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Goals of endoscopic examination. What is endoscopy

Endoscopy - study of hollow or tubular organs, which consists of direct examination of their internal surface using special devices - endoscopes. An endoscope is a flexible rod consisting of fiberglass threads through which an image is transmitted. The diagnostic value of endoscopy increases due to the ability, during the study, to take material from the surface of the mucous membrane or pieces of tissue (biopsy) for cytological and histological examination.

Fibroesophagogastroduodenoscopy .

is an endoscopic method for examining the esophagus, stomach and 12 duodenum using a flexible gastroscope, which allows you to assess the lumen and condition of the mucous membrane of the esophagus, the condition of the mucous membrane of the stomach and duodenum - color, the presence of erosions, ulcers, neoplasms. By using additional techniques You can determine the acidity of gastric juice and, if necessary, perform a targeted biopsy for morphological examination. FGDS is also used for medicinal purposes: performing polypectomy, stopping bleeding, local use of drugs.

Preparation:

1. It is necessary to provide instructions on preparation for the study:

on the eve of the study, dinner no later than 18:00

In the morning on the day of the study, exclude food, water, medications, do not smoke, and do not brush your teeth.

2. Warn the patient not to talk or swallow saliva during the examination. If you have dentures, they must be removed.

3. Before the examination, the pharynx and initial parts of the pharynx are irrigated with an anesthetic solution by a nurse in the endoscopy room.

4. Warn that you should not eat food for two hours after the procedure.

Colonoscopy. The essence of the method and diagnostic value: This is an endoscopic method for examining high-lying parts of the colon using a flexible endoscope, allowing one 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 involves excluding gas-forming foods (brown bread, dairy products, vegetables and fruits) from the diet. Mostly liquid, easily digestible dishes are recommended: white bread, semolina porridge, jelly, omelet, rice soup.

2. If the patient is bothered by bloating, he should take chamomile infusion, activated carbon, carbolene, simethicone or enzyme preparations for three days.

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 – light dinner.

at 20:00 -21:00 on the eve of the study, cleansing enemas are performed until the effect of “clean water” is achieved.

4. On the morning of the examination, 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 medications.

6. In the endoscopy room, it is necessary to help the patient take a position for the examination - lying on his left side with his legs pulled up to his stomach, anesthetize the anal area with 3% dicaine ointment.

Sigmoidoscopy. The essence of the method and diagnostic value: This is a visual examination using a rigid endoscope of the mucous membrane of the rectum and sigmoid colon. The proctoscope is inserted at a distance of 20–30 cm into the rectum.

Preparation:

Provide instructions on preparing the patient for the procedure according to the following scheme:

The study is carried out on an empty stomach;

For 3 days before the study - a slag-free diet; if necessary, to reduce gas formation, take activated carbon; to improve digestion - enzyme preparations;

The evening before the study, no later than 6 pm, light dinner (white dry bread; weak unsweetened tea);

Two cleansing enemas at 20:00 and 22:00;

On the morning of the test, exclude food, water, medications, and do not smoke;

No later than 2 hours before the study - a cleansing enema;

Immediately before the examination, empty your bladder in order to avoid discomfort during the procedure.

Help the patient take a 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 lavage water of the bronchi for bacteriological, cytological and immunological studies, as well as carry out treatment.

Preparation for bronchoscopy:

1. If the examination is prescribed 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. For 2-3 days before the study, the patient takes a 0.1% atropine solution, 6-8 drops 3 times a day to reduce salivation and dilation of the bronchi.

3. The study is carried out on an empty stomach. 30-40 minutes before the manipulation, premedication is carried out as prescribed by the doctor: inject subcutaneously 1 ml of a 0.1% atropine solution and 1 ml of a 2% promedol solution (make an entry in the medical history and the narcotic drug log).

4. If, using a bronchoscope, a contrast agent and radiography is performed, this method is called bronchography . Before bronchography, to exclude allergies to iodolipol, 1 tablespoon is prescribed once 2-3 days before the study. this drug inside, then the patient's condition is monitored.

