What Is a Gastroscope?
Gastroscopy is a medical examination method and also refers to the equipment used for this examination. It extends into the stomach through a thin, soft tube, and doctors can directly observe the lesions of the esophagus, stomach and duodenum, especially for small lesions. Gastroscopy can directly observe the true situation of the inspected part. It can also be used for pathological biopsy and cytological examination of suspicious lesions to further confirm the diagnosis. It is the first choice for upper gastrointestinal diseases [1] .
- Chinese name
- gastroscopy
- Foreign name
- gastroscope
- Definition
- Medical examination method or medical examination instrument
- inventor
- Kusmore
- Invention time
- 1868
- Improver
- Uji Taro
- Gastroscopy is a medical examination method and also refers to the equipment used for this examination. It extends into the stomach through a thin, soft tube, and doctors can directly observe the lesions of the esophagus, stomach and duodenum, especially for small lesions. Gastroscopy can directly observe the true situation of the inspected part. It can also be used for pathological biopsy and cytological examination of suspicious lesions to further confirm the diagnosis. It is the first choice for upper gastrointestinal diseases [1] .
- The earliest gastroscope was the German Coosmore tube, which was borrowed from the swordsmanship of the rivers and lakes in 1868. It was actually a long metal tube with a mirror at the end. However, because this gastroscope easily punctured the patient's esophagus, it was soon discarded. In 1950, Japanese doctor Uji Taro succeeded in inventing the prototype of soft gastroscope-intragastric camera [2] . The most advanced gastroscope in clinical practice is capsule endoscope.
Introduction to gastroscopy
- Gastroscopy is a thin tube of black plastic covering light guide fibers with a diameter of about 1 cm.
- Merge Atlas (2 photos)
- For general gastroscopy, doctors usually hold the front end of the scope with their right hand and slowly place the gastroscope into the mouth to the base of the tongue. When nausea is obvious, or when swallowing, the upper esophagus is opened, and the doctor will insert the gastroscope into the esophagus along the opening at the moment of opening. When some people don't cooperate well, the doctor often instructs them to do so. [4]
Development of Gastroscopy
- The development of digestive endoscopy has gone through 4 periods [5] :
Gastroscopy rigid endoscope
- In 1805, Philipp Bozzini, German doctor of medicine, first proposed the concept of endoscopy [5] .
- In 1826, French urologist Pierre Segalas developed cystoscopy and esophagoscopy [5] .
- In 1868, the German doctor Adolph Kussmaul made the first esophagogastroscope [5] .
Gastroscope
- In 1932, the German technician Georg Wolf and the German doctor Rudolf Sc.hincller jointly developed a large area of the stomach. The examinee can take the left side. Position, so that gastroscopy has reached a more practical stage, which has great significance in the history of gastroscopy development [5] .
- In 1950, the Japanese doctor Uji Taro succeeded in inventing the prototype of a soft gastroscope-an intragastric camera [5] .
Gastroscopy fiberscope
- In 1958, American gastroenterologist Basil Hirschowitz made the first fiber endoscope, and the endoscope entered the stage of fiber optic microscopy [5] .
Electronic gastroscopy
- In 1983, the United States WeIoh Allyn company first developed the world's first electronic gastroscope, and its advent was the third milestone in the history of endoscopic development [5] .
- In 2000, Israel developed the first medical camera that continuously transmits images to the outside of the body. The shape resembles a pharmaceutical capsule, so it is commonly called a capsule endoscope. This type of endoscope is completely different from the above types of endoscopes in terms of appearance and operation mode, and can be automatically recorded and excreted with gastrointestinal peristalsis without the need for doctors to operate. The patient has less pain, especially small bowel lesions that are currently blind areas of the digestive tract. Opened up a new approach for endoscopy [5] .
Gastroscopy China Development
- China's endoscope development is a bit late. Since the 1950s, some large hospitals have carried out hard endoscopy (or semi-curvature endoscopy) examinations, but the number of endoscopy examinations in each hospital rarely exceeds 50. 5] .
- In the early 1970s, China began to introduce fiber endoscopy, which gradually carried out gastroscopy, colonoscopy, and endoscopic ret-rograde cholangio-pancreatography (ERCP) inspections [5] .
