Endoscopic methods for examining the intestines: description and preparation. Types of endoscopic examinations Possible limitations to intestinal endoscopy
Endoscopy - study of hollow or tubular organs, which consists of direct examination of their internal surface using special devices - endoscopes. An endoscope is a flexible rod consisting of fiberglass threads through which an image is transmitted. The diagnostic value of endoscopy is increased due to the ability, during the study, to take material from the surface of the mucous membrane or pieces of tissue (biopsy) for cytological and histological examination.
Fibroesophagogastroduodenoscopy .
This is an endoscopic method for examining the esophagus, stomach and duodenum using a flexible gastroscope, which allows you to assess the lumen and condition of the mucous membrane of the esophagus, the condition of the mucous membrane of the stomach and duodenum - color, the presence of erosions, ulcers, neoplasms. Using additional techniques, you can determine the acidity of gastric juice and, if necessary, perform a targeted biopsy for morphological examination. FGDS is also used for medicinal purposes: performing polypectomy, stopping bleeding, local use of drugs.
Preparation:
1. It is necessary to provide instructions on preparation for the study:
on the eve of the study, dinner no later than 18:00
In the morning on the day of the study, exclude food, water, medications, do not smoke, and do not brush your teeth.
2. Warn the patient not to talk or swallow saliva during the examination. If you have dentures, they must be removed.
3. Before the examination, the pharynx and initial parts of the pharynx are irrigated with an anesthetic solution by a nurse in the endoscopy room.
4. Warn that you should not eat food for two hours after the procedure.
Colonoscopy. The essence of the method and diagnostic value: This is an endoscopic method for examining high-lying parts of the colon using a flexible endoscope, allowing one to examine the mucous membrane of the colon.
Preparation:
1. Instruct the patient: Three days before the study, a slag-free diet is prescribed, which involves excluding gas-forming foods (brown bread, dairy products, vegetables and fruits) from the diet. Mostly liquid, easily digestible dishes are recommended: white bread, semolina porridge, jelly, omelet, rice soup.
2. If the patient is bothered by bloating, he should take chamomile infusion, activated carbon, carbolene, simethicone or enzyme preparations for three days.
3. On the eve of the study:
at 15:00 -16:00 the patient receives 30 g of castor oil (in the absence of diarrhea).
no later than 18:00 – light dinner.
at 20:00 -21:00 on the eve of the study, cleansing enemas are performed until the effect of “clean water” is achieved.
4. On the morning of the examination, no later than 2 hours before the colonoscopy, 2 cleansing enemas are performed with an interval of one hour.
5. On the day of the study, the patient should not drink, eat, smoke or take medications.
6. In the endoscopy room, it is necessary to help the patient take a position for the examination - lying on his left side with his legs pulled up to his stomach, anesthetize the anal area with 3% dicaine ointment.
Sigmoidoscopy. The essence of the method and diagnostic value: This is a visual examination using a rigid endoscope of the mucous membrane of the rectum and sigmoid colon. The proctoscope is inserted at a distance of 20–30 cm into the rectum.
Preparation:
Provide instructions on preparing the patient for the procedure according to the following scheme:
The study is carried out on an empty stomach;
For 3 days before the study - a slag-free diet; if necessary, to reduce gas formation, take activated carbon; to improve digestion - enzyme preparations;
The evening before the study, no later than 6 pm, light dinner (white dry bread; weak unsweetened tea);
Two cleansing enemas at 20:00 and 22:00;
On the morning of the test, exclude food, water, medications, and do not smoke;
No later than 2 hours before the study - a cleansing enema;
Immediately before the examination, empty your bladder in order to avoid discomfort during the procedure.
Help the patient take a knee-elbow position.
Bronchoscopy . The essence of the method and diagnostic value: This is an endoscopic research method that allows you to examine the mucous membrane of the larynx, trachea, bronchi, collect contents or bronchial lavage water for bacteriological, cytological and immunological studies, as well as carry out treatment.
Preparation for bronchoscopy:
1. If the examination is prescribed for a woman, warn that there is no varnish on the nails and no lipstick on the lips (to control the color of the red border of the lips and nails).
2. For 2-3 days before the study, the patient takes a 0.1% atropine solution, 6-8 drops 3 times a day to reduce salivation and dilation of the bronchi.
3. The study is carried out on an empty stomach. 30-40 minutes before the manipulation, premedication is carried out as prescribed by the doctor: inject subcutaneously 1 ml of a 0.1% atropine solution and 1 ml of a 2% promedol solution (make an entry in the medical history and the narcotic drug log).
