Endoscopic methods of examination of the intestine: description and preparation. Types of endoscopy Possible limitations to bowel endoscopy
Endoscopy - the study of hollow or tubular organs, which consists in the direct examination of their inner surface with the help of special devices - endoscopes. An endoscope is a flexible rod consisting of fiberglass filaments through which an image is transmitted. The diagnostic value of endoscopy increases due to the possibility 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 mucosa of the esophagus, the condition of the mucous membrane of the stomach and duodenum 12 - color, the presence of erosions, ulcers, neoplasms. With the help of additional techniques, it is possible to determine the acidity of gastric juice, if necessary, perform a targeted biopsy for morphological examination. FGDS is also used for therapeutic purposes: performing a polypectomy, stopping bleeding, topical application of medicinal substances.
Preparation:
1. It is necessary to conduct a briefing on preparation for the study:
on the eve of the study dinner no later than 18 00 hours
in the morning on the day of the study, exclude food, water, drugs, do not smoke, do not brush your teeth.
2. Warn the patient that during the study it is impossible to talk, swallow saliva. If there are dentures, they must be removed.
3. Before the study, the pharynx and the initial sections of the pharynx are irrigated with an anesthetic solution by a nurse in the endoscopy room.
4. Warn that within two hours after the procedure you can not eat.
Colonoscopy. The essence of the method and diagnostic value: This is an endoscopic method for examining high-lying sections of the colon using a flexible endoscope, which allows you 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 provides for the exclusion from the diet of gas-forming products (black bread, dairy products, vegetables and fruits). Mostly liquid, easily digestible dishes are recommended: white bread, semolina porridge, kissel, scrambled eggs, rice soup.
2. If the patient is concerned about bloating - within three days it is necessary to take an infusion of chamomile, activated charcoal, carbolen, simethicone or enzyme preparations.
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 - a light dinner.
at 20 00 -21 00 on the eve of the study, cleansing enemas are carried out to the effect of "clean water".
4. On the morning of the study, 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 medication.
6. In the endoscopic room, it is necessary to help the patient take a position for the study - lying on his left side with his legs pulled up to his stomach, anesthetize the anus with 3% dicaine ointment.
Sigmoidoscopy. The essence of the method and diagnostic value: This is a visual examination with a rigid endoscope of the mucosa of the rectum and sigmoid colon. The rectoscope is inserted at a distance of 20-30 cm into the rectum.
Preparation:
Conduct a briefing on preparing the patient for the procedure according to the following scheme:
The study is carried out on an empty stomach;
Within 3 days on the eve of the study - a non-slag diet; if necessary, to reduce gas formation - take activated charcoal; to improve digestion - enzyme preparations;
On the evening before the study, no later than 18 oo, a light dinner (dry white bread; weak unsweetened tea);
Two cleansing enemas at 2000 and 2200;
In the morning on the day of the study, exclude food, water, drugs, do not smoke;
Not later than 2 hours before the study - a cleansing enema;
Immediately before the study, empty the bladder in order to exclude discomfort during the procedure.
Help the patient to take the 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 the contents or washings of the bronchi for bacteriological, cytological and immunological studies, as well as treatment.
Preparation for bronchoscopy:
1. If the study is scheduled 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. Within 2-3 days before the study, the patient takes a 0.1% solution of atropine, 6-8 drops 3 times a day to reduce salivation and expand the bronchi.
3. The study is carried out on an empty stomach. 30-40 minutes before the manipulation, premedication is carried out according to the doctor's prescription: inject 1 ml subcutaneously - 0.1% atropine solution and 1 ml 2% promedol solution (make an entry in the medical history and drug register).
4. If a contrast agent is injected into the lumen of the bronchi with the help of a bronchoscope and an x-ray is performed, this method is called bronchography . Before bronchography, to exclude allergy to yodolipol, 2-3 days before the study, 1 tablespoon of this drug is administered orally, then the patient's condition is monitored.
3. Ultrasound examination (ultrasound) (syn.: echography) is a diagnostic method based on differences in the reflection of ultrasonic waves passing through media and tissues of different densities.
Ultrasound - 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 wave beam. Ultrasonic waves are absorbed differently by different tissues ("fade 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 body, without having a harmful effect on the body, without causing discomfort to patients. The method is highly informative, it is used in obstetrics and gynecology, pediatrics, in the diagnosis of the cardiovascular, digestive, genitourinary and endocrine systems. For ultrasound examination of the heart (Echocardiography) no special preparation is required. The patient should have a medical history and an electrocardiogram with them.