- Since the 1980s, it has developed rapidly. Electronic gastroscopy, ERCP examination, and endoscopic interventional treatment have basically been in line with international standards. By the 1990s, endoscopy has been popularized in grassroots hospitals across the country [5] .
- China began to develop fiber endoscopes in 1966. In 1973, Shanghai Medical Optical Instrument Factory produced the first XW-I fiber gastroscope, which achieved the localization of fiber endoscopes [5] .
Gastroscopy
- 1. Prepare beforehand. Do not eat or drink for at least 8 hours before the test. Food in the stomach may affect the diagnosis of the physician and may cause nausea and vomiting in the subject. In order to reduce the discomfort of the throat, the medical staff will spray anesthetic on the subject's throat 3 minutes before the examination [6] .
- 2. During the inspection process, first put on loose clothing, adopt the left side lying position, and slightly bend your legs. When the physician extends the gastroscope from the plastic device contained in the subject's mouth, he should relax his body and do a little swallowing motion so that the gastroscope can pass through the throat and enter the esophagus. When passing through the throat, I feel pain for several seconds and want to vomit. This is a less comfortable time during gastroscopy [6] .
- 3. When the doctor is making a diagnosis, do not swallow. Instead, inhale through the nose and exhale slowly in the mouth so that the examination can be completed successfully. Some people feel flatulent and nauseous because the air enters the stomach with the tube. If you feel pain and discomfort, please make a gesture to the medical staff, do not hold the tube or make a sound [6] .
- 4. After the treatment, do not eat within 1 to 2 hours after the examination. If the throat does not feel uncomfortable, you can drink water first; if it does not, you can eat soft food first to prevent rough food from causing bleeding to the esophagus or stomach. Some people have a brief sore throat and a foreign body sensation, which usually recovers within 1 to 2 days [6] .
Gastroscopy surgery nursing
Gastroscopy before care
- Learn more about history
- It is the doctor's responsibility to ask the medical history before the operation, and it is also an important job for the nurse in the gastroscopy room. Understanding the medical history can make the operator know the heart and give the patient proper care. Special attention should be paid to the history of contraindications and allergies to narcotic drugs. Measure blood pressure, pulse, and breathing, and notify the doctor to deal with it if you find any abnormalities. If you have dentures, you should remove them before examination to prevent suffocation due to falling off [7-8] .
- Emphasis on psychological care
- Gastroscopy is an invasive procedure. Many patients think that this test is painful, and they have concerns about the degree of safety and the effect of gastroscopy disinfection, and they have a sense of fear. It is not clear how to cooperate during surgery and postoperative precautions [7- 8] .
- Therefore, it is necessary to do a good job of explaining before the examination, and introduce them to the importance and advantages of electronic gastroscopy. Gastroscopy can directly observe the abnormal changes in the gastrointestinal tract, accurately determine the size and depth of the lesion, and clamp the living tissue to do Pathological examination. The electronic gastroscope is safe and convenient to use, the images are clearer, the diagnosis rate is high, and it has direct effects that other tests cannot replace. At the same time, the purpose of the examination, the method of cooperation during the operation and possible complications should be explained, patient questions should be answered, and concerns should be eliminated to ensure the success of the examination. For subjects, targeted psychological care is adopted according to different ages, different occupations, and different cultures [7-8] .
Preparation for Gastroscopy
- Fasting is required for at least 5 hours on the day of the test and on an empty stomach. In order to make the insertion progress smoothly, reduce the throat response, and achieve the desired anesthetic effect, the throat anesthesia time should not be less than 10 minutes, and the spray should reach the posterior wall of the throat. In order to prevent anesthesia accidents, the first dose should be less. During the local anesthesia, allergic reactions should be strictly observed. If you experience dizziness, dyspnea, pale face, weak pulse, etc., you should stop using it immediately and proceed. Adapt to treatment and report to the doctor in time [8] .
- The success of the position insertion is closely related to the patient's position. In our work, we think that the subject should lie on the left side with the knees bent, and the cushion should be high and low. The patient is advised to loosen the collar buckle and trousers, then tilt the head slightly forward, and lower the chin to adduct to reduce the spine. Forward convexity. Place a towel on the mouth and place a curved plate on the towel to receive saliva or vomit from the mouth cavity [8] .