4. If a contrast agent is injected into the lumen of the bronchi using a bronchoscope and radiography is performed, this method is called bronchography . Before bronchography, to exclude allergies to iodolipol, 1 tablespoon of this drug is prescribed orally 2-3 days before the study, then the patient’s condition is monitored.
3. Ultrasound examination (ultrasound) (syn.: echography) - a diagnostic method based on differences in the reflection of ultrasonic waves passing through media and tissues of different densities.
Ultrasound is acoustic high-frequency vibrations from 20 to 100 kHz, which are no longer perceived by the human ear. The possibility of using ultrasound for diagnostic purposes is due to its ability to propagate in media in certain directions in the form of a thin concentrated beam of waves. Ultrasound waves are absorbed differently by different tissues (“fading away in them”), and unabsorbed rays are reflected and captured using special equipment. The advantage of the method is that it allows you to determine the structure of the organ without causing any harmful effects on the body or causing discomfort in patients. The method is highly informative and is used in obstetrics and gynecology, pediatrics, and in the diagnosis of cardiovascular, digestive, genitourinary and endocrine systems. For ultrasound examination of the heart (Echocardiography) no special preparation required. The patient must have a medical history and an electrocardiogram with him.
Ultrasound examination of the abdominal cavity .The essence of the method and diagnostic value: This is an instrumental method for studying the abdominal organs (liver, spleen, gall bladder, pancreas, kidneys), based on the reflection of ultrasonic waves from the boundaries of tissues with different densities. Using ultrasound, it is possible to determine the size and structure of the abdominal organs and diagnose pathological changes (calculi, tumors, cysts). The advantage of this method is its harmlessness and safety for the patient, the ability to conduct research in any condition of the patient, and immediate results.
Preparation:
It is necessary to instruct the patient in preparation for the study according to the following plan:
exclude gas-forming foods from the diet for three days before the study: vegetables, fruits, dairy and yeast products, brown bread, legumes, fruit juices;
for flatulence, take activated carbon (4 tablets 3 times a day) or simethicone (espumisan 2 capsules 3 times a day) for 2 days as prescribed by your doctor (do not take tablet laxatives);
warn the patient about the need to conduct the study on an empty stomach, the last meal at 18:00 on the eve of the study;
warn about the undesirability of smoking before the study, because it causes contraction of the gallbladder. If you have constipation, give a cleansing enema the evening before the test.
4. Laparoscopic examination usually performed in the operating room. First, air is introduced into the abdominal cavity (pneumoperitoneum), then the anterior abdominal wall is pierced with a trocar, and a laparoscope is inserted through this hole.
5. Radioisotope research methods.
The essence of the radioisotope research method (scanning) is that the patient is injected with an organotropic radioactive isotope that can concentrate in the tissues of a certain organ. The patient is placed on a couch under the detector of the scanning machine. The detector receives impulses from an organ that has become a source of ionizing radiation. The signals are converted into scanograms. Scanning allows you to determine the shape of an organ, its displacement, reduction, as well as a decrease or increase in functional activity by diffuse compaction or rarefaction of points (lines) of the scanogram. Scanning is primarily used to study the structure and function of the thyroid gland, liver, kidneys, spleen, heart, and skeletal system.
6. NMRI – nuclear magnetic resonance tomography is a study using a powerful magnetic field. It is used for diagnosing primarily oncological diseases, as well as diseases of the skeletal system, digestive organs, cardiovascular, excretory systems, and so on.
7. Functional research methods.
Research methods external respiration functions.
External, or pulmonary, respiration is the exchange of gases at the stage “blood of the pulmonary capillaries - atmospheric air”. The study of external respiration makes it possible to judge the presence of respiratory failure when there are no symptoms of respiratory failure yet, and to monitor the dynamics of tidal volumes, which change under the influence of treatment.
Pulmonary ventilation. Indicators of pulmonary ventilation are determined and changed not only due to the pathological process in the respiratory system, but also largely depend on the constitution and physical training, height, body weight, gender and age of the person. Therefore, the obtained data are evaluated in comparison with the so-called proper values, which take into account all these data and are the norm for the person being studied.
Measurement of tidal volumes.
1) tidal volume (TI) - the volume of air inhaled and exhaled during quiet breathing in one breathing phase. On average it is 500 ml (from 300 to 900 ml). Of this volume, approximately 150 ml is the volume of the so-called functional dead space air (AFSD) in the larynx, trachea, bronchi, which does not take part in gas exchange, although, mixing with the inhaled air, it moisturizes and warms it (the physiological role of AFSD).