Abdominal Ultrasound .The essence of the method and diagnostic value: This is an instrumental method for examining the abdominal organs (liver, spleen, gallbladder, pancreas, kidneys), based on the reflection of ultrasonic waves from the boundaries of tissues with different densities. With the help of ultrasound, it is possible to determine the size and structure of the abdominal organs, diagnose pathological changes (calculi, tumors, cysts). The advantage of this method is its harmlessness and safety for the patient, the possibility of conducting research in any condition of the patient, and immediate results.
Preparation:
It is necessary to instruct the patient in preparing for the study according to the following plan:
exclude gas-producing foods from the diet for three days before the study: vegetables, fruits, dairy and yeast products, black bread, legumes, fruit juices;
in case of flatulence, take activated charcoal (4 tablets 3 times a day) or simethicone (2 capsules 3 times a day) as prescribed by a doctor for 2 days (do not take tablet laxatives);
warn the patient about the need for 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. For constipation in the evening on the eve of the study, put a cleansing enema.
4. Laparoscopic examination usually done in the operating room. Air is first 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 particular 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 the organ, its displacement, reduction, as well as a decrease or increase in functional activity by diffuse compaction or rarefaction of dots (dashes) of the scan. Scanning is mainly used to study the structure and function of the thyroid gland, liver, kidneys, spleen, heart, and skeletal system.
6. NMRI - nuclear magnetic resonance imaging - This is a study using a powerful magnetic field. It is used to diagnose 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 functions of external respiration.
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 still no symptoms of respiratory failure, to monitor the dynamics of respiratory volumes that 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, sex and age of a person. Therefore, the data obtained are evaluated in comparison with the so-called due values, which take into account all these data and are the norm for the person under study.
Measurement of respiratory volumes.
1) tidal volume (TO) - the volume of air inhaled and exhaled during quiet breathing in one phase of breathing. 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 (HFMP) in the larynx, trachea, bronchi, which does not take part in gas exchange, although, mixing with the inhaled air, it moisturizes and warms it (physiological role of the HFMP).
2) expiratory reserve volume (RO vyd.) - 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, the maximum exhalation is made;
3) inspiratory reserve volume (RO ind.) - equal to 1500-2000 ml. This is the volume of air that a person can inhale after a quiet breath;
4) the vital capacity of the lungs (VC) is equal to the sum of the reserve volumes of inhalation and exhalation and the tidal volume. The average VC is 3700 ml;
5) residual volume (RO) 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 volumes and is equal to 5000-6000 ml.
Spirometry - a method of recording changes in lung volumes during the performance of respiratory maneuvers over time. Spirography - registration of ventilation values (respiratory fluctuations) on a moving millimetric tape of a spirograph. In addition to measuring lung volumes, using a spirograph, you can determine a number of additional ventilation indicators: respiratory and minute ventilation volumes, maximum lung ventilation, forced expiratory volume (it is possible separately for each lung).
Forced expiratory volume (FEV)- this is the amount of air that the subject exhales during a quick exhalation after a maximum inspiration (Watchal test). Tifno test One second forced expiratory volume (FEV1) is the volume of air exhaled in the first second. Normally, it is 70-80% of the VC. With a decrease in the indicator, one can think of 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 forcing exhalation and inhalation. Normally, the volumetric velocity of the air stream during exhalation ranges from 5 to 8 liters per 1 second for men and from 4 to 6 liters per 1 second for women. The volumetric velocity of the air stream during inhalation is less than during exhalation. Indicators of pneumotachymetry decrease in violation of the patency of the bronchi and a decrease in the elasticity of the lung tissue.
Peakflowmetry - a method for measuring peak expiratory flow (PEV) - the maximum air velocity during a forced expiration after a full breath. It is used to select a method of treatment for bronchial obstruction. Peak flowmetry has become widespread using a portable peak flowmeter that the patient can use at home.
Electrocardiography.
Electrocardiography is a method of graphic recording of electrical processes that occur during the activity of the heart. The resulting curve is called electrocardiogram.
Used drugs:
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, explore). This method is widely used for diagnostic and therapeutic purposes in surgery, gastroenterology, pulmonology, urology, gynecology and other fields of medicine.
Depending on the organ under study, there are:
bronchoscopy (endoscopy of the bronchi),
esophagoscopy (endoscopy of the esophagus),
gastroscopy (endoscopy of the stomach),
intestinoscopy (endoscopy of the small intestine),
colonoscopy (colon endoscopy).
