What Is a Fundoscopy?

Gastroscopy can sequentially and clearly observe the state of the mucosa of the esophagus, stomach, duodenum and even the descending part, and the process of pathological and cytological examination of the living body is called gastroscopy. Gastroscopy is reliable and safe.

Basic Information

English name: gastroscopy, stomachoscopy

Visiting department: Functional Inspection Division
Common locations: stomach

Gastroscopy indication

1.Symptoms of upper gastrointestinal tract, including upper abdominal discomfort, swelling, pain, heartburn and acid reflux, swallowing discomfort, belching, belching, hiccups and unexplained loss of appetite, weight loss, anemia, etc.

2. Barium meal angiography of upper gastrointestinal tract can not confirm that the lesions or symptoms are not consistent with the results of barium meal examination.

3. Unexplained acute (slow) upper gastrointestinal bleeding. The former can be performed by emergency gastroscopy to determine the cause and perform hemostatic treatment.

4. Diseases to be followed, such as ulcers, atrophic gastritis, precancerous lesions, and postoperative gastric symptoms.

5. General survey of high-risk groups (high incidence of esophageal and gastric cancer).

6. Suitable for gastroscopy, such as foreign body in the stomach, gastric polyps, esophageal and cardia stenosis.

Gastroscopy Contraindications

Absolute contraindication

(1) Severe heart disease, such as severe arrhythmia, active phase of myocardial infarction, and severe heart failure.

(2) Severe lung diseases: those with asthma or respiratory failure who cannot lie flat.

(3) People who cannot cooperate with severe hypertension, mental illness and obvious disturbance of consciousness.

(4) Acute perforation of the esophagus, stomach and duodenum.

(5) Those who cannot insert gastroscope in acute severe throat disease.

(6) Acute phase of corrosive esophageal injury.

2. Relative contraindications

Acute episodes of acute or chronic diseases that can be recovered after treatment, such as acute tonsillitis, pharyngitis, and acute asthma attacks

Gastroscopy complications

1. Heart accident.

2. Pulmonary complications.

3. Perforation.

4. Infection.

5. Bleeding.

6. Dislocation of the mandible.

7. Throat spasm.

8. Swollen parotid glands.

9. Other.

Preparation before gastroscopy

1. To avoid cross-infection, develop reasonable disinfection measures. Patients need to be checked for HbsAg, anti-HCV, anti-HIV, etc. before the test.

2. Fast for 6 to 8 hours before the test. Check on an empty stomach. If there is food in the stomach, it will affect the observation. Those who have had a barium meal check should wait for the barium to be emptied before performing gastroscopy; patients with pyloric obstruction should fast for 2 to 3 days, if necessary, gastric lavage before surgery to remove food accumulated in the stomach.

3. Oral defoamers, such as simethicone, have the effect of removing surface tension, making the foam attached to the mucosa rupture and disappearing, and the vision is clearer.

4. Pharyngeal anesthesia, the purpose is to reduce the pharyngeal reaction, make the lens smooth, and reduce the patient's pain. With an allergy to narcotic drugs, anesthesia is not required. There are two methods: 15 minutes before spraying with pharyngeal spray anesthesia such as 1% dicaine or 2% lidocaine, once every 1-2 minutes for a total of 2 or 3 times; It can be inspected before swallowing, this method is simple and time-saving.

5. Sedatives and antispasmodics: generally not necessary for patients. For patients with mental stress, intramuscular injection or slow intravenous injection of diazepam 10mg 15 minutes before the test to relieve tension; antispasmodics such as anisodamine or atropine can reduce gastric motility and spasm for easy observation, but pay attention to its side effects .

6. Ask the patient to loosen the neckline and trousers. If the patient has active dentures, take out the teeth and gently bite the pad; lie on the examination bed on the left side with the head slightly inclined, the body relaxed, and the legs flexed; Put a disinfection pad on the mouth side, and place a curved plate on the disinfection pad to support the saliva or vomit from the mouth cavity.

Gastroscopy

Observation and operation

(1) The pylorus and gastric antrum are centered on the pylorus. Adjust the angle knob to observe the walls of the gastric antrum respectively. If the small curvature cannot all be seen, you can observe the gastroscope along the large curvature side. The normal pylorus is star-shaped when contracted, and it is a circular opening when it is opened. You can see part of the duodenum's mucosa through the pyloric cavity, and even some lesions in the bulb. The gastric antrum, especially the small curvature of the gastric antrum, is a common area for gastric cancer. During gastroscopy, you should take a close look after looking down at the whole picture, and pay attention to the presence of ulcers, erosions, nodules, local discoloration, stiffness and other lesions. After gastric cancer lesions, the pyloric duct development should be carefully observed to see if it is normal and symmetrical to understand whether gastric cancer has affected the pyloric duct. Generally speaking, early gastric cancer has less accumulated pyloric duct.

