upper gastrointestinal endoscopy

Upper gastrointestinal endoscopy, also known as esophagus, stomach, duodenoscopy or EGD, is the insertion of a tiny tube with a light and a camera at the tip into the upper digestive tract for observation of the esophagus, stomach and small intestine. The first part of the duodenum. You should take the lateral position during the examination. The doctor inserts the endoscope into your mouth and enters your stomach through your esophagus (the food channel from the mouth to the stomach). Most upper gastrointestinal endoscopy requires 15 to 20 minutes to complete. Basic Information Specialist classification: Digestive examination classification: endoscope Applicable gender: whether men and women apply fasting: fasting Tips: Do not eat anything for 8 hours, and do not drink any beverages. Normal value The physician holds the gastroscope manipulation part on the left, and the right hand is about 20cm. The gastroscope is inserted into the oral cavity through the bite mouth under direct vision, and slowly spreads into the esophagus along the back of the tongue and the posterior pharynx. The deep breathing of the patient, combined with swallowing action will reduce nausea and help to insert the mirror. Pay attention to the movements and avoid violence. Do not mistakenly enter the trachea. Clinical significance Abnormal results: upper gastrointestinal inflammation, ulcers, tumors, etc. During the 72 hours after the examination, the patient developed severe abdominal pain, continuous cough or fever, chills, chest pain, nausea or vomiting. People who need to check: 1. Have upper gastrointestinal symptoms: upper abdominal discomfort, abdominal pain, bloating, burning, indigestion, difficulty swallowing, vomiting, belching, hiccups, etc. are unknown. 2. Suspected upper gastrointestinal lesions, still not confirmed by X-ray barium meal examination. 3. The cause of upper gastrointestinal bleeding is unknown. 4. The upper digestive tract disease has been diagnosed and needs to be reviewed after endoscopic follow-up or after various treatments. 5. High-risk cancer population survey; need to undergo endoscopic treatment or microscopic examination of the upper gastrointestinal tract physiological function. Precautions Taboo before inspection: Do not eat anything for 8 hours, and do not drink any beverages. Requirements for examination: The patient is placed in the lateral position during the examination. Inspection process 1. The patient takes the left lateral position, the head is slightly tilted forward, and the legs are bent. 2. Remove the patient's active dentures, loosen the collar and belt, and let the subject bite the ring (pad). 3. Mirror method (1) One-handed method: the operator faces the patient, the left hand is operated by the manipulation part, the right hand is held at a distance of 20 cm from the end of the mirror, the mirror is aimed at the base of the patient's tongue, and the mirror end is inserted from the mouth pad to the posterior pharyngeal wall, on the left hand side. Adjust the direction of the corner button so that it reaches the throat smoothly. The patient is swallowed and gently inserted into the esophagus. Avoid violent hard insertion. (2) Two-handed method: a small number of patients can not effectively swallow, can be used as a two-handed method, the method is: the surgeon faces the patient, first put the mouth cushion on the mirror body. Use the left-hand index finger and the middle finger to test the patient's throat, and the right hand-held mirror end to the entrance cavity (be sure to make the mirror direction or the end curvature curved parallel to the base of the tongue). Insert the lens into the throat under the 2 finger in the left hand. If there is resistance, the direction of the mirror should be adjusted and must not be forced. After inserting the throat, the assistant quickly handed over the manipulation of the microscope to the surgeon. The assistant can also insert the mirror, and the operator holds the control unit. 4. After insertion, the endoscope is directly viewed from the upper end of the esophagus into the mirror, followed by esophagus → cardia → stomach → gastric antrum → pylorus → duodenum. In the withdrawal of the mirror, according to the duodenum → gastric antrum → stomach angle (low position flip) → stomach body → stomach bottom sacral (high position flip) → esophagus → withdrawal. In order of comprehensive observation, the application of rotating mirror body, flexing mirror end and other methods, in order to observe the entire inner mucosal surface of the upper digestive tract, such as mucosa color, smoothness, mucus, peristalsis and the shape of the lumen. The lesion should be identified for its traits, extent and location and recorded in detail. Photography, biopsy, and cytology can be taken when necessary. 