Gastroscopy of the stomach without swallowing the probe

The second half of the twentieth century gave the medicine a fibrogastroduodenoscopic method of investigation( FGDS).He allowed to visually examine the patient's gastrointestinal tract from the esophagus to the initial parts of the duodenum.

A new era has opened in the development of gastroenterology. Doctors were able to identify and classify various forms of diseases, stages and complications, diagnose early preclinical course of malignant tumors, examine millions of people with hereditary pathology, prescribe optimal treatment and use surgery in a timely manner.

While it remains indispensable to use the FGDS to take material from suspicious mucous areas for biopsy, bacteriological analysis. Modernization of the equipment made it possible to design fibrogastroscopes with thin endonasal probes( inserted through the nasal passages).

However, the science of the 21st century does not stand still, and in 2001 the method of capsular endoscopy was certified in the USA, it is also called gastroscopy of the stomach without swallowing the probe. Alternative to GHG is also registered in Israel, the European Union, Australia.

How does the video camera work and work?

For capsule endoscopy, a device with an optical device and a probe is not needed. The creators included a transmission technique and a color micro-camera with four light sources for video surveillance in a capsule measuring 26 x 11 mm and weighing 4 g. All materials are safe for humans.

Inside, there are four optical systems that output an image to the camera, recording. Snapshots complete the picture, conducted at a rate of 3 frames per second. The device and the radio transmitter operate from built-in batteries or from an external source. It is supplemented by an external receiver that collects the transmitted information.

After swallowing the capsule by the patient, it passes through the whole of the digestive tract in a few hours, produces tens of thousands of pictures, transmits them to the antennas placed on the body of the person being examined. Everything is stored in the memory of the receiving device.

An important achievement is that with the help of gastric gastroscopy without swallowing the probe, you can examine not only the inner surface of the stomach, but also inaccessible areas of the small intestine for fibrogastroscopy. In this case, the patient does not experience discomfort and painful sensations.

Species of bezsonde endoscopes for examination of the esophagus and stomach, small and large intestine

have already been developed for patients. To whom is gastroscopy indicated?

Check the stomach endoscopic capsule is recommended for people who can not swallow the probe because of narrowing and spasm of the esophagus or are afraid, do not want to do it. But the symptomatology of the disease requires a more precise diagnosis.

No-sonde gastroscopy is recommended if the patient is worried:

• heartburn;
• nausea and vomiting;
• difficulty in swallowing;
• choking and coughing while eating;
• constant bloating;
• weight loss;
• pain in the epigastric region, whether or not related to food;
• the appearance of clots or fresh blood in the feces and vomit;
• anemia( anemia) with weakness, dizziness.

Fibrogastroskopyu certainly carried out:

• in case of need to take material for morphological examination of the mucosa( taken from five sites);
• for the removal of polyps in the stomach;
• with tank.analysis of mucus for the presence of helicobacteria;
• for accurate determination of the acidity of the gastric juice of the patient;
• if necessary to stop bleeding from ulcers;
• to monitor the effectiveness of the treatment course.

There are contraindications to fibrogastroscopy, in these cases only endoscopic capsule can replace it. It is difficult or impossible to conduct the probe:

• for tumors that significantly narrowed the lumen in the esophagus and stomach;
• expressed by defects of the thorax and spine;
• of the available diverticula in the esophagus wall;
• mental disorders of the patient;
• aortic aneurysm, significant myocardial hypertrophy;
• diseases of hemopoiesis with impaired coagulability and a tendency to bleeding;
• severe form of bronchial asthma.

Gastroenterologists with a long experience with video capsules, allocate absolute and relative indications

Absolute indications include mandatory conditions of examination: prolonged causeless permanent weakness, blood in the stool, Gergersen's positive reaction( to latent blood), weight loss, symptoms of avitaminosis with sufficient nutrition.

With these signs, patients are suspected of:

• anemia - with hemoglobin below 100 g / l, the indicator should especially alarm in male patients, as women are often associated with heavy menstruation;
• latent gastrointestinal hemorrhage - manifested by signs of anemia, registration of a positive Gregersen reaction at least two times, absence of the revealed pathology on fibrogastroscopy and colonoscopy, examination is necessary to exclude bleeding ulcers of the small intestine or tumor;
• acute gastrointestinal bleeding in the absence of an explicit source, when a routine examination shows that there are no erosions, ulcers, tumors, diverticula, but there is blood in the stool;
• Crohn's disease with small intestine lesion - the applied colonoscopy makes it possible to examine the lower part of the small intestine( about 10-15 cm before the connection with the thick one), and with Crohn's disease, the changes may be higher, therefore hidden from the standard examination;
• hereditary syndromes, accompanied by polypous growths - they are usually suspected in children, adolescents, if already in the family, from close relatives.