2) expiratory reserve volume (ER ext.) - it is approximately 1500-2000 ml. This is the air that a person can exhale after a calm, normal exhalation, if after a calm exhalation he exhales as much as possible;
3) reserve inspiratory volume (RO in.) - equal to 1500-2000 ml. This is the volume of air that a person can inhale after a quiet breath;
4) vital capacity of the lungs (VC) is equal to the sum of the reserve volumes of inhalation and exhalation and tidal volume. On average, vital capacity is 3700 ml;
5) residual volume (VR), equal to 1000-1500 ml - air remaining in the lungs after maximum exhalation;
6) the total maximum lung capacity (TLC) is the sum of the respiratory, reserve (inhalation and exhalation) and residual volume and is equal to 5000-6000 ml.
Spirometry – a method for recording changes in lung volumes during respiratory maneuvers over time. Spirography – registration of ventilation values (respiratory oscillations) on a moving millimeter tape of a spirograph. In addition to measuring lung volumes, using a spirograph you can determine a number of additional ventilation indicators: tidal and minute ventilation volumes, maximum ventilation of the lungs, forced expiratory volume (can be done separately for each lung).
Forced expiratory volume (FEV)- this is the amount of air that the subject exhales during a rapid exhalation after a maximum inhalation (Wotchal test). Typhno sample- one-second forced expiratory volume (FEV1) is the volume of air exhaled in the first second. Normally it is 70-80% of vital capacity. If the indicator decreases, you can think about emphysema, bronchial obstruction.
The degree of ventilation impairment can also be judged from the data pneumotachymetry. This method determines the maximum volumetric velocity of the air stream during forced exhalation and inhalation. Normally, the volumetric velocity of the air stream during exhalation ranges from 5 to 8 liters per 1 second in men and from 4 to 6 liters per 1 second in women. The volumetric velocity of the air stream during inhalation is less than during exhalation. Pneumotachymetry indicators decrease when bronchial patency is impaired and the elasticity of the lung tissue decreases.
Peak flowmetry – a method for measuring peak expiratory flow (PEF) – the maximum air speed during forced exhalation after a full inhalation. Used to select a treatment method for bronchial obstruction. Peak flowmetry using a portable peak flow meter, which the patient can use at home, has become widespread.
Electrocardiography.
Electrocardiography is a method of graphically recording electrical processes occurring during the activity of the heart. The resulting curve is called electrocardiogram.
Drugs used:
Endoscopy is a method of examining internal organs using special devices - endoscopes. The term "endoscopy" comes from two Greek words (endon - inside and skopeo - look, examine). This method is widely used for diagnostic and therapeutic purposes in surgery, gastroenterology, pulmonology, urology, gynecology and other areas of medicine.
Depending on the organ being studied, there are:
bronchoscopy (endoscopy of the bronchi),
esophagoscopy (endoscopy of the esophagus),
gastroscopy (stomach endoscopy),
intestinoscopy (endoscopy of the small intestine),
colonoscopy (endoscopy of the large intestine).
Gastroscopy Have you been prescribed an esophagogastroduodenoscopy?
(EGD) is an endoscopic research method in which the upper parts of the gastrointestinal tract are examined: the esophagus, stomach and duodenum.
Gastroscopy is performed by qualified endoscopists. At the patient's request, gastroscopy during sleep (medicated sleep) is possible.
An endoscope is a long, thin, flexible tube with a lens at the end. Operating the endoscope, the doctor, under visual control, safely guides the instrument into the upper parts of the digestive tract to carefully examine its inner surface.
Gastroscopy will help make the correct diagnosis for many conditions, including stomach pain, bleeding, ulcers, tumors, difficulty swallowing and many others.
It is very important in preparation for gastroscopy that you should not eat for 6-8 hours before the examination.
During the gastroscopy, everything possible will be done to make it as easy as possible for you. Your condition will be closely monitored by medical staff. If gastroscopy scares you, it can be done in your sleep.
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Tracheobronchoscopy (the shorter name is often used - bronchoscopy) is an endoscopic method for assessing the mucous membrane and lumen of the trachea and bronchi (tracheobronchial tree).
Diagnostic tracheobronchoscopy is performed using flexible endoscopes that are inserted into the lumen of the trachea and bronchi.
How to prepare for bronchoscopy?
Tracheobronchoscopy is performed on an empty stomach to avoid accidental release of food or liquid into the respiratory tract during vomiting or coughing, so the last meal should be no later than 21 hours on the eve of the study.
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Colonoscopy is an endoscopic examination during which the condition of the colon mucosa is visually assessed. Colonoscopy is performed with flexible endoscopes.
