I often hear people say that gastroscopy is a terrible thing to do, and people around me are reluctant to have gastroscopy even if their stomach is not feeling well. However, do you know that “this scary thing” is the most effective means to diagnose gastric cancer, which is irreplaceable by any other methods?
It can not only visualize the change of mucosa, but also directly take the lesion tissue for cytological and pathological examination to obtain pathological diagnostic evidence, and a variety of treatments can be performed through gastroscopy.
I. Is gastroscopy really necessary?
Any kind of tumor is very scary to us, especially stomach cancer which has a high incidence today. In our country, most people are often not in early stage when they find stomach cancer.
In fact, the best way to avoid this situation is to have a timely gastroscopy, which at least allows us to detect stomach cancer early and treat it in time.
Since the stomach is located inside our body, it is difficult to detect even if lesions occur; while gastroscopy is like an extension of our eyes, with flexible and convenient operation, clear imaging, and direct vision biopsy and cytological examination, the diagnosis rate of gastric cancer qualitative and localization reaches 95% and 98.5%.
II. Under what circumstances gastroscopy is needed
Many people are confused about this – what exactly is the need for gastroscopy? Is it when you feel slightly uncomfortable? Or after a period of time? This is indeed a difficult question.
The advantage of gastroscopy is that it can detect early gastric cancer, small gastric cancer, and even micro gastric cancer, which are often clinically asymptomatic. Therefore, for some high-risk groups, gastroscopy is also recommended when there are no symptoms.
Under what circumstances should gastroscopy not be performed?
Although gastroscopy is safe, not everyone is suitable for gastroscopy.
1. Absolute contraindications
(1) Serious systemic diseases, such as coronary heart disease, heart failure, severe pneumonia, epilepsy, etc;
(2)Those who cannot cooperate or are mentally disturbed;
(3) Esophageal stricture due to various causes, recent perforation of ulcer disease, recent swallowing of corrosive agents, aneurysm, huge esophageal hiatal hernia, etc.
2. Relative contraindications
(1) Penetrating gastroduodenal ulcer;
(2) Extraluminal compression of the esophagus (mediastinal masses, lung and bronchial carcinomas, tuberculosis);
(3) Severe deformity of the spine;
(4) Severe esophageal varices;
(5) Stomach displacement or deformation caused by hepatosplenomegaly, pancreatic swelling, post-surgical adhesions, etc.
4.What does gastric cancer look like under gastroscopy?
The different forms of gastric cancer seen by gastroscopy are closely related to different pathological changes and different stages of development of gastric cancer.
1.Early gastric cancer
The detection of early gastric cancer often predicts good prognosis and survival. Early gastric cancer refers to gastric cancer only confined to mucosa or submucosa layer, regardless of whether there is lymph node metastasis or not.
The depth of infiltration of early gastric cancer is only limited to the mucosal layer, so the morphological changes are also shown only in the mucosa. Except for small gastric cancer and micro gastric cancer, the endoscopic manifestation of early gastric cancer can be divided into three types: augmented type, flat type and depressed type.
(1) Rising type
The cancer is in the shape of polyp, the elevation is more than two times of mucosal thickness, the surface is uneven and covered with white or filthy exudate. The color is reddish or pale, with bleeding spots, erosion and other changes, with or without a tip. For broad-based lesions, early gastric cancer should be highly suspected.
(2) Superficial type
Superficial type is also divided into superficial elevated type – the height of elevation is less than 2 times of mucosal thickness, the surface of elevation is irregular or slightly depressed, and sometimes the area is larger, and the lesion has bleeding, erosion or moss attachment. There are uneven granules and bleeding or erosion is seen in the surrounding mucosa. The diagnosis is often difficult and easily misdiagnosed as gastritis. Second, superficial flat type – the elevation or depression is not obvious and hard to detect, the color can be grayish white or crimson, the mucosa is not smooth, bleeding when touched, and the boundary with mucosa is unclear, which is the most difficult type of early gastric cancer to detect. Thirdly, superficial depressed type – the most common, with shallow depression or erosion of mucosa, tiny particles at the bottom or covered with thin white moss, irregular edges, and mucosal folds focusing toward the center.
(3) Depressed type
The cancer is obviously depressed or ulcerated, often covered with bleeding or necrotic exudate at the base, with irregular edges, vesicular bleeding, hardening or occasionally nodular, simple depression is rare, often mixed with superficial depression.
2.Progressive gastric cancer
Progressive gastric cancer refers to those who have infiltrated into the muscle layer of gastric wall and the deeper layers below.
(1)Raised type
A hemispherical or block-like mass protrudes into the gastric cavity with uneven surface or large nodules, which can be cauliflower-shaped and often shows congestion, erosion or shallow ulceration, which can be accompanied by bleeding or by filthy moss and secretions.
(2) Ulcer confined type
More obvious localized elevated swelling with deep irregular ulcers at the top, with hard dyke-like elevation at the edge of the ulcer, well-defined, resembling a volcano or flat dish, its diameter is usually more than 3 cm, nodular unevenness at the bottom of the ulcer, which can be smeared with dirty moss, irregular looking edges, nodular unevenness, brittle tissue, contact bleeding, and dyke-like elevation around the ulcer.
(3) Infiltrating ulcer type
The size of the ulcer is generally larger than that of the limited ulcer type, with its similar ulcer characteristics, but the difference is that the surrounding mucosa and gastric wall are infiltrated by the cancer and become stiff, and the deformation of the gastric cavity is more obvious and larger in scope.
(4) Diffuse infiltration type
Due to diffuse infiltration of cancer tissue, the gastric wall becomes thicker, stiffer, the gastric cavity becomes narrower and cannot be expanded even after inflation, the peristalsis of gastric wall disappears, the gastric mucosal folds are coarse and nodular, sometimes congestion and erosion are seen on the mucosal surface, which is easily confused with gastritis. The typical pathology resembles a leather pouch, which is called “leather pouch stomach”.
PS: How to make gastroscopy not so hard?
1.Injections or oral sedatives and antispasmodics should be taken according to medical advice before the examination to reduce gastric peristalsis and gastric juice secretion;
2, the day before the examination should not be too full dinner, it is appropriate to eat easily digestible food, do not eat irritating food, fasting after 9 pm, do not take drugs, do not smoke; with pyloric obstruction, gastric lavage before the examination;
3, deep breathing during the examination can reduce the feeling of nausea.