3. Ultrasound examination (ultrasound) (syn.: echography) - a diagnostic method based on differences in the reflection of ultrasonic waves passing through media and tissues of different densities.

Ultrasound is 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 beam of waves. Ultrasound waves are absorbed differently by different tissues (“fading 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 an organ without having a harmful effect on the body, without causing discomfort. The method is highly informative and is used in obstetrics and gynecology, pediatrics, and in the diagnosis of the cardiovascular, digestive, genitourinary and endocrine systems. To carry out ultrasound examination hearts (Echocardiography) no special preparation required. The patient must have a medical history and an electrocardiogram with him.

Ultrasound examination of the abdominal cavity .The essence of the method and diagnostic value: This instrumental method studies of the abdominal organs (liver, spleen, gall bladder, pancreas, kidneys), based on the reflection of ultrasonic waves from the boundaries of tissues with different densities. Using ultrasound, it is possible to determine the size and structure of the abdominal organs and diagnose pathological changes (calculi, tumors, cysts). The advantage of this method is its harmlessness and safety for the patient, the ability to conduct research in any condition of the patient, and immediate results.

Preparation:

It is necessary to instruct the patient in preparation for the study according to the following plan:

exclude gas-forming foods from the diet for three days before the study: vegetables, fruits, dairy and yeast products, brown bread, legumes, fruit juices;

for flatulence, take activated carbon (4 tablets 3 times a day) or simethicone (espumisan 2 capsules 3 times a day) for 2 days as prescribed by your doctor (do not take tablet laxatives);

warn the patient about the need to conduct 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. If you have constipation, give a cleansing enema the evening before the test.

4. Laparoscopic examination usually performed in the operating room. First, air is 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 certain 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 an organ, its displacement, reduction, as well as a decrease or increase in functional activity by diffuse compaction or rarefaction of points (lines) of the scanogram. Scanning is primarily used to study structure and function thyroid gland, liver, kidneys, spleen, heart, skeletal system.

6. NMRT – nuclear magnetic resonance tomography is research using powerful magnetic field. It is used for diagnosing 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 external respiration .

External, or pulmonary, respiration is the exchange of gases at the stage “blood of the pulmonary capillaries - atmospheric air”. Examination of external respiration makes it possible to judge the presence of respiratory failure when there are no symptoms yet respiratory failure, monitor the dynamics of tidal volumes, which 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, gender and age of the person. Therefore, the obtained data are evaluated in comparison with the so-called proper values, which take into account all these data and are the norm for the person being studied.

Measurement of tidal volumes.

1) tidal volume (VT) - the volume of air inhaled and exhaled during quiet breathing in one breathing phase. 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 (AFSD) in the larynx, trachea, bronchi, which does not take part in gas exchange, although, mixing with the inhaled air, it moisturizes and warms it (the physiological role of AFSD).

2) expiratory reserve volume (ER ext.) - 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 he exhales as much as possible;

3) reserve inspiratory volume (RO in.) - equal to 1500-2000 ml. This is the volume of air that a person can inhale after a quiet breath;

4) vital capacity of the lungs (VC) is equal to the sum of the reserve volumes of inhalation and exhalation and tidal volume. On average, vital capacity is 3700 ml;

5) residual volume (VR), 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 volume and is equal to 5000-6000 ml.

Spirometry – a method for recording changes in lung volumes during respiratory maneuvers over time. Spirography – registration of ventilation values ​​(respiratory oscillations) on a moving millimeter tape of a spirograph. In addition to measuring lung volumes, using a spirograph you can determine a number of additional ventilation indicators: tidal and minute ventilation volumes, maximum ventilation of the lungs, forced expiratory volume (can be done separately for each lung).

Forced expiratory volume (FEV)- this is the amount of air that the subject exhales during a rapid exhalation after a maximum inhalation (Wotchal test). Typhno sample- one-second forced expiratory volume (FEV1) is the volume of air exhaled in the first second. Normally it is 70-80% of vital capacity. If the indicator decreases, you can think about 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 forced exhalation and inhalation. Normally, the volumetric velocity of the air stream during exhalation ranges from 5 to 8 liters per 1 second in men and from 4 to 6 liters per 1 second in women. The volumetric velocity of the air stream during inhalation is less than during exhalation. Pneumotachymetry indicators decrease when bronchial patency is impaired and the elasticity of the lung tissue decreases.