Sometimes, before a colonoscopy, an X-ray examination of the colon is performed - irrigoscopy. Colonoscopy can be performed 2-3 days after irrigoscopy.
How to prepare for a colonoscopy?
In order to examine the mucous membrane of the colon, it is necessary that there is no feces in its lumen.
The success and informativeness of a colonoscopy is determined mainly by the quality of preparation for the procedure, so pay the most serious attention to following the following recommendations: If you do not suffer from constipation, that is, the absence of independent bowel movements for 72 hours, then preparation for a colonoscopy consists of the following:
On the eve of the colonoscopy at 16:00 you need to take 40-60 grams of castor oil. Other laxatives (senna preparations, bisacodyl, etc.) lead to a pronounced increase in the tone of the colon, which makes the study more labor-intensive and often painful.
After independent bowel movements, you need to do 2 enemas of 1-1.5 liters each. Enemas are given at 20 and 22 hours.
On the morning of the colonoscopy, you need to do 2 more of the same enemas (at 7 and 8 o'clock).
There is no need to fast on the day of the test.
Ancient healers could not even imagine that in the future it would be possible to examine without making incisions on the body. Currently, such a survey has become a reality. Medical science is constantly evolving, making it possible to promptly identify various pathological conditions and provide the necessary assistance to patients. allow you to assess the condition of the tissues of hollow organs from the inside. There are several types of such diagnostics, which will be discussed in this article.
What is endoscopy?
In medical practice, the term “endoscopy” refers to the examination of internal organs that have a cavity using lighting devices. To perform this procedure, an endoscope is used - rigid or flexible tubes of small diameter. In the first case, the basis of the device is a fiber-optic system. On one side there is a light bulb, and on the other there is an eyepiece that allows you to adjust the size of the image. Flexible endoscopes allow you to explore the most inaccessible places. The bundle of fibers transmits a clear image despite the bends of the system. A new step in the development of this area of diagnostics is capsule endoscopy.
Using flexible endoscopes, you can not only perform diagnostics, but also take tissue samples for a more detailed study of the pathological process. Endoscopic examinations make it possible to determine the nature of the disease and monitor the dynamics of treatment. A unique device allows you to assess the condition of almost any organ. The procedure itself is carried out exclusively in medical institutions by specially trained personnel.
Advantages of the method
The main advantage of diagnostics using an endoscope is the ability to see the condition of internal organs without surgical intervention. The procedure is painless for the patient. The only thing he can feel is discomfort. During the examination, the person is conscious.
Sometimes used for operations. In this case, a small incision is made in the skin through which a tube with a lighting device will be inserted. Such manipulation is necessary when removing benign tumors on internal organs and when removing foreign bodies. Endoscopic research methods can be used to administer medications.
Applications of endoscopy
The advent of endoscopy made it possible to examine almost all organs. The diagnostic method is used in the following areas of medicine:
- gynecology (colcoscopy, hysteroscopy);
- neurology and neurosurgery (ventriculoscopy);
- pulmonology (bronchoscopy);
- otolaryngology (otoscopy, pharyngolaryngoscopy);
- gastroenterology (gastroscopy, colonoscopy, esophagogastroduodenoscopy, laparoscopy);
- cardiology (cardioscopy);
- urology (cystoscopy, ureteroscopy).
Recently, endoscopy has also been used to diagnose knee joints. During the diagnostic process (arthroscopy), the patient is introduced to a special device - an arthroscope, which allows the specialist to assess the condition of the joint and perform the procedure with minimal surgical intervention. Carrying out endoscopic examinations also makes it possible to recognize the disease at an early stage, so they are often prescribed for preventive purposes to patients at risk.
Indications for bowel examination
The only way to see the condition of the intestines is to perform an endoscopy. In medical terminology, endoscopic studies of this kind are called esophagogastroduodenoscopy, colonoscopy, or rectomanoscopy. Indications for diagnosing the esophagus, stomach, large and small intestines, and rectum are the following pathological conditions:
- Peptic ulcer disease.
- Suspicion of bleeding.
- Oncological diseases.
- Gastritis.
- Paraproctitis.
- Stool disorders.
- Hemorrhoids (chronic).
- Discharge of blood and mucus from the anus.
Depending on the preliminary diagnosis, the specialist will select the most appropriate option for endoscopic examination.
Colonoscopy of the intestine
One type of endoscopic examination is colonoscopy. The method allows diagnostics to be carried out using a flexible colonoscope device, consisting of an eyepiece, a light source, a tube through which air is supplied and special forceps for collecting material. The device allows you to see a fairly high-quality image displayed on the screen of the condition of the colon mucosa. The length of the tube used for this type of diagnosis is 1.5 meters.
