating due to the fact that air can enter the gastrointestinal tract when the endoscope is inserted. There is a risk of throat discomfort, which usually goes away within a day. After the procedure, you must eat food no later than 21 hours later.

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 when gastrointestinal bleeding, bloody vomiting, tarry stools, pain behind the sternum or in the epigastrium, reflux esophagitis, dysphagia, anemia, strictures of the esophagus and gastric outlet, peptic ulcer of the stomach and duodenum; it is also performed to remove foreign bodies of the esophagus and stomach and for postoperative relapses of diseases of these organs. Endoscopy often eliminates the need for diagnostic thoracotomy or laparotomy and can identify small or superficial lesions that cannot be detected by X-ray examination. In addition, EGDS, due to the possibility of performing pinch and brush biopsies, makes it possible to clarify the nature of the lesion identified during X-ray examination. Using EGDS, you can also remove foreign bodies, both small and soft in consistency by suction, and large and hard ones using a coagulation loop and forceps.

Target

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

Preparation

• The patient should be explained that endoscopy will allow examination of the mucous membrane of the esophagus, stomach and duodenum.
• It is necessary to find out whether the patient is allergic to the drugs that are supposed to be used for pain relief, what drugs he is taking, clarify and detail his complaints.
• The patient should refrain from eating for 6-12 hours before the test.
• The patient should be warned that during the examination, an endoscope with a camera mounted at the end will be inserted through his mouth, and also be informed who will conduct the examination and where, and that it will last approximately 30 minutes.
• When performing an emergency EGD, the patient should be warned about the need for aspiration through nasogastric tube stomach contents.
• The patient should be warned that in order to suppress the gag reflex, the cavity of his mouth and pharynx will be treated with a solution of a 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 flow 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, but will not interfere with breathing.
• Before starting the study, set up a system for intravenous infusions, through which sedatives are administered to induce relaxation. If the procedure is performed on an outpatient basis, it is necessary for the patient to be accompanied home by someone after the procedure, since the administration of a sedative will cause drowsiness. In some cases, they resort to the administration 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 distension when insufflating air or carbon dioxide. Anxious patients are given intravenous meperidine or any analgesic 30 minutes before the test to suppress gastric secretion, which may complicate the study, atropine is administered subcutaneously.
• 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 tight underwear.

Procedure and aftercare

• The patient’s basic physiological parameters are determined and a tonometer cuff is attached to the shoulder to monitor blood pressure during the procedure.
• ECG monitoring is carried out in patients with cardiac disease, 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 placed next to the patient for spitting saliva and discarding napkins; if necessary, saliva is evacuated with an electric suction.

The patient is placed on his left side, his head is tilted forward and he is asked to open his mouth. The doctor passes the end of the endoscope through the mouth and into the throat. When the endoscope passes the posterior wall of the pharynx and its inferior constrictor, the patient is asked to slightly straighten his neck, while his chin should not deviate from the midline. Then, under visual control, the 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 towards the table to drain saliva from the oral cavity. After examining the mucous membrane of the esophagus and cardiac sphincter, the endoscope is turned clockwise and advanced further to examine the mucous membrane of the stomach and duodenum. To improve visibility during the examination, you can insufflate air into the stomach and irrigate the mucous membrane with water and suck out the secretions.

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 introducing biopsy forceps or a brush, you can obtain material for histological or cytological examination. The endoscope is slowly withdrawn, re-examining suspicious areas. The resulting tissue samples are immediately placed in a 10% formaldehyde solution, smears are prepared from the cellular material and placed in a Coplin vessel containing 96% ethanol.

Warning. When monitoring the patient, special attention should be paid to symptoms of perforation. For perforation cervical region esophagus, pain appears when swallowing and when moving the head. Perforation thoracic esophagus causes pain behind the sternum or in the epigastrium, aggravated by breathing and body movements; perforation of the diaphragm is manifested by pain and dyspnea; Gastric perforation causes abdominal and back pain, cyanosis, increased body temperature and fluid accumulation in the pleural cavity.

• Be aware of the danger of aspiration of gastric contents, which can cause aspiration pneumonia.
• Basic physiological parameters should be determined periodically.
• The appearance of a gag reflex is checked by touching back wall throat with a spatula.
• Intake of food and liquids can be allowed only after the gag reflex has recovered (usually 1 hour after the test). You should start by drinking water, then light food.
• The patient should be warned about the possibility of belching with insufflated air and a sore throat for 3-4 hours. Throat tablets and gargling with a warm 0.9% sodium chloride solution can alleviate a sore throat.
• If pain occurs at the site where the IV is connected, warm compresses are prescribed.
• Due to the administration of sedatives, patients should refrain from drinking alcohol for 24 hours and from driving for 12 hours. When performing the study in an outpatient setting, ensure that patients are transported home.
• The patient should be warned that if they experience difficulty swallowing, pain, fever, tarry stools, or bloody vomiting he immediately informed the doctor.