Peak flowmetry – measurement method peak speed exhalation (EPV) – maximum speed air during forced exhalation after full breath. Used to select a treatment method for bronchial obstruction. Peak flowmetry using a portable peak flow meter, which the patient can use at home, has become widespread.

Electrocardiography.

Electrocardiography is a method of graphically recording electrical processes occurring during the activity of the heart. The resulting curve is called electrocardiogram.

Endoscopic examination of the respiratory system (bronchoscopy)
Bronchoscopy used to examine the respiratory organs (mucous membrane of the larynx, trachea and bronchi) with a special optical instrument - a bronchoscope. There are two types of bronchoscopy: diagnostic (clarification of the localization of the pathological process, taking changed tissues (biopsy) and sputum for examination) and therapeutic (removal of accumulated mucus, pus, foreign bodies in order to restore patency respiratory tract; injection of medicinal substances into the pathological focus, washing (lavage) of small bronchi, stopping pulmonary hemorrhage, straightening collapsed areas of lung tissue (atelectasis)).

Bronchoscopy is used for purulent-inflammatory diseases of the trachea and bronchi, if a tumor or tuberculosis is suspected.

The use of bronchoscopy is limited in people with bronchial asthma, coronary disease heart, respiratory failure.

Bronchoscopy is performed depending on the patient’s condition under local anesthesia (irrigation of the root of the tongue and mucous membrane of the larynx with dicaine) or general anesthesia. The study is carried out with the patient lying or sitting.

4-5 hours before the study, food intake is excluded, antispasmodics and sedatives are prescribed.

After the examination, the patient is under the supervision of a doctor for several hours.

Endoscopic examination of the esophagus, stomach and duodenum(esophagogastroduodenoscopy)
Esophagogastroduodenoscopy- examination of the esophagus (“esophago-”), stomach (“gastro-”) and duodenum (“duodeno-”) if erosion, ulcers, or various tumor-like diseases are suspected using an optical device - a gastroscope. The possibilities of diagnostic esophagogastroduodenoscopy are expanded due to such additional research methods as endoscopic intragastric pH-metry, identification of altered areas, sampling of material for morphological and cytological examination (biopsy), and determination of the presence of bacteria on the gastric mucosa.

Therapeutic and surgical esophagogastroduodenoscopy includes irrigation of mucosal defects with drugs, local injection of reparants (drugs that stimulate healing), sclerosing agents, hemostatic agents, removal of foreign bodies, diathermocoagulation (cauterization) of the source of bleeding, electrical excision (removal) of polyps.

Contraindications to the study are acute, hemophilia, stage III hypertension, stage III pulmonary heart failure, esophagus, aortic aneurysm.

The study is carried out on an empty stomach. The day before, a light dinner is possible no later than 18.00. On the day of the study, you are allowed to drink a small amount of still water. You must have a towel with you during the examination.

During the examination, the patient is in a lying position on his left side, on a special table that allows you to change the patient’s position. The gastroscope is inserted through the mouth after preliminary local anesthesia dicaine solution (irrigation of the root of the tongue and pharynx). Often, to improve visibility, a small amount of air is pumped into the stomach, which can cause belching, vomiting, and pain.

Sigmoidoscopy
Sigmoidoscopy is a study during which a section of the intestine (up to 30 cm) is examined using a special device (rectoscope) inserted into the anus. The night before and in the morning, 2–3 hours before the study, the patient is given a cleansing enema. During the examination, the patient stands on the dressing table with his knees spread apart so that his feet hang over the edge of the table. With your elbows spread, you need to lean on the table while bringing your chest as close as possible to the surface of the table. The rectoscope is lubricated with Vaseline before insertion.

Colonoscopy
Colonoscopy is a study similar to sigmoidoscopy, but a section of the intestine up to 1 m long is examined. Preparation is carried out in several ways.