(2) Gastric angle notch Gastric angle notch is one of the difficult points of observation in the stomach. It is made by turning the small curvature of the gastric mucosa. When viewed from the cardia side, it looks like an arch. You can see the cardia side mucosa. Reverse method (J-shaped reversal method), that is, try to make the angle knob up, push the gastroscope, the gastroscope is high (visible pylorus), and the image is upside down at this time. The gastric horn and its adjacent sides are the most common sites of early gastric cancer and must be observed.

(3) Gastric body The gastric body cavity is similar to a tunnel. The mucosal folds on the side of the large curve below are thicker, walking longitudinally like a brain gyrus, and the small curve on the upper side is the continuation of the gastric angle. The body of the stomach is larger, which is called the upper, middle, and lower parts of the stomach, and the middle part is also called the vertical part. Because the back wall is tangent to the mirror axis, it is easy to miss lesions. The observation of the stomach body generally uses a combination of U-shaped inverted mirror and retrospective observation. When a suspicious lesion is found, the lens is placed close to the lesion for focused observation. When there is a lesion in the vertical part, the adjustable angle button is made to the right. Observe carefully.

(4) This part of the cardia and the bottom of the stomach can be observed with a high or middle U-shaped inversion method. The U-shaped inversion is to send the gastroscope into the middle of the stomach body. Rotate the endoscope 90 ° -180 ° clockwise to advance the endoscope while observing the mucosa of the back wall. At this time, the endoscope advances to the cardia side until you can see the cardia and the insertion tube that enters the stomach from the cardia. At this time, the insertion tube is U-shaped, so it is called U-shaped inversion. The endoscope insertion tube (lens body) seen when the U-shaped is reversed is located on the small curve side. The front objective lens of the endoscope is facing from the large curve side to the small curve side. The insertion tube covers the mucosa on the small curve side and is rotated. Part to expose the covered part. It should be noted that when the observation is reversed, there is a small curve below the gastroscope, a large curve above, a rear wall on the left, and an anterior wall on the right. If you need cotton to observe the cardia and the bottom of the stomach, the key of the inspection method is to turn the lens body and lift the gastroscope in various directions. This inspection method is also the most important endoscopic operation in improving the level of early cardiac diagnosis.

(5) After the observation of the esophagus and cardia is completed, the stomach gas should be exhausted to reduce postoperative abdominal distension. The gastroscope should be lowered below the esophagus and the cardia should be observed from the front. In addition to careful observation of the cardia mucosa and dentate line, Cardiac opening and closing movements. The total length of the esophagus is about 25cm, and it is divided into upper, middle, and lower sections. The left section of the esophagus has a left atrial pressure trace, and pulsating movement can be seen. Because the esophagus is a straight tube, the positioning of the esophagus wall is slightly different from that of the stomach and duodenum. The upper part of the visual field is the right wall, the lower part is the left wall, and the left and right sides are divided into front and rear walls.

2. Biopsy and cytology

(1) After selecting the biopsy site to find the lesion, make a comprehensive and careful observation, understand the nature of the lesion, determine the location of the biopsy, adjust the direction of the gastroscope, place the lesion in the middle of the field of view, and point the biopsy forceps as vertically as possible. The distance between the head of the gastroscope and the lesion was moderate (3 to 5 cm). Uplift lesions should be taken from the top (easy to find erosion, malignant changes, etc.) and the tissues at the base; flat lesions such as erosion, dimples or rough mucous membranes, and color changes should be biopsied at the interruption and center of mucosal folds around the lesion; gastric cancer In most cases, ulcerative ulcers are the most common. It should be clamped on the edge of the ulcer, especially at the junction of the nodular bulge and the inside of the edge of the ulcer, to increase the positive rate, because the positive rate of sampling in the tissue necrosis of gastric cancer is low.

(2) Diseases with different numbers of biopsies will differ in different uses. The number of early gastric cancer biopsies is directly proportional to the positive rate. It is not uncommon for only one or even a small part of multiple biopsy specimens to be gastric cancer tissues. Generally, the number of biopsies is 4-8. The biopsy site was located at 5 points during the study and only 3 points for clinical use. Biopsy specimens of different parts should be packed in different test tubes, and the specimens should be immersed in the formaldehyde fixing solution in time.