The procedure is quite simple. The patient is asked to lie on his left side and pull his legs bent at the knees to his chest. Then the doctor carefully inserts a colonoscope into the rectum. The anus may first be lubricated with an anesthetic gel. The tube is gradually advanced deeper, examining the intestinal walls. For a clearer image, air is constantly supplied during the diagnostic process. The procedure takes no more than 10 minutes.
Is preparation necessary?
Of course, to obtain an accurate picture of the condition of the large intestine, the patient should prepare for a colonoscopy. Preparation for an endoscopic examination consists primarily of following a diet. Products that contribute to fecal retention and increased gas formation should be excluded from the daily menu at least a week before the expected date of diagnosis.
On the day of the examination, you should refrain from eating in the morning. Only liquids are allowed. Before the procedure itself, experts recommend cleaning the rectum with an enema or using laxatives.
Endoscopic examination of the intestines - colonoscopy - is a painless procedure and therefore you should not be afraid of it. The patient may feel only minor discomfort. In some cases, the manipulation is carried out under anesthesia, but most often it is limited to sedatives and painkillers.
Capsule endoscopy
A relatively new direction in the diagnosis of diseases of the gastrointestinal tract is capsule endoscopy. The method appeared only in 2001. The endoscope used for research resembles a medicinal capsule, which greatly facilitates the process of inserting the device. You just need to take this tablet with water. The device is activated immediately after opening the individual packaging. Passing through the gastrointestinal tract, the capsule takes many pictures, which will later help make a diagnosis.
The advantages of this method are obvious - the patient does not need to swallow the hose or worry about having a colonoscopy. The capsule reaches the most remote parts of the intestine, where a conventional endoscope cannot access. On the other hand, this method does not allow taking material for a biopsy or removing polyps. Therefore, doctors still prefer to use capsule and traditional endoscopy of the digestive tract in a comprehensive manner.
Esophagoscopy
Endoscopic examination is carried out to diagnose various pathologies. Most often, esophagoscopy is combined with examination of the stomach and duodenum. This allows you to get a more complete picture of the state of the digestive tract. The method allows you to identify ulcers, hemorrhages, inflammatory processes, polyps on the mucous membrane. Taking material for a biopsy allows us to establish the etiology of the disease. The inspection is carried out with both flexible and rigid instruments.
Indications for examination include structural anomalies, chemical burns of the mucous membrane, the need for a biopsy, the presence of a foreign body, and inflammatory processes.
Endoscopic ultrasound examination
To diagnose the walls of the digestive tract, endoscopy using ultrasound can be used. The latter allows you to obtain images of organs using sound waves. This method is most often used to detect benign neoplasms, tumors, stones in the bile ducts, and inflammation of the pancreas. Endoscopic examinations using ultrasound make it possible to evaluate the mucous membrane of the entire digestive system.
The endoscope is inserted into the patient through the larynx, first into the esophagus, gradually moving it into the stomach and duodenum. The larynx is first treated with an analgesic spray to relieve discomfort. Ultrasound may be needed to take tissue samples.
Consequences of the procedure
Endoscopic research methods in most cases do not cause serious disturbances in the functioning of the body. If the procedure is carried out correctly, the patient can return to his normal lifestyle within a few hours without feeling any discomfort. However, there are still situations when, after diagnosis, a person is forced to seek medical help. Damage to the walls of organs is most often recorded during the passage of an endoscope. This can be determined by the pain syndrome, which does not go away for a long time, and the presence of blood in the feces.
An allergic reaction to the analgesic used during the study may occur. In this case, the use of antihistamines is indicated. Arrhythmia after the procedure often develops in patients with cardiovascular pathologies.
Proper preparation of the patient for endoscopic examinations will avoid many undesirable consequences. The diagnosis itself must be carried out in a hospital or clinic. The doctor must first exclude all contraindications for conducting this type of examination.
Intestinal endoscopy- This is an examination of the mucous membrane using a flexible probe equipped with a video camera, displaying an image on a monitor screen. There is no damage during examination; different parts of the digestive tract can be examined through the mouth or anus.
Depending on the department being examined, intestinal endoscopy is divided into several types:
Comparison table of endoscopic methods
Visual examination of the inner intestinal mucosa is the best method for diagnosing all diseases, but each method has its pros and cons.
| Diagnostic method | Advantages | Flaws |
| Anoscopy |
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| Sigmoidoscopy |
|
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| Colonoscopy |
|
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| Capsule endoscopy |
|
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| Esophagogastroduodenoscopy |
|
|
What can endoscopic methods detect?