Relative indications( desirable but not mandatory) are: suspicion of celiac disease - impaired digestion is caused by damage to the villous layer of the small intestine by foods containing gluten protein( gluten of wheat, barley, oats, rye), timely diagnosis allows you to prescribe the right diet and completelyrestore the patient's digestion.

Also contraindications are the need to assess the prevalence of bowel disease in Crohn's disease and the results of treatment, prolonged complaints of the patient for abdominal pain with unclear reasons or the ineffectiveness of the prescribed therapy, the same applies to diarrhea incomprehensible to the gastroenterologist if the liquid stool lasts several times a day.

To date, the best video cassettes are Israeli

Are there any contraindications for research with a video cassette?

Specific contraindications for the introduction of the video capsule include: examination of pregnant women at any time, suspicion of obstruction of the intestinal tract, epilepsy in the patient, the age of children under 12 years old, the presence of a pendant pacemaker.

What picture can you see in the pictures and from the "video on the gastrointestinal tract"?

Viewing can be done in the constant "movie" mode or select the desired areas according to the time specified on the pictures. Study helps:

• assess the condition of the mucosa of the esophagus, stomach, small intestine;
• reveal areas of hyperemia, erosion, ulceration;
• to detect the disturbed structure of organs;
• can check whether veins are widened in the esophagus zone and at the curvature of the stomach, which confirms the presence of portal hypertension;
• fix traumatic injuries, foreign bodies, worms.

How to prepare a patient for the procedure?

If a video capsule is to be used without swallowing the optical probe of the fibroadastroscope, the patient is warned about the need for preliminary preparation. It consists in the rejection of products: causing excessive gassing in the intestine for three days before the study( cabbage, legumes, carbonated water), heavy for digestion, capable of long stays in the stomach( fried and fatty meat dishes, cakes and cream cakes), alcoholic beverages( including beer).

For 3 days the patient is recommended to stop smoking, as this harmful habit stimulates the production of acid in the gastric juice, bile

A diet consisting of only cooked and ground foods is prescribed. It is not recommended to have breakfast from morning to day.

How is the procedure performed?

Electrodes( according to the type of ECG study) and the receiving device are installed on the human body. The patient swallows the endocapsule in the presence of a doctor and drinks it with water. The process of video surveillance and shooting lasts 8 hours. During this time, the capsule must go all the way from the esophagus to the large intestine.

There is no need to observe the doctor, so the patient is released into his home environment, he can do his own business. It is required not to make sudden movements, not to engage in physical exercises and sports.

The doctor assigns a second reception time. After the end of the video shooting, the electrodes are removed from the person. The received information is analyzed by a medical specialist, an opinion is given for a gastroenterologist or therapist. Perhaps the diagnosis will be set accurately or additional research will be required. A few days later the capsule will leave the intestine with feces.

How do specialists evaluate the advantages and disadvantages of a no-probe gastroscopy?

Advantage is: the patient's comfort, lack of fear, discomfort, objectivity and visibility of the examination, accessibility in the recording of repeated viewing of the staff( out of 60 thousand), collective discussion by the doctors, simplicity of preparation, safety of the method( injuries, the probability of infection,since the capsule is disposable).

The disadvantages are:

• high cost, respectively, low accessibility for the population( in different clinics from 50 thousand rubles);
• low quality of a portion of the images, especially the folds of the gastric mucosa;
• lack of the ability to take material for cytological and bacteriological analysis, pH of gastric juice at the time of the patient's study, the need for additional examination;
• for therapeutic manipulation has to resort to fibrogastroscopy.

The medical literature has information on the undesirable delay of the capsule in the human intestine for an indefinite period. Various authors estimate this deficiency with large deviations from 0.5 to 21% of cases of all video-video observations.

It is found out that the frequency of the delay is related to the observance of the indications, and not the patient's desire. The check on healthy people showed no excess of the daily period of stay of the device.
1.5% of cases accompany the procedure for suspected hidden gastrointestinal bleeding.

With a high probability of Crohn's disease, the figure reaches 5%, and in patients with signs of intestinal obstruction up to 21%.The maximum recorded capsule delay is 4 years 5 months 21 days.

In cases of prolonged delay, it is necessary to remove the capsule depending on the level of fibrogastroscope or laparotomy( abdominal abdominal surgery).

Where can I make a non-probe gastroscopy?

Currently, due to the high cost of imported capsules, public medical institutions are not in a position to buy them, so at a gastroenterologist's appointment at a polyclinic, it is necessary to find out the feasibility and possibility of conducting the procedure in private clinics.

For complete diagnosis, you will still need additional studies of feces, blood, urine. X-ray method of diagnosis with swallowing contrast barium mixture also does without a probe. With the skilled use of an experienced radiologist, it provides enough information for the diagnosis.

Perhaps after consulting a gastroenterologist and analyzing the findings, the patient will no longer need to spend money unnecessarily. To choose a method for examining the stomach, you need to listen to the opinion of a specialist, not friends and acquaintances. Experience has shown that the commercialization of health care is often accompanied by deception of patients.