Gastroscopy is an important tool for gastroenterology treatment. Clinically, we encounter many people who are afraid of gastroscopy and dare not undergo gastroscopy because they think it is very painful and some patients refuse to undergo gastroscopy at the early stage of upper gastrointestinal tumor, but at the late stage, they are diagnosed as cancer and it is irremediable.
In fact, nowadays, the new electronic gastroscope is thin, soft and has good compliance, and coupled with the proper operation of professional doctors, the examination can be completed in 3-10 minutes with only some nausea and not much pain. In foreign countries, such as Japan, the detection rate of early gastric cancer reaches 60%, mainly due to the high popularity of gastroscopy, which has been used as one of the health check-up items. For this reason, we would like to introduce the knowledge about gastroscopy.
Why is gastroscopy necessary?
1, can provide the diagnosis of the disease basis. Only with a clear diagnosis can treatment methods be selected and treatment be targeted. For example, the internal treatment of benign, active gastric and duodenal ulcers requires anti-ulcer treatment for 4-8 weeks, after which, another half amount of anti-ulcer drugs for 6-18 months; for HP infection, a course of uninterrupted treatment with two, three or four anti-HP drugs, and an additional course of treatment for heavy cases; if the diagnosis is a tumor, it should be taken as soon as possible If the diagnosis is tumor, we should take radical surgery as soon as possible, and cooperate with radiotherapy and chemotherapy, etc.
2, to understand the development trend and prognosis of the lesion. For example: chronic superficial gastritis, most of them have good prognosis; while active peptic ulcer, if further developed, may be accompanied by pyloric obstruction, perforation, bleeding and other comorbidities, which need to be closely observed to prevent accidents; atrophic gastritis, gastric polyps, recurrent peptic ulcer above moderate level, belong to pre-cancerous diseases of stomach; in the pathological sense, gastric epithelial hyperplasia of esophageal mucosa, intestinal epithelial hyperplasia, atypical hyperplasia or intestinal epithelial hyperplasia and atypical hyperplasia of gastric mucosa are precancerous lesions. Pre-cancerous diseases and pre-cancerous lesions need to be actively treated, closely observed and regularly reviewed to prevent the development of lesions, and even if cancer occurs, it can be detected and cured at an early stage.
3.Provide evidence of diagnosis and treatment activities for both doctors and patients. Gastroscopy not only provides scientific diagnosis for patients and treatment basis for doctors, but also provides scientific evidence to protect the interests of both doctors and patients and prevent medical disputes. The images and text data examined by the gastroscopy room are stored in the computer hard disk and can be called when needed.
4. It can relieve the psychological burden of patients. Some patients are hypochondriacs and suspect that they are suffering from gastrointestinal tumor. Gastroscopy can eliminate the patient’s worries, which is better than drug treatment alone.
5.Objective examination is the main index of scientific research. For example, clinical observation of drug research for the treatment of upper gastrointestinal mucosal lesions as well as control groups require gastroscopy before and after taking drugs. Gastroscopy is the main objective indicator to reflect the efficacy of treatment.
Under what circumstances should gastroscopy be performed?
1. Any suspected esophageal. Gastrointestinal and duodenal diseases that cannot be diagnosed by comprehensive examination (including X-ray examination).
2, pain behind the sternum. Burning sensation and difficulty in swallowing, suspected of esophageal disease.
3.Esophagus. Gastrointestinal and duodenal ulcers can be detected by gastroscopy, and their healing should be followed up to identify their benignity and malignancy.
4.Patients suspected of esophageal cancer and gastric cancer, gastroscopy can improve the accuracy of diagnosis, detect early history and can be treated.
5.Polyp and bulging lesion in upper gastrointestinal tract, and treatment.
6.Cases of upper gastrointestinal hemorrhage, the cause can be determined and treated.
7.Chronic inflammation of the upper gastrointestinal tract needs to be diagnosed by gastroscopy; chronic atrophic gastritis with intestinal epithelial hyperplasia or atypical hyperplasia can be diagnosed and followed up by gastroscopy.