Gastroscopy Have you been prescribed esophagogastroduodenoscopy?
(EGDS) is an endoscopic examination method in which the upper sections of the gastrointestinal tract are examined: the esophagus, stomach and duodenum.
Gastroscopy is performed by qualified endoscopists. At the request of the patient, gastroscopy in a dream (drug sleep) is possible.
An endoscope is a long, thin, flexible tube with a lens on the end. Operating the endoscope, the doctor, under the control of vision, safely guides the instrument into the upper parts of the digestive tract in order to carefully examine its inner surface.
Gastroscopy can help diagnose many conditions, including stomach pain, bleeding, ulcers, tumors, difficulty swallowing, and more.
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 you are afraid of gastroscopy, it can be done in a dream.
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Tracheobronchoscopy (often used for a shorter name - 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 a bronchoscopy?
Tracheobronchoscopy is performed on an empty stomach to avoid accidental throwing of food or liquid residues 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 - an irrigoscopy. Colonoscopy can be performed 2-3 days after barium enema.
How to prepare for a colonoscopy?
In order to examine the mucous membrane of the colon, it is necessary that there are no feces in its lumen.
The success and information content of a colonoscopy is determined mainly by the quality of the preparation for the procedure, so pay the most serious attention to the following recommendations: If you do not suffer from constipation, that is, the absence of an independent stool for 72 hours, then the preparation for a colonoscopy is as follows:
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 time-consuming and often painful.
After an independent chair, it is necessary to make 2 enemas of 1-1.5 liters each. Enemas are done 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 hours).
There is no need to fast on the day of the study.
Ancient healers could not even imagine that in the future it would be possible to inspect and not make incisions on the body. At present, such a survey has become a reality. Medical science is constantly developing, thanks to which it is possible to detect various pathological conditions in a timely manner and provide the necessary assistance to patients. allow assessing the condition of the tissues of hollow organs from the inside. There are several varieties of such diagnostics, which will be discussed in this article.
What is endoscopy?
In medical practice, the term "endoscopy" means the examination of internal organs with a cavity, using lighting devices. To perform such a procedure, an endoscope is used - rigid or flexible tubes of small diameter. In the first case, the device is based on an optical fiber system. On one side is a light bulb, and on the other - an eyepiece that allows you to adjust the size of the image. Flexible endoscopes allow you to explore the most inaccessible places. A clear picture is transmitted through the fiber bundle despite the bends of the system. A new step in the development of this field of diagnostics is capsule endoscopy.
With the help of flexible endoscopes, you can not only diagnose, but also take tissue samples for a more detailed study of the pathological process. Endoscopic studies allow you to determine the nature of the disease, track 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 diagnosing with an endoscope is the ability to see the state 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 skin incision is made through which a tube with a lighting device will be inserted. Such manipulation is necessary when removing benign neoplasms on internal organs, when removing foreign bodies. Endoscopic examination methods can be used to administer drugs.
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 (colposcopy, 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. In the process of diagnostics (arthroscopy), a special device is introduced to the patient - an arthroscope, which allows the specialist to assess the condition of the joint and perform the procedure with minimal surgical intervention. Conducting endoscopic studies also allows you to recognize the disease at an early stage, so they are often prescribed for the prevention of patients at risk.
Indications for examination of the intestine
The only way to see the condition of the bowel is to do an endoscopy. In medical terminology, endoscopic studies of this kind are called esophagogastroduodenoscopy, colonoscopy, rectomanoscopy. Indications for the diagnosis of the esophagus, stomach, large and small intestines, rectum are the following pathological conditions:
- Ulcer disease.
- Suspicion of bleeding.
- Oncological diseases.
- Gastritis.
- Paraproctitis.
- Chair disorders.
- Hemorrhoids (chronic).
- Discharge of blood, mucus from the anus.
Depending on the preliminary diagnosis, the specialist will select the most appropriate variant of endoscopic examination.
Colonoscopy of the intestine
One type of endoscopic examination is a colonoscopy. The method allows for diagnostics using a flexible colonoscope device, consisting of an eyepiece, a light source, a tube through which air is supplied and special forceps for sampling material. The device allows you to see a sufficiently high-quality image displayed on the screen, the state of the mucous membrane of the colon. The length of the tube that is used for this type of diagnosis is 1.5 meters.