Gastroscopy Nursing
- Lie the patient on their side and bend their legs. The patient was instructed to include an upper mouth cushion and bite it gently. The nurse fixed the mouth cushion with his left hand and stood with the right hand mirror at 20cm at the front of the patient. When the root of the tongue is inserted to the entrance of the esophagus, the patient is instructed to swallow, and the gastroscope can pass through the pharynx smoothly [8] .
Gastroscopy postoperative care
- Postoperatively, patients were told that no biopsy was allowed to eat about 30 minutes after the anesthetic was taken. If the biopsy was taken, it would take 2 hours to eat a warm liquid diet to reduce friction on the wound surface of the gastric mucosa [8] .
- There may be throat discomfort or pain, or hoarseness after surgery, telling patients that they will improve in a short period of time, without nervousness, can be rinsed with fresh saline or used laryngeal tablets [8] .
- Pay attention to observe whether there is active bleeding, such as vomiting blood, blood in the stool, abdominal pain, bloating, and important vital signs such as heart rate and blood pressure. When abnormality is found, it will be dealt with immediately [8] .
- You may feel vomiting after the gastroscopy is completed. Do not get out of bed immediately to avoid fainting. Because gastroscopy requires fasting, so that the stomach is empty during the examination, the gastroscope should inflate the stomach after entering the stomach. After the examination, some people have no special reaction, and some people have pain. This pain usually disappears within one to two hours, but if the pain persists for 4 hours or more, it needs to be treated by a doctor [8] .
Gastroscopy considerations
- 1. In order to prevent hepatitis infection, separate the gastroscope of hepatitis patients and those without hepatitis, and perform liver function and hepatitis B surface antigen tests before gastroscopy [8] .
- 2. In order to clearly see the mucous membrane of the digestive tract, the site to be examined must be clean, that is, no food or blood clots remain. If you have a gastroscopy in the morning, after 8 pm the day before the inspection, do not enter food and drinks, and smoking is prohibited. The day before dinner, eat less residue and digestible food. Because even if the patient drinks a small amount of water, the color of the gastric mucosa can be changed. For example, in the natural lesions of atrophic gastritis, the gastric mucosa can become red after drinking, which makes the diagnosis wrong. If you have a gastroscopy in the afternoon, you can drink some sugar water before 8am that day, but you ca nt eat anything, and you do nt eat at noon. For patients with pyloric obstruction, gastric lavage must be performed the night before the examination, and the contents of the gastric lavage must be thoroughly cleaned until the flushing fluid is clear. Before the gastric tube is withdrawn after gastric lavage, the patient adopts a supine posture with the head down, the feet high, so that the residual fluid in the stomach is completely discharged. Gastric lavage cannot be done on the same day, because gastric lavage can change the color of gastric mucosa. If a barium meal examination has been performed, the barium meal barium may be attached to the gastrointestinal mucosa, especially the ulcer lesion, which makes the diagnosis of fiber gastroscopy difficult. Therefore, the gastroscope examination must be performed 3 days after the barium meal examination. At the same time, in order to reduce saliva secretion, reduce reflexes and reduce tension, take atropine 0.5 mg and diazepam 10 mg or Lumina 0.1 g 15 to 30 minutes before the test, and drink 2 to 3 ml of defoaming agent after injection [8] .
- 3. Local anesthesia is used for anesthesia, which is limited to the throat and upper esophagus. Before using the above medicine, tell your doctor about your history of drug allergies, that is, what drugs you have allergic to in the past. Local anesthesia is sprayed with 2% dicaine or 2% sirocaine, and the patient makes an "A" sound when the mouth is opened. At this time, the soft palate and the lingual arch are moved upward, and the root of the tongue is moved downward. , Three times. After each spray, the patient swallows the medicine left in the mouth to anesthetize the lower part of the pharynx. There are also pastes, which are placed in the mouth and held up to keep the drug in the throat and flow naturally into the esophagus, acting as a local anesthetic [8] .
- 4. The patient and the doctor must cooperate. Before the examination, the patient goes to urinate and empty the bladder. After entering the examination room, loosen the neckline and trousers, remove the dentures and glasses, take the left lateral position, or change to other positions as needed. After the mirror, you cannot use your teeth to bite the mirror, to prevent the plastic body and head of the mirror body from turning. This may damage the mirror and hurt the internal organs. If there is discomfort, the patient tolerates it for a period of time and is really intolerable. He can use a gesture to indicate to the operator (doctor or nurse) in order to take necessary measures [8] .