It is important that the image of the suspicious area can be enlarged to see the details. It is also possible to rotate the endoscopic probe inside the intestine to examine adjacent areas of interest, as well as to determine the extent of the lesion down to healthy tissue.
Contraindications: absolute and relative
There are no absolute contraindications for examination of the upper intestines or endoscopy, but it is recommended to postpone the examination in case of severe general diseases: intoxication, myocardial infarction and cerebral stroke, exacerbation of bronchial asthma. This procedure is not recommended for burns of the esophagus, aortic aneurysm, or multiple scars of the esophagus. However, if a disease of the digestive canal threatens the patient’s life, the study is performed in these conditions, but with extreme caution. Availability of an intensive care unit is necessary, and local and general anesthesia can be used during the study.
Studies in which equipment is inserted through the anus have a greater number of contraindications, but they are also assessed in the same way. The final decision is made by the doctor, focusing on the severity of the patient’s condition. The contraindications are:
If the patient’s condition allows, the diagnostic procedure is completed with therapeutic measures: infusion of medication, stopping bleeding, removal of a tumor or foreign body. This is easier for the patient to endure than abdominal surgery.
Preparation for endoscopic examinations
The point of preparation is to remove contents from the intestines as much as possible. The better the intestines are prepared, the more the doctor will see and the more accurately the diagnosis will be made.
Cleansing consists of two points: proper nutrition and cleansing itself with the help of enemas and laxatives.
2-3 days in advance, you need to stop taking activated carbon, iron supplements, lactofiltrum and De-Nol medication, if they were previously used.
Conducting surveys
The technique is simple, but requires excellent knowledge of anatomy.
Oral access
If the probe is inserted through the mouth, the mucous membrane is pre-treated with a local anesthetic. This is done to suppress cough and gag reflexes, as well as for greater patient comfort. A plastic mouthguard is inserted into the mouth to prevent involuntary movements. The examination is performed in the lateral position. The probe moves slowly to the depth that the equipment allows. The doctor examines all areas, records details, and, if necessary, selects (pinches off) a piece of living tissue for biopsy. After the inspection is completed, the equipment is removed and processed. 
With access through the anus
The probe is inserted through the anus in a knee-elbow position or on the side. The procedure is painless, but unpleasant. In sensitive patients, anesthesia is used, often local. Additionally, the endoscope tube is lubricated with an anesthetic. A rigid tip is inserted into the rectum, and a flexible probe is inserted through it. The doctor has the ability to rotate the probe inside the intestine and record everything he sees in digital format. Biopsy and therapeutic procedures are available.
Recently, endoscopy of the lower intestine is increasingly performed in a state of therapeutic sleep, lasting no more than half an hour. This eliminates any possible discomfort.
Are there alternatives to endoscopic examinations?
By and large, there are none. No other research method provides such a complete picture of the disease, allowing us to see not only the structure of the intestine, but also its function.
A doctor who sees a living intestine immediately understands what disease he is dealing with. Visually determined:
- and other abbreviations;
- color and structure of the mucosa;
- normal and pathological discharge;
- various growths and contractions;
- tumors;
- boundaries of healthy tissues.
Endoscopy is the only method that allows you to see the organ directly. With all other methods, the image of the intestine is distorted and redundant data is mixed in.
In what cases is it necessary to undergo examinations?
You need to undergo endoscopy (even if you don’t want to) in the following conditions:
- the presence of blood in the stool;
- digestive and stool disorders;
- frequent constipation;
- constant heartburn and belching;
- flatulence;
- dramatic weight loss without dieting;
- intolerance to any type of food;
- discharge of pus or mucus from the anus;
- putrid odor from the mouth.
It is advisable for people over 45 years of age to undergo an endoscopic examination annually, especially if there has been a history of tumor formations in the family. Timely detection of tumors and their removal has saved thousands of lives, and this number is constantly growing.
Endoscopy– a diagnostic and therapeutic technique using special devices that allow one to obtain visual information about the condition of hollow organs and natural cavities of the human body. In most cases, the endoscope is inserted through natural routes (into the stomach - through the mouth, into the large intestine - through the rectum, into the uterus - through the vagina, etc.). Less commonly, cavities are examined through punctures or small incisions. Endoscopy is used to obtain data on the state of the gastrointestinal tract, respiratory system, urinary tract, female genital organs, inner surfaces of joints, chest and abdominal cavities.