The procedure is quite simple. The patient is asked to lie on the left side and pull the legs bent at the knees to the chest. After that, the doctor gently inserts the colonoscope into the rectum. The anus can first be lubricated with an anesthetic gel. The tube is gradually advanced inward, examining the walls of the intestine. For a clearer image during the diagnostic process, air is constantly supplied. The procedure takes no more than 10 minutes.
Is preparation necessary?
Of course, in order to obtain an accurate picture of the condition of the large intestine, the patient should prepare for a colonoscopy. Preparation for endoscopic examination consists primarily in diet. Products that contribute to the retention of feces and increased gas formation should be excluded from the daily menu at least a week before the expected date of the diagnosis.
On the day of the examination, you need to refrain from eating in the morning. Only liquids are allowed. Before the procedure itself, experts recommend cleansing the rectum with an enema or using laxatives.
Endoscopic examination of the intestine - colonoscopy - is a painless procedure and therefore you should not be afraid of it. The patient may feel only slight 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 introducing the device. This tablet should simply be swallowed with water. The device is activated immediately after opening the individual package. Passing through the organs of the gastrointestinal tract, the capsule takes a lot of pictures that will later help to make a diagnosis.
The advantages of this method are obvious - the patient does not need to swallow the hose or worry about the colonoscopy. The capsule enters the most remote parts of the intestine, where there is no access to a conventional endoscope. On the other hand, this method does not allow taking material for biopsy, removing polyps. Therefore, doctors still prefer to use capsular and traditional endoscopy of the digestive tract organs in a complex way.
Esophagoscopy
Endoscopy is performed to diagnose various pathologies. Most often, esophagoscopy is combined with an 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 to reveal ulcers, hemorrhages, inflammatory processes, polyps on the mucous membrane. Taking material for a biopsy allows you to establish the etiology of the disease. Inspection is carried out with both a flexible and a rigid device.
Indications for examination are structural anomalies, chemical burns of the mucosa, the need for a biopsy, the presence of a foreign body, and inflammatory processes.
Endoscopic Ultrasound
To diagnose the walls of the digestive tract, the method of endoscopy using ultrasound can be used. The latter allows you to get an image of the organs thanks to sound waves. This method is most often used to detect benign neoplasms, tumors, stones in the bile ducts, inflammation of the pancreas. Endoscopic studies using ultrasound allow you 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. Previously, the larynx is treated with an analgesic spray to relieve discomfort. An 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 a normal lifestyle in a few hours and at the same time not feel any discomfort. However, there are still situations when, after the diagnosis, a person is forced to seek medical help. The most frequently recorded damage to the walls of organs during the passage of the endoscope. This can be determined by the pain syndrome, which does not go away for a long time, the presence of blood in the feces.
An allergic reaction to the analgesic used in 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 should be carried out in a hospital or clinic. Previously, the doctor must exclude all contraindications for such an examination.
Intestinal endoscopy- this is an examination of the mucous membrane using a flexible probe equipped with a video camera, with the display of the image on the 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 that is examined, intestinal endoscopy is divided into several types:
Comparative table of endoscopic methods
Visual examination of the internal lining of the intestine 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 neighboring areas of interest, as well as to find out the extent of the lesion up to healthy tissues.
Contraindications: absolute and relative
There are no absolute contraindications for examining the upper intestines or EFGDS, but it is recommended to postpone the study 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, multiple scars of the esophagus. However, if the disease of the digestive canal threatens the life of the patient, the study is also performed under these conditions, but with extreme caution. The 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, however, they are also evaluated in the same way. The final decision is made by the doctor, focusing on the severity of the patient's condition. Contraindications are:
If the patient's condition allows, the diagnostic procedure is completed with therapeutic measures: infusion of the drug, stopping the bleeding, removal of the tumor or foreign body. It is easier for the patient to transfer it than abdominal surgery.
Preparation for endoscopic examinations
The meaning of preparation is to remove the 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 the actual cleansing with enemas and laxatives.
For 2-3 days, you need to stop taking activated charcoal, iron preparations, lactofiltrum and De-Nol medication, if they have been previously used.
Conducting surveys
The technique is simple, but requires excellent knowledge of anatomy.
With mouth access
If the probe is inserted through the mouth, then the mucosa is pre-treated with a local anesthetic. This is done to suppress the cough and gag reflexes, as well as for greater patient comfort. A plastic mouth guard is inserted into the mouth to prevent involuntary movements. The study is performed in the lateral position. The probe slowly advances to the depth that the equipment allows. The doctor examines all areas, fixes the details, if necessary, selects (pinches off) a piece of living tissue for a biopsy. After the inspection is completed, the equipment is removed and processed. 