Precautionary measures

• When tissue samples are taken, they should be immediately labeled and sent to the laboratory.
• Endoscopy is a relatively safe test; perforation of the esophagus, stomach or duodenum is sometimes possible, especially if the patient is restless or does not comply with the doctor's instructions.
• Endoscopy is usually contraindicated in patients with Zenker's diverticulum, large aortic aneurysm, recent perforation of an ulcer or suspected perforation of a hollow organ, as well as in unstable hemodynamics and severe violation breathing.
• Endoscopy can be performed only 2 days after X-ray contrast examination of the gastrointestinal tract.
• For patients with carious teeth, it is advisable to administer antibiotics before the study.

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

Normal picture

Normally, the mucous membrane of the esophagus is yellowish-pink in color and has 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 close location of the aortic arch. The mucous membrane of the esophagus at the level of the esophagogastric junction passes into the mucous membrane of the stomach, which is orange in color. The transition line has an 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. Distal section The duodenum has a velvety appearance and pronounced circular folds.

Deviation from the norm

EGDS in combination with histological and cytological examination allows you to diagnose acute or chronic ulcers, benign or malignant tumors, inflammatory process (esophagitis, gastritis, duodenitis), as well as diverticula, varicose veins veins, Mallory-Weiss syndrome, esophageal rings, stenosis of the esophagus and pylorus, hernia hiatus diaphragm. EGDS also makes it possible to identify gross disturbances of esophageal peristalsis, for example with achalasia, but in this regard manometry is more exact method research.

Factors influencing the result of the study

• The patient is taking anticoagulants ( increased risk bleeding).
• Failure to comply with the requirements for the study.
• Late delivery of tissue samples to the laboratory.
• Lack of proper contact with the patient makes the study difficult.

B.H. Titova

"What is esophagogastroduodenoscopy" and others

Esophagogastroduodenoscopy is one of the modern effective methods for studying the mucous membranes of the upper parts of the human digestive system. This diagnostic method allows you to identify diseases of the stomach, esophagus, and duodenum of various natures. Let's figure out what the EGDS method is based on, how to prepare for the study, and how to decipher the results.

The essence of esophagogastroduodenoscopy

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

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

If preparation of endoscopy appointed due to suspicion of cancer stomach or esophagus; during the procedure, the specialist may also perform 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 stomach;
• a feeling of acidity or bitterness in the mouth;
• belching;
• chronic heartburn;
• quick feeling of fullness in the stomach;
• bad breath not related to poor condition teeth;
• causeless vomiting;
• diarrhea with black contents;
• problems swallowing food;
• disturbances in the passage of food through the esophagus;
• regurgitation of ingested food;
• chronic cough;
• chronic intestinal diseases.

Contraindications for carrying out

Esophagogastroduodenoscopy is prohibited in the following situations:

• serious condition of the patient;
• myocardial infarction;
• post-infarction 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 EGD of the stomach

You cannot begin research without special preparation. Incorrect preparation or lack thereof can lead to the fact that the results of the procedure will be incorrect and the doctor will not be able to make the 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), dinner the day before should take place no later than 20-00. It is advisable to eat only light, quickly digestible foods. Boiled egg whites, slimy porridge with water, and chicken broth cooked on the breast work well.

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

In the morning before undergoing 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. It is best to discuss the menu with the doctor who is specifically treating you.

Also, before endoscopy, the use of various medications that prevent blood clotting is unacceptable. This applies not only to oral drugs, but also to those administered intramuscularly, intravenously, subcutaneously, etc.

What to take for the procedure

You need to take with you to the clinic:

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

Immediately before EGDS, you need to remove jewelry from your neck, tie, scarf, and glasses. If the patient has dentures or dentures, these should also be removed temporarily.

How is EGDS performed?

The research methodology itself is as follows:

• To ensure the effectiveness of the procedure and reduce discomfort, the patient’s pharynx is treated local anesthetic- spray. Subsequently, for greater relaxation, the patient may be given an additional anesthetic intravenously;
• The subject lies down on the couch on his left side. He clamps the mouthpiece in his teeth to prevent uncontrolled teeth clenching during the examination;
• The doctor carefully 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 examination;
• The specialist alternately examines the mucous membrane of the esophagus, then the stomach and duodenum.

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

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

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

An incorrectly performed EGD procedure can lead to complications. However, this happens quite rarely. TO possible complications include mechanical injuries mucous membrane of the stomach and/or esophagus.