History of endoscopy
The history of endoscopic diagnostics began at the end of the 18th century, when the German scientist Bozzini invented a device that can be considered the first endoscope. The device was designed to examine the uterus, colon and nasal cavity. Bozzini used a candle as a light source. Because of possible burns, the scientist was afraid to use the endoscope on people and conducted research on animals. The scientist's invention was greeted with caution by his contemporaries. The Vienna Faculty of Medicine punished the researcher “for being curious,” and interest in the technology faded for some time.
In 1826, Segales improved Bozzini's device, and a year later Fischer demonstrated to his colleagues a similar device of his own design. Despite the recognition of the merits of Bozzini and Fischer in the development of endoscopy, the founder of the technique is considered to be the French doctor Desormus, who in 1853 designed an endoscope with a system of lenses and mirrors and used it to study the genitourinary system. The second half of the 19th century was marked by the rapid development of endoscopy. European specialists invented a number of devices for various purposes, but due to the lack of safe light sources, the use of endoscopy was limited.
The situation changed after the invention of the incandescent lamp. Devices were reduced in size and rapidly improved. At the beginning of the 20th century, the first operations using an endoscope were performed. In the 30s of the 20th century, the first semi-flexible endoscopes appeared, and in the 50s - flexible endoscopes. The use of improved instruments has expanded the capabilities of specialists in studying the cavities of the human body. The examination has become simpler, safer and more painless. High information content and affordable prices for endoscopy in Moscow have allowed this technique to take its rightful place in the list of modern diagnostic tests and displace traditional surgery in the treatment of a number of pathological processes.
Principles of conducting
The diagnostic process uses an endoscope - an optical device, the main part of which is a metal tube with a lens at one end and a camera at the other. Inside the tube there is a fiber optic system. A light cable and an air or liquid supply system are connected to the device. The endoscope is inserted into a natural opening or small incision above the cavity being examined. Air or saline solution is supplied into the cavity - this allows for the best conditions for visual inspection and increases the information content of the study.
The image from the camera is transmitted to the monitor screen. When performing an endoscopy, the doctor can change the position of the lens, examining different parts of the cavity. If necessary, photographs and video recordings are taken. According to indications, a biopsy, removal of polyps or foreign bodies, stopping bleeding, administering medications, etc. can be performed. At the end of the procedure, the endoscope is removed. If the examination was carried out through a natural opening, no additional therapeutic measures are required. If endoscopy was performed through a puncture created using a trocar, the wound is sutured and covered with an aseptic dressing.
Types of research
Taking into account the purposes, endoscopy can be therapeutic, diagnostic and therapeutic-diagnostic, taking into account the timing - emergency, planned, urgent or delayed. There are dozens of types of diagnostic endoscopies, which can be combined into several large groups:
- Endoscopic examinations of the gastrointestinal tract. They include esophagoscopy, gastroscopy, colonoscopy, sigmoidoscopy, choledochoscopy, diagnostic laparoscopy and a number of other endoscopies. Most studies are carried out through natural openings, diagnostic laparoscopy - through a puncture, choledochoscopy - through a surgical incision.
- Endoscopic examination of female genital organs. Includes hysteroscopy and diagnostic laparoscopy. Hystroscopy is performed through the genital tract, diagnostic laparoscopy is performed through punctures of the anterior abdominal wall.
- Endoscopic examination of the respiratory system and chest cavity. These include bronchoscopy, mediastinoscopy and diagnostic thoracoscopy. Bronchoscopy is performed through natural openings (nasal passages or oropharynx), mediastinoscopy and diagnostic thoracoscopy through punctures of the chest.
- Endoscopic examination of the urinary tract. Includes nephroscopy, ureteroscopy, cystoscopy and urethroscopy. Nephroscopy can be performed through a natural orifice (the device is inserted through the urethra, bladder and ureter), a puncture in the lumbar region, or a surgical incision. Other studies are performed through natural openings.
- Endoscopic examination of joints(arthroscopy). They are performed on large and medium-sized joints and are always performed through a puncture.
Endoscopy can be conventional, using a dye (chromocystoscopy, chromoscopy of the esophagus, stomach and colon) or with a biopsy.
Indications
The purpose of endoscopy may be to make a diagnosis if a traumatic injury, a chronic disease, or an emergency condition resulting from pathological changes in a particular organ is suspected. Endoscopy is prescribed to clarify the diagnosis and carry out differential diagnosis in cases where other studies do not clearly establish the nature of the existing pathology. In addition, the study is used to determine treatment tactics and during follow-up.