Method 1: 3 days before the test, you need to exclude fruits, vegetables, legumes, and milk from your diet. 2 days before the study, a cleansing enema with a volume of 1.5-2 liters of water at room temperature is performed in the evening. The morning before, one enema is given, in the evening two cleansing enemas are given with an interval of 1 hour. On the morning of the examination, you cannot have breakfast, two enemas are given with an interval of 1 hour. The last enema is given 2-3 hours before the examination.

Method 2: taking a laxative (Fortrans). Four packets of fortrans need to be dissolved in 3-4 liters boiled water. For each liter of solution, it is advisable to add 3 measuring spoons of the suspension (or 3 capsules until completely dissolved) and take 1 liter of solution per 1 hour (1 glass in 15 minutes).

With insufficient preparation, a detailed examination of the colon mucosa is impossible. Failure to follow the recommendations will lead to an increase in examination time and the need for re-examination.

Endoscopic examination of the urethra (urethroscopy)

Urethroscopy- visual examination of the mucous membrane of the urethra in various diseases. For this, a special endoscopic instrument is used - a urethrocystoscope, which is a narrow tube with an optical system. During urethroscopy, the doctor inserts a device through the urethra into the bladder. The urethroscope is slowly removed from the urethra, examining its mucous membrane.

Endoscopic examination of the vagina (colposcopy)
Colposcopy- examination of the vagina and vaginal part of the cervix using a colposcope with an optical magnification of 30 times or more. No special preparation of the woman is required, the examination is carried out on a gynecological chair, the procedure is absolutely painless. This method can detect changes in the cervical epithelium, background and precancerous conditions, choose the location of the biopsy, and monitor changes during treatment.

Endoscopic examination of the uterus (hysteroscopy)
Hysteroscopy- a method that allows you to examine the uterine mucosa using a hysteroscope (with a magnification of 50 times) in order to identify polyps, hyperplasia, cancer, intrauterine adhesions, etc., as well as remove small pathological formations. A woman’s preparation consists of preliminary treatment of vaginal diseases and toileting of the external genitalia. Before the study, it is necessary to perform a cleansing enema and empty the bladder. The hysteroscope is inserted into the uterine cavity after dilation cervical canal. The procedure is painful, so it is performed with preliminary anesthesia.

Endoscopic examination of the abdominal cavity (laparoscopy)

Laparoscopy- This operative method a study used to visually examine the internal organs of the abdominal cavity and identify possible changes. Laparoscopy is today one of the most common, most advanced techniques in the diagnosis and treatment of a number of diseases, conducting diagnostic and medical procedures. Several (usually two) tiny incisions are made in the abdominal cavity. The first incision is made with a special needle, designed so as not to injure internal organs. Through this incision, gas (air, carbon dioxide, etc.) is pumped into the abdominal cavity, which helps to increase the field of view of the specialist conducting the study. Through other incisions, a device is inserted - a laparoscope (a thin tube with a lens at one end and an eyepiece at the other, or one end of the laparoscope can be connected to a video camera, the image from which is transmitted to the screen during manipulation), as well as the instruments necessary for manipulations in the abdominal cavity. cavities.

TO positive aspects This method includes the absence of postoperative scars (tiny incisions heal quickly and well and are almost invisible), the length of stay in the hospital for laparoscopy and after does not exceed 2-3 days. Small incisions cause very mild pain, which eliminates the need to take strong painkillers after laparoscopy, which negatively affect all organs and systems of the body. During laparoscopy, very little blood loss occurs, and organs are practically not injured. Laparoscopy allows organ preservation in some cases in which traditional surgical methods require removal of the entire organ. During laparoscopy, there is no contact of the patient's tissues with the surgeon's gloves, napkins, or gauze swabs, which eliminates trauma to the peritoneum covering the internal organs. After laparoscopic surgery there is no need to remain in bed; All this greatly facilitates the postoperative recovery period. Thus, laparoscopy increases the surgeon's capabilities while minimizing negative consequences for the patient.

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In oncology, one of the leading places in the diagnosis (visualization) of malignant tumors is occupied by endoscopic (Greek endo - inside and skopeo - looking) research methods that allow you to examine inner surface hollow organs and body cavities, diagnose a tumor