Complications from the respiratory and cardiovascular systems. The risk group includes elderly people, as well as patients with pulmonary pathology, heart failure or stenosis.

If there was food in the patient’s stomach before esophagogastroduodenoscopy, it may enter the stomach during the procedure. Airways, and this, in turn, is fraught with asphyxia or subsequent pneumonia.

After the examination, the person feels pain or a burning sensation in the larynx. Less commonly, patients experience pain in the stomach area. Typically 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 gentle as possible.

Interpretation of the results of esophagogastroduodenoscopy

The study is analyzed by a gastroenterologist. Typically, 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 to be able to take the images for reading to another specialist or to conduct a medical consultation.

Using the data obtained from endoscopy, the following problems can be identified:

• hiatal hernia;
• voluminous benign or malignant formations(polyps, cancer, papillomas);
• the presence of scars, narrowings, strictures of the stomach, esophagus;
• obstruction of the esophagus and/or stomach;
• protrusion of muscle 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.

Endoscopy 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.

Today, esophagogastroduodenoscopy is the most effective method diagnostics It helps to detect the presence inflammatory process, tumor formation 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 for gastroscopy, but the main specialists are: gastroenterologist, therapist, oncologist and surgeon. There are many reasons to perform an endoscopy, but since the procedure is extremely unpleasant, people are referred for it only in cases of urgent need.

The main indications for which a patient is recommended to undergo esophagogastroduodenoscopy are:

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

In addition, the patient is referred for EGD with such signs as:

• severe pain in the abdominal area;
• frequent or constant vomiting, nausea, heartburn, acid belching;
• a feeling of heaviness in the stomach not only after eating, but also in a state of absolute rest;
• flatulence.

Oncologists refer the patient for gastroscopy in case of suspected cancer of the esophagus or stomach, as well as to check for the presence of metastases. A gastroenterologist prescribes EGDS in case of gastric or duodenal ulcer, for the purpose of prevention after treatment.

In order for the diagnosis to be more accurate, it is recommended to take a series 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 cannot be performed. Contraindications for endoscopy include:

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

In addition, gastroscopy is prohibited for patients with mental disorders due to the fact that it is unknown how the patient may behave during the procedure.

Preparing for the examination

Proper preparation for endoscopy plays a very important role, since it determines not only how successful and accurate the examination will be, but also how the patient will feel during the procedure. To prepare for endoscopy, you must not eat foods that cause gas for 12 hours before the procedure, and also not consume fermented milk and dairy products. It is advisable to eat something light during dinner - broth, boiled fish or meat, weak tea or jelly.

Do not forget that meat and fish should be only lean varieties. It is advisable to avoid alcohol, spicy, salty and fried foods three days before the procedure. On the day of the procedure, you must completely avoid eating. 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 EGDS is performed in the afternoon, you can have breakfast 8–9 hours before it starts. At the same time, do not forget that you only need to eat light food.

The use of medications that can affect acidity, enzymes and contraction of the intestinal and stomach muscles is strictly prohibited. Preparation also includes giving up cigarettes until the examination. Before going to bed, you can take some mild sedative, but only with your doctor's permission. If you are allergic to medications, you must notify your specialist.

An hour or two before the procedure, you should not take any medications, except those on which the patient’s life depends. If the doctor allows, you can take a sedative. This is the preparation for carrying out endoscopy ends.

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, this will help smooth out discomfort and reduce the gag reflex. It is advisable to breathe deeply during the procedure, but a little less frequently than usual.

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

Examination stages

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 pharynx 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 the 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 biopsy. During tissue extraction for analysis, the patient may experience pain, but this procedure lasts a maximum of 2 minutes, and therefore does not require additional preparation.

If a foreign body is present, 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 EGD procedure can take from 20 to 45 minutes in total.

Discomfort from the EGDS procedure can be minimized provided that the preparation was carried out based on all the doctor’s requirements, and in addition, so that the patient does not feel any discomfort, 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 follow any special regime. If there was no biopsy, the patient can eat within 1-2 hours after the examination. The effect of lidocaine usually wears off within 1–2 hours, and along with it the feeling of a lump in the throat disappears.

If during the examination the patient felt unwell, began to feel nauseous, tachycardia began and blood pressure rose, the doctor will give the patient the necessary medication and suggest that he spend some time in a horizontal position.

Possible complications

The equipment used for esophagogastroduodenoscopy is equipped with new technologies, thereby minimizing the risk of any complications. The only consequence that can occur is perforation of the gastric tissue, which requires surgery to eliminate. However, these types of complications occur extremely rarely, so there is no need to worry about this.