Access through the anus
The introduction of the probe through the anus occurs in the knee-elbow position or on the side. The procedure is painless but uncomfortable. 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 along it. The doctor has the ability to rotate the probe inside the intestine and record everything he sees in digital format. Biopsy and therapeutic manipulations 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, they are not. No other research method gives such a complete picture of the disease, does not allow you to see not only the structure of the intestine, but also the function.
A doctor who sees a live intestine immediately understands what disease he is dealing with. Visually defined:
- and other abbreviations;
- color and structure of the mucosa;
- normal and pathological discharge;
- various growths and narrowings;
- 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, excess data is mixed in.
In what cases is it necessary to undergo examinations?
Endoscopy should be performed (even if you do not want to) in such conditions:
- the presence of blood in the stool;
- digestive and stool disorders;
- frequent constipation;
- constant heartburn and belching;
- flatulence;
- dramatic weight loss without diets;
- intolerance to any type of food;
- discharge from the anus of pus or mucus;
- putrid odor from the mouth.
It is advisable for people over 45 years of age to undergo an endoscopic examination annually, especially if there were 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 obtaining visual information about the state 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 often, the study of cavities is carried out 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, the inner surface of the joints, chest and abdominal cavity.
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 study the uterus, colon and nasal cavity. Bozzini used a candle as a light source. Due to possible burns, the scientist was afraid to use the endoscope on humans and conducted research on animals. The invention of the scientist was cautiously perceived by his contemporaries. The Vienna Medical Faculty punished the researcher "for curiosity", and interest in the technology faded for a while.
In 1826, Segales improved Bozzini's device, and a year later, Fischer demonstrated to his colleagues a similar apparatus 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 the French physician Desormu, 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, however, due to the lack of safe light sources, the use of endoscopy was limited.
The situation changed after the invention of the incandescent lamp. Instruments were reduced in size and improved rapidly. At the beginning of the 20th century, the first operations using an endoscope were performed. In the 30s of the XX century, the first semi-flexible, and in the 50s - flexible endoscopes appeared. The use of advanced instruments has expanded the capabilities of specialists in the study of the cavities of the human body. Research has become simpler, safer and painless. The 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 studies and to replace traditional surgery in the treatment of a number of pathological processes.
Principles of
In the diagnostic process, an endoscope is used - 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 is an optical fiber 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 to be examined. Air or saline is supplied to the cavity - this allows you to provide the best conditions for visual inspection and increase the information content of the study.
The image from the camera is transmitted to the monitor screen. During 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, bleeding arrest, administration of drugs, etc. can be performed. At the end of the procedure, the endoscope is removed. If the study was carried out through a natural opening, additional therapeutic measures are not required. If endoscopy was performed through a puncture created using a trocar, the wound is sutured and closed with an aseptic dressing.
Research types
Taking into account the goals, endoscopy can be therapeutic, diagnostic and treatment-diagnostic, taking into account the timing - emergency, planned, urgent or delayed. There are dozens of types of diagnostic endoscopies that can be combined into several large groups:
- Endoscopy of the gastrointestinal tract. They include esophagoscopy, gastroscopy, colonoscopy, sigmoidoscopy, choledocoscopy, 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 the female genital organs. Includes hysteroscopy and diagnostic laparoscopy. Hystroscopy is performed through the genital tract, diagnostic laparoscopy - through punctures of the anterior abdominal wall.
- Endoscopic examinations 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 chest punctures.
- Endoscopy of the urinary tract. These include nephroscopy, ureteroscopy, cystoscopy, and ureteroscopy. Nephroscopy can be performed through a natural opening (the device is inserted through the urethra, bladder and ureter), a puncture in the lumbar region, or a surgical incision. The rest of the research is done through natural openings.
- Endoscopic examinations of the joints(arthroscopy). They are carried out on large and medium joints, they are always performed through a puncture.
Endoscopy can be conventional, using a stain (chromocystoscopy, chromoscopy of the esophagus, stomach, and large intestine) or with a biopsy.
Indications
The purpose of endoscopy may be to diagnose a suspected traumatic injury, a chronic disease, or an emergency resulting from pathological changes in one or another organ. Endoscopy is prescribed to clarify the diagnosis and conduct differential diagnosis in cases where other studies do not unequivocally establish the nature of the existing pathology. In addition, the study is used to determine the tactics of treatment and in the process of dynamic observation.
