Gastroscopy

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View into the duodenum of a patient with celiac disease

The gastroscopy ( Greek  γαστήρ observe = stomach and σκοπεῖν =) or gastroscopy , also Esophagogastroduodenoscopy duodenoscopy called (EGD), a medical examination method of the upper part of the digestive tract.

With the help of gastroscopy, it is possible to view the inside of the esophagus , the stomach (gaster) and the duodenum . Small tissue samples ( biopsies ) can be taken from the mucous membrane for microscopic examinations and foreign bodies , larger tissue areas or polyps can also be removed with a loop. If there is a narrowing ( stenosis ), it can be opened using argon laser or electrocoagulation. Bleeding from stomach ulcers , from erosions , in Mallory-Weiss syndrome can be stopped by injections or by clamping off the bleeding vessel with a clip. Bleeding from esophageal varices is often stopped by a rubber band ligation , those from vascular malformations, for example, by coagulation with electricity .

A special endoscope , the gastroscope , is used for the examination . The doctor can see through the flexible tube with the help of fiber optics . While older devices were provided with optics that the doctor looked directly into, the standard today is video optics that transmit the images to a monitor and save them on a storage medium.

A gastroscopy is recommended for persistent epigastric discomfort, recurrent heartburn, difficulty swallowing, unclear diarrhea and if a stomach ulcer or gastric cancer is suspected . Regular check-ups may be necessary depending on the findings. In the case of sudden bleeding from the stomach, esophagus or duodenum, an emergency gastroscopy to locate and stop the source of the bleeding is often life-saving. Sources of bleeding are usually stomach ulcers, which are brought to a standstill by injections with medication, clips or adhesive technology. Bleeding from esophageal varices is particularly life-threatening in patients with liver cirrhosis .

In the meantime, such examinations can also take place through the nose (transnasal). A very thin tube is not passed through the mouth but through the nose. Research shows that most of the subjects found this more comfortable than access through the mouth. However, with the thin device, the passage through the stomach gate ( pylorus ) is more difficult, so that the duodenum cannot be displayed as often.

history

As early as 1806, Phillip Bozzini from Frankfurt had presented a light guide with a mirror and tube system and a simple candle for inspecting body cavities, which is considered to be the "archetype of the widely ramified endoscopy family.

Gastroscopy was founded in 1881 by the surgeon Johann Freiherr von Mikulicz-Radecki and Viktor von Hacker with the help of the instrument maker Josef Leiter. These first gastroscopes were rigid devices with a light source made from a water-cooled platinum wire that was made to glow by a battery. Carl Anton Ewald reported (at the same time as Leopold Oser , Vienna) on the use of the soft (rubber) stomach tube and thus created a simple method for the systematic examination of gastric secretion and stomach contents. The next generation of semi-flexible devices was developed and introduced from 1928 to 1932 by Rudolf Schindler together with the Berlin designer Georg Wolf . The semi-flexible device was a standard instrument in gastroscopy until the end of the 1950s.

The first gastroscopy atlas was also published by Rudolf Schindler in 1923.

examination

The person to be examined must not eat or drink anything about six hours before the examination. The investigation is preceded by an informative discussion. For the examination, the throat is locally anesthetized, for example with lidocaine spray, to reduce the gag reflex. Anxious patients are prepared with medication: they are given a sedative such as midazolam before the examination and are then briefly anesthetized with a drug such as propofol . After such sedation , patients must remain in bed for an hour or two. They are not allowed to actively participate in traffic for hours afterwards. Until the anesthetic has completely subsided, there is a risk of inhaling particles into the lungs when eating and drinking ( aspiration ).

The patient lies on his left side with his head comfortably on a pillow for the examination. A mouthpiece between the patient's teeth prevents him from biting the endoscope. The patient cannot swallow during the examination. This is uncomfortable, but tolerable for most patients. The endoscope is inserted through the tongue into the throat and from there into the esophagus under visual observation. The instrument is gradually led down the esophagus, whereby abnormal changes are noted. The device is now rapidly advanced through the stomach and the gastric porter (pylorus) into the first and second sections of the duodenum. To stretch the organs, they are inflated with air. When this is complete, the endoscope is withdrawn into the stomach and the stomach floor and stomach wall are thoroughly examined. The endoscope is also brought into a J-shape by a so-called J-maneuver at the tip, so that the confluence of the esophagus into the stomach can also be viewed from below. The air is now sucked in again and the endoscope is withdrawn.

Complications

Serious complications rarely or very rarely occur during gastroscopy. Cardiovascular problems are the most common reactions to sedatives and analgesics , and pneumonia from aspiration , perforations and bleeding after biopsies or removal of polyps can also occur. Hoarseness and sore throat can occur due to irritation of the larynx . During the procedure, there is little risk of gastric perforation by damaging the stomach wall. By sedation it can lead to respiratory insufficiency and respiratory failure. This makes the administration of oxygen, antagonizing drugs or, very rarely, short-term ventilation necessary. However, with consistent monitoring, at least by pulse oximetry , serious problems can be virtually completely avoided.

literature

  • Karsten Schwarting: gastrointestinal tract. In: Jörg Braun, Roland Preuss (Ed.): Clinic Guide Intensive Care Medicine. 9th edition. Elsevier, Munich 2016, ISBN 978-3-437-23763-8 , pp. 371–388, here: pp. 372–375 ( upper gastrointestinal bleeding ), especially p. 374 ( esophagogastroduodenoscopy ).

Web links

Individual evidence

  1. ^ Mann G. Der Frankfurter Lichtleiter, News about Phillip Bozzinis and his endoscope. Med hist J 1973; 8: 105-130, her 105.
  2. Neumann HA, Hellwig A. From sword swallowers to fiber optics; 37
  3. 100 years of the German Society for Digestive and Metabolic Diseases , August Dreesbach Verlag, p. 125. Retrieved on July 3, 2020
  4. 100 years of the German Society for Digestive and Metabolic Diseases 2013. ISBN 978-3-944334-17-2