- 5. After the examination, the patient sits up and spit out saliva. Although some air was injected during the examination, although some of them were aspirated at the time of withdrawal, some people still felt abdominal distension and belching. Because the anesthetic effect does not disappear, eating food prematurely can make the food enter the trachea, so 2 hours after the examination, try to eat liquid food after the pharyngeal anesthetic effect disappears. Within 1 to 4 days, patients may feel pharyngeal discomfort or pain, but without affecting their diet, most people can work as usual, and those with more illnesses can rest. The driver cannot drive alone on the day. Gastroscopy is best accompanied by family members and escorted home after the examination. Gastroscopy cannot be performed for some diseases, such as spinal deformity, unconsciousness, psychosis, pulmonary heart disease, asthma, high blood pressure, and patients who are not considered suitable for gastroscopy by doctors [8] .
Gastroscope for people
- 1. Have upper gastrointestinal symptoms, including upper abdominal discomfort, swelling, pain, heartburn (heartburn) and acid reflux, swallowing discomfort, infarcts, belching, hiccups, and lack of appetite for unknown causes, weight loss, anemia, etc. [9] .
- 2. Upper gastrointestinal barium angiography does not identify those whose lesions or symptoms are inconsistent with the results of the barium test [9] .
- 3 Unexplained acute (slow) upper gastrointestinal bleeding or who need endoscopic hemostasis [9] .
- 4 After upper gastrointestinal lesions (esophagus, stomach, duodenum), symptoms reappear or worsen, and those with suspected anastomotic lesions [9] .
- 5. Lesions that require regular follow-up, such as ulcers, atrophic gastritis, and precancerous lesions [9] .
- 6. General survey of high-risk groups (high incidence of esophageal and gastric cancers) [9] .
- 7. Those who need endoscopic treatment [9] .
Gastroscopy contraindications
Relative contraindication to gastroscopy
- 1) Cardiopulmonary insufficiency [9] ;
- 2) gastrointestinal bleeding, large or unstable blood pressure [9] ;
- 3) High blood pressure in patients with severe hypertension [9] ;
- 4) Severe bleeding tendency, hemoglobin less than 50 g / L or prolonged PT for more than 1.5 seconds [9] ;
- 5) High spinal deformity [9] ;
- 6) Giant diverticulum in the digestive tract [9] .
Gastroscopy is absolutely contraindicated
- 1) Severe cardiopulmonary disorders, unable to tolerate endoscopy [9] ;
- 2) Critical patients suspected of having shock or perforation of the digestive tract [9] ;
- 3) People with mental illness who cannot cooperate with endoscopy [9] ;
- 4) Acute inflammation of the digestive tract, especially in patients with corrosive inflammation [9] ;
- 5) Obvious thoracoabdominal aortic aneurysm [9] ;
- 6) Patients with stroke [9] .
Gastroscopy technology advantages
Easy gastroscopy
- An electronic gastroscope is used to perform the examination so that the patient can complete the entire examination and treatment process in the awake state. The entire gastroscopy only takes 2 to 3 minutes. After the examination and treatment, it usually takes about 5 to 10 minutes to rest before going home. Gastroscopy and treatment are less painful, shorter time, high diagnosis rate, good effect, and high safety, so this technology is welcomed by the majority of patients with gastrointestinal diseases [10] .
Gastroscope at a glance
- When performing a gastroscopy with a gastroscope, the diseased tissue is enlarged. With a clear field of vision, the doctor can have a comprehensive overview of the gastric diseases, check no dead ends, no injuries, and have a high diagnosis rate. The examination and treatment are safe and short in time. The patient will not be nervous before the examination, there will be no discomfort during the examination, and the patient will recover soon after the examination. The doctor's examination results are more accurate, which is conducive to the judgment and treatment of the disease [10] .
Gastroscopy intervention
- Gastroscopy is not only used to examine and diagnose diseases, but also plays a significant role in interventional treatment of gastric diseases. Under the direct view of the gastroscope, polyps can be removed directly with a high-frequency electric knife, completely avoiding the pain of the previous operation, and avoiding malignant changes in the polyps [10] .