8.Follow up of cases after gastric surgery.
9.Treatment of foreign body in upper gastrointestinal tract.
Under what circumstances can gastroscopy not be done?
I. Absolute contraindications
1.Severe coronary heart disease and myocardial injury with severe cardiac insufficiency.
2.Oesophageal stenosis or cardia obstruction.
3.Aortic aneurysm.
4.Hemorrhagic shock.
5.Acute pharyngitis and tonsillitis.
6.Pneumonia or other infections with hyperthermia.
7, Asthmatic dyspnea.
8.Severe pulmonary dysfunction.
9.Extreme physical weakness.
10.Patients who are uncooperative or mentally abnormal.
II. Relative contraindications
Acute disease or chronic disease acute attack, after treatment can be recovered, such as acute tonsillitis, pharyngitis, esophagitis, bronchial asthma attack, etc.
What should I pay attention to during gastroscopy?
1, such as in the morning for gastroscopy, the day before the examination after 8 pm, no food and drinks, no smoking. Eat less crumbly and easily digestible food for dinner the day before. If the gastroscopy is done in the afternoon, the patient can drink some sugar water before 8:00 a.m. that day, but can not eat anything else, and do not eat anything at noon. If the patient is pyloric obstruction. Gastric lavage must be performed the night before the examination to thoroughly wash out the stomach contents until the refluxed fluid is clear. Before the gastric tube is withdrawn after gastric lavage, the patient adopts a supine position with head low and feet high to allow complete drainage of residual fluid from the stomach. Gastric lavage cannot be performed on the same day. If barium meal examination has been done, gastroscopy must be done 3 days after the barium meal examination.
2.In order to reduce salivary secretion, diminish reflex and tension, play atropine 0.5 mg and valium 10 mg or luminal 0.1 g 15-30 minutes before the examination, and drink 2-3 ml of defoamer after the injection.
3, anesthesia to take local anesthesia, limited to the pharynx and upper esophagus. Local anesthesia is to spray 2% dicaine, the patient opened his mouth to make the “a” sound, when the soft palate and tongue and palate arch moved up, the tongue root moved down, so that the back of the tongue, throat, soft palate sprayed drugs, successively 3 times. After each spray, the patient swallowed the medicine left in the mouth to anesthetize the subpharynx. There is also the use of paste, contained in the mouth tilted head so that the drug in the throat to stay natural flow into the esophagus, to play a local anesthetic effect.
4, the patient and the doctor to cooperate, the patient before the examination to urinate to empty the bladder, enter the examination room, loosen the collar and trouser belt, remove the dentures and glasses, take the left side lying position, or switch to other positions as needed. After entering the mirror, you should not bite the mirror with your teeth to prevent breaking the plastic tube of the mirror body. The body and head should not be turned to prevent damage to the mirror and injury to the internal organs. If there is any discomfort, the patient should tolerate it for a period of time, and if he/she cannot tolerate it, he/she can indicate to the surgeon with hand signals so that necessary measures can be taken.
5.After the examination, the patient sits up and spits out saliva. As some air is injected during the examination, although it is sucked out when the mirror is retired, some people still have a feeling of abdominal distension and belching a lot. Because the effect of anesthesia has not disappeared, premature eating is easy to make food enter the trachea, so 2 hours after the examination, wait for the effect of pharyngeal anesthetics to disappear before trying to eat liquid food.
6. Within 1 to 4 days after gastroscopy, the patient may feel transient pharyngeal discomfort or pain, while the posterior pharyngeal wall may have a foreign body sensation due to local anesthesia, and there is often a reflex to cough up secretions. Patients should be advised not to forcefully cough up secretions to avoid mucosal damage, and to use some sterile mouthwash or tablets to reduce symptoms and facilitate recovery. Use warm and cool semi-liquid or soft food for a day, so as not to rub the rough food on the gastric mucosa wound, causing bleeding.