5. When the cavity is insufficiently inflated and the mucous membrane is close to the mirror surface, a small amount of gas may be injected, and it is forbidden to inflate too much. When you need to pump or attract liquid, you should stay away from the mucous membrane and be intermittently attracted. When the objective lens is stained, a small amount of water can be filled to clean the mirror surface. 6. Photographic photography should be performed before observation and biopsy. The camera should be properly attached and it is in place. The field of view should be clear when shooting, pay attention to the characteristics of the target and the background of the sign with the displayable parts. The patient's name and photo number should be carefully registered after each photo. 7. Biopsy (1) The assistant assists in manipulating the opening of the biopsy forceps by the assistant. (2) The operator's right hand will slowly feed the clamp head from the biopsy valve hole. When the clamp head enters the field of view, the jaws are opened and the endoscope is operated, so that the biopsy forceps hit the selected biopsy point, and the pressure is slightly pressurized, so that the biopsy forceps are closed and the forceps are taken out, that is, the material is taken once. The obtained specimen is pasted on a small filter paper, placed in a 10% formalin solution, and sent for pathological examination. The principle of biopsy tissue should be taken, and 4-6 pieces of material should be taken at different parts of the boundary between the lesion and the normal tissue. Uplifting lesions should also be taken from the center. The order of the materials should be gradually raised to the high point at the low point. Otherwise, the blood flowing down after the high position can affect the correct selection and hit of the low point material. The biopsy site should be traced clearly, and it is best to mark it. 8. Cytological material: should be performed after the biopsy and before the end of the examination. Remove the biopsy forceps valve and replace the brush valve. Insert the cytological brush through the brush valve, insert the brush head into the esophagus or gastrointestinal cavity through the biopsy tube, and gently wipe the lesion around it. After brushing, the brush should be retracted to the exit of the biopsy hole (the side should be retracted into the exit slot of the biopsy hole) and then pulled out with the endoscope. After making 2-4 smears, remove the cell brush from the endoscope. The smear was immediately placed in 95% ethanol for fixation. Not suitable for the crowd 1. Uncooperative psychosis, over-stressed patients, people with significant mental impairment, pregnancy or patients with drug allergy. 2. Serious heart, lung, liver, kidney and other organic diseases with dysfunction or systemic intolerance, such as bronchial asthma, severe coronary heart disease, rheumatic heart disease, heart failure, hepatic coma, uremia, Shock, severe infection, cerebral hemorrhage, severe diabetes, obvious bleeding quality, high blood pressure can not afford to check. 3. Endoscopic insertion difficult or prone to risk, such as acute suppurative pharyngitis, descending aortic aneurysm, acute bronchitis, esophageal gastrointestinal perforation, acute diffuse peritonitis. Adverse reactions and risks (1) pharyngeal infection: pharyngeal lesions, secondary infection due to pharyngeal injury, and even pharyngeal cellulitis or posterior pharyngeal abscess. Rest and antibiotic treatment should be given. (2) esophageal perforation: for serious or even fatal complications, especially in patients with mediastinal inflammation, antibiotic treatment, surgical suture or drainage treatment. (3) gastric perforation: not as serious as perforation of the esophagus, antibiotics and surgical suture treatment. (4) Bleeding: due to mucosal damage or biopsy, the tissue is too deep and excessive tearing. When the amount of bleeding is small, it can stop itself; if there is too much bleeding, endoscopic hemostasis should be performed. (5) Cardiovascular accident: may be caused by vagus nerve reflex, there are individual cases of cardiac arrest. According to the heart condition at that time, it should be treated accordingly, including oxygen, antiarrhythmic drugs, and resuscitation. (6) Dislocation of the temporomandibular joint: When the patient is disgusted by forcefully biting the dental pad, it is prone to dislocation due to abnormal movement of the temporomandibular joint.