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 for suspected presence of intrauterine adhesions, fibroids, polyps, erosions, endometriosis, cancer, inflammatory diseases and other pathological conditions accompanied by changes in the mucous membrane. During colposcopy, special samples with coloring solutions can be used - this allows you to detect mucosal defects that are not visible during normal examination.
Endoscopy in pulmonology is widely used in the process of diagnosing diseases of the lungs, bronchi, pleura and mediastinum. Bronchoscopy is used to detect neoplasms, inflammatory processes, the source of bleeding and abnormalities in the development of the bronchi. During endoscopy, sputum may be collected and a tissue sample taken for subsequent histological or cytological examination. Thoracoscopy is performed with an increase in intrathoracic lymph nodes, suspicion of diffuse and focal processes in the lungs, pneumothorax of unclear etiology, recurrent pleurisy and other lesions of the respiratory system.
Urinary tract endoscopy is used to evaluate the condition of the urethra, bladder, kidneys, and ureters. The method allows to detect benign and malignant neoplasms, developmental anomalies, calculi and inflammatory processes. Endoscopy is used mainly at the stage of clarifying the diagnosis and differential diagnosis with insufficient information content of other methods. It is prescribed for pain, urination disorders, hematuria, recurrent inflammation, the presence of fistulas, etc. In the process of endoscopy, dye solutions can be used, as well as sampling for cytological or histological examination.
Arthroscopy is a highly informative endoscopic method for examining joints. Usually used at the final stage of the survey. Allows you to assess the condition of the articular ends of the bones, covering them with hyaline cartilage, capsule, ligaments and synovial membrane of the joint. It is prescribed for pain of unknown origin, hemarthrosis, recurrent synovitis, traumatic injuries and degenerative-dystrophic diseases of the joints.
Contraindications
General contraindications to planned endoscopy are violations of the patency of hollow organs caused by pathological changes in this anatomical zone (with cicatricial strictures, compression by pathologically altered nearby organs, changes in anatomical relationships in injuries, etc.), acute disorders of the coronary and cerebral circulation, cardiac and respiratory stage III insufficiency, agony and unconsciousness (with the exception of situations when the patient is under anesthesia).
As contraindications to planned endoscopy, the general serious condition of the patient, blood clotting 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 orifices or supposed surgical incisions are also considered.
Along with the general ones, there are particular contraindications for certain types of planned endoscopy. For example, hysteroscopy is not performed during menstruation, gastroscopy is contraindicated for abdominal aortic aneurysm, etc. In emergency conditions, the patient's agonal state is considered an absolute contraindication to endoscopy, in other cases, the possibility and necessity of the study are determined individually.
Preparation for endoscopy
Depending on the type of study and the identified somatic pathology, before starting the procedure, the patient may be referred for a general examination (general blood test, biochemical urinalysis, coagulogram, ECG, chest x-ray) and for consultations with various specialists (cardiologist, nephrologist, endocrinologist, etc.). ). Before conducting a subanesthetic study, an examination by an anesthesiologist and therapist is mandatory.
The preparation plan depends on the studied organ. Before endoscopy of the bronchi and upper gastrointestinal tract, you should refrain from drinking water and food for 8-12 hours. Before a colonoscopy, it is necessary to clean the intestines using laxatives or enemas. Before cystoscopy, you need to empty your bladder. Before hysteroscopy, you should undergo a gynecological examination, shave off pubic hair, empty the intestines 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 special chair in the supine or side position. Medicines are administered for pain relief, reducing the level of secretion of mucous membranes, eliminating pathological reflexes and normalizing the psycho-emotional state of the patient. At the end of the endoscopy, the specialist gives recommendations on further behavior, prepares a conclusion, hands it over to the attending physician or gives it to the patient.
The cost of endoscopy in Moscow
Endoscopic examinations are an extremely wide group of diagnostic procedures of various levels of complexity, which causes significant price fluctuations for different types of techniques. The cost of the method is affected by the area under study, the amount of manipulation (for example, esophagogastroduodenoscopy is more expensive than gastroscopy, and colonoscopy is more expensive than sigmoidoscopy), the need to perform additional actions (material sampling, therapeutic measures). When conducting a study under anesthesia, the price of endoscopy in Moscow increases, taking into account the labor costs of the anesthetic team and the cost of the anesthetic drug.
