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Gastroscopy includes the following range of examinations:
- diagnostic gastroscopy,
- gastroscopy with the test for Helicobacter pylori,
- gastroscopy with the collection of biopsy specimens,
- gastroscopy with removal of polyps.
The definition of gastroscopy.
Gastroscopy is the endoscopic examination which allows doctors to assess thoroughly the upper part of gastrointestinal track. This examination consists of checking oesophagus, stomach and duodenum. Not only can gastroscopy be diagnostic examination but also therapeutic examination which includes the removal of foreign body and polyps, the control bleeding as well as the endoscopic dilation of narrowing.
How is gastroscopy proceeded? Where can the examination be performed and how often?
During gastroscopy the flexible instrument (known as gastroscope) is inserted into the mouth. However, before that, the patient's throat is anaesthetized with the 10% lidocain solution. Gastroscopy is a short examination that lasts about 5-10 minutes. Although this is an invasive method that interferes in body cavities, the examination is comparatively safe for the patient and the complications hardly ever occur.
On account of the fact that gastroscopy is the invasive method that interferes in body cavities, the patient needs to sign a consent form by previous reliable well-informed appointment with the specialist regarding the process of examination and the use of anaesthetization. The diagnostic gastroscopy is defined as save examination, that is why it could be carried out in the hospital as well as in the outpatients' clinic. The therapeutic gastroscopy is usually carried out in the hospital, however, some procedures could be performed in the outpatients' clinic assuming that the medical personnel has the suitable qualifications. On the account of the fact that some therapeutic procedures are much more complicated and they required advanced equipment as well as healthy professionals, they are carried out in the academic centres or in the specialized endoscopic centres.
Putting the patient through the examination does not involve harmful conditions. Therefore, according to the doctor's orders, the gastroscopy could be repeated in a short space of time. The patient's condition or the therapeutic procedures sometimes might require repeating the examination even within twenty-four hours.
What is the aim of the examination? What could be detected?
The diagnostic gastroscopy allows the doctor to make the appraisal of the condition of the upper part in gastrointestinal truck, the flow of the content in its lumen as well as motility of walls in oesophagus, stomach and duodenum. Endoscopy allows specialists to take the samples for the histopathology, cytology, inoculation and to do direct examination (traumatic test) for Helicobacter pylori. The period of time in which the sample is taken, is not felt by the patient but it prolongs the examination slightly and does not influence the patient's safety.
In most cases, gastroscopy allows health specialists to make a correct diagnosis in the following instances:
- bacterial, viral and mycotic inflammatory conditions,
- changes/lesions caused by the effect of chemical substances: acids and bases, bile as well as some medicine with physical factors, for example: postradiation lesions,
- benign and malignant tumour,
- the assessment in the advance lesions of the conditions and its qualification, for example: oesophageal varices, gastroesophageal reflux disease, gastric and duodenal ulcers as well as the assessment of the source of bleeding in the upper part of gastrointestinal truck.
Who can perform this examination?
Gastroscopy should be carried out by a healthcare professional with the assistance of a nurse. One of the most significant factors that influences the examination and the patient's safety is the length of doctors' and nurses' service in this area and the number of the diagnostic and therapeutic procedures which where performed by then.
When should the patient have gastroscopy?
The indications for gastroscopy are very vast; the examination should be performed at the age of 45 years and more for those with abdominal complaints as well as the younger patients with the need of diagnosis, differentiation and mostly with the symptoms such as: the lost of body weight, swelling disorders, fever, anaemia, coffee-grounds and bloody vomiting. The diagnostic gastroscopy is carried out mostly with the following indications:
- the occurrence of dyspeptic symptoms (stomachache, belching, bloats, heartburn),
- the suspicion of gastric or duodenal ulcers,
- the suspicion of cancer on the basis of the general symptoms occurrence,
- dysphagia – difficulties with swelling,
- the suspicion or the occurrence of bleeding in the gastrointestinal truck,
- the suspicion of drug-induced damage of the mucous membrane in the upper part of the gastrointestinal truck with those patients who take nonsteroidal anti-inflammatory drugs,
- as a screening or the follow-up examination with patients of the higher risk of cancer (patients with long-standing gastroesophageal reflux disease, Barretta's oesophagus, pernicious anaemia in the course of atrophic inflammation of the mucous membrane in stomach, after resection of stomach).
In the case of peptic ulceration, there is the necessity of histopathology verification and the collection of biopsy specimens as well as the control of gastroscopy after 6 weeks. Duodenal ulcer does not need the histopathological verification due to the fact that it has not got the cancerous base. The peptic ulceration as well as duodenal ulcer required the traumatic test of the Helicobacter pylori. After the eradication of the bacterium, the control examination should be performed at least 4 weeks after the antibiotic-therapy.
What kind of preparations should be made by the patient before the examination?
The examination is taken on empty stomach and the patient is not allowed to take any medicine before gastroscopy because the dissolved tablets make the accurate assessment of mucous membrane difficult. When the examination is performed during the afternoon hours the patient should not eat for at least 6 hours before gastroscopy. For those patients who suffer from difficulty of gastrointestinal passage, longer periods of being on empty stomach are recommended together with the supplements of liquids and electrolytes given intravenously.
Before the examination, the doctor should take the patient's medical history focusing on the anticoagulant drugs from the group of oral anticoagulants and the existence of ahaemophilia based on different origin. The above conditions increase the risk of bleeding from the gastrointestinal truck in the case of biopsy specimens' collection or some therapeutic treatments.
What are the contraindications against gastroscopy?
As the examination is short-lasting and safe, gastroscopy does not load the patient and his/her body much. However, there are some absolute contraindications against gastroscopy, such as: heart attack, coronary failure, respiratory failure, coronary insufficiency, arrhythmia, clinical picture of 'acute stomach'. There are also relative contraindications, for example: the lack of patient's cooperation, aortic aneurysm, uncompensated coagulopathy and the early stage of abdominal cavity operation.
Is gastroscopy the only diagnostic method of the gastrointestinal truck?
There are many diagnostic methods of the upper part of gastrointestinal truck including: radiology with barium meal, ultrasound scan of the abdominal cavity, computed tomography, magnetic resonance, scitniscanning, manometry, pH-metry, echoendoscopy and intestinal capsule. The last two methods are one of the newest and despite of their high costs, they find application in practice. It is significant that all methods mentioned before have the supplementary meaning in accordance with diagnostic gastroscopy and they cannot replace it.
Gastroscopy vs. pregnant women.
Pregnancy is not the contraindication against gastroscopy. In case of exact recommendation for the examination, gastroscopy can be performed with the pregnant woman. It should be remembered that in this situation special attention should be paid while making a decision about the necessity of gastroscopy, mainly because pregnancy predisposes to many stomach complaints, such as: nausea, vomit or heartburn.
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