Endoscopy in gynecology is used in the process of examining the vaginal part of the cervix and the uterine cavity. Hysteroscopy is used to identify the causes of infertility in women, uterine bleeding and miscarriage. The study is prescribed if the presence of intrauterine adhesions, fibroids, polyps, erosions, endometriosis, cancer, inflammatory diseases and other pathological conditions accompanied by changes in the mucous membrane is suspected. During colposcopy, special samples with dyeing solutions can be used - this makes it possible to identify mucosal defects that are not visible during a normal examination.
Endoscopy in pulmonology is widely used in the diagnosis of diseases of the lungs, bronchi, pleura and mediastinum. Bronchoscopy is used to identify neoplasms, inflammatory processes, sources of bleeding and abnormalities in the development of the bronchi. During endoscopy, sputum may be collected and a tissue sample may be taken for subsequent histological or cytological examination. Thoracoscopy is performed for enlarged intrathoracic lymph nodes, suspicion of diffuse and focal processes in the lungs, pneumothorax of unknown etiology, recurring pleurisy and other lesions of the respiratory system.
Urinary tract endoscopy is used to evaluate the urethra, bladder, kidneys and ureters. The method allows you to identify benign and malignant neoplasms, developmental anomalies, stones and inflammatory processes. Endoscopy is used mainly at the stage of clarifying the diagnosis and differential diagnosis when other methods are insufficiently informative. It is prescribed for pain, urination problems, hematuria, recurrent inflammation, the presence of fistulas, etc. During endoscopy, dyeing solutions can be used, and samples can be taken for cytological or histological examination.
Arthroscopy is a highly informative endoscopic method for examining joints. Typically used at the final stage of the examination. Allows you to assess the condition of the articular ends of the bones, the hyaline cartilage covering them, the capsule, ligaments and synovial membrane of the joint. Prescribed for pain of unknown origin, hemarthrosis, recurrent synovitis, traumatic injuries and degenerative diseases of the joints.
Contraindications
General contraindications to planned endoscopy are violations of the patency of hollow organs caused by pathological changes in a given anatomical zone (with scar strictures, compression by pathologically altered nearby organs, changes in anatomical relationships due to injuries, etc.), acute disorders of the coronary and cerebral circulation, cardiac and respiratory stage III failure, agony and unconsciousness (except in situations where the patient is under anesthesia).
The general serious condition of the patient, bleeding disorders, mental disorders, exacerbation of chronic diseases (decompensation of diabetes mellitus, renal and heart failure), general acute infections and local inflammatory processes in the area of natural openings or proposed surgical incisions are also considered as contraindications to routine endoscopy.
Along with general ones, there are specific contraindications for certain types of planned endoscopy. For example, hysteroscopy is not performed during menstruation, gastroscopy is contraindicated in cases of abdominal aortic aneurysm, etc. In emergency conditions, the agonal state of the patient is considered an absolute contraindication to endoscopy; in other cases, the possibility and necessity of the study is determined individually.
Preparing for endoscopy
Depending on the type of examination and the identified somatic pathology, before starting the procedure, the patient may be referred for a general examination (general blood test, biochemical urine test, coagulogram, ECG, chest x-ray) and for consultation with various specialists (cardiologist, nephrologist, endocrinologist, etc. ). Before conducting a sub-anesthesia study, an examination by an anesthesiologist and therapist is required.
The preparation plan depends on the organ being examined. Before endoscopy of the bronchi and upper gastrointestinal tract, you should abstain from drinking water and food for 8-12 hours. Before a colonoscopy, it is necessary to cleanse the intestines using laxatives or enemas. Before cystoscopy, you need to empty your bladder. Before hysteroscopy, you should undergo a gynecological examination, shave your pubic hair, and empty your bowels and bladder.
The doctor tells the patient about the features of the procedure and the rules of conduct during the study. During endoscopy of the bronchi and upper gastrointestinal tract, the patient is asked to remove dentures. The patient is asked to lie on a table or a special chair in a supine or lateral position. Medicines are administered to relieve pain, reduce the level of mucous secretion, eliminate pathological reflexes and normalize the patient’s psycho-emotional state. At the end of the endoscopy, the specialist gives recommendations on further behavior, prepares a conclusion, passes it to the attending physician or hands it to the patient.
Cost of endoscopy in Moscow
Endoscopic examinations are an extremely wide group of diagnostic procedures of varying levels of complexity, which causes significant price fluctuations for different types of techniques. The cost of the method is influenced by the area being studied, the volume of manipulation (for example, esophagogastroduodenoscopy is more expensive than gastroscopy, and colonoscopy is more expensive than sigmoidoscopy), the need to perform additional actions (material collection, therapeutic measures). When conducting an examination under anesthesia, the price of endoscopy in Moscow increases taking into account the labor costs of the anesthesiological team and the cost of the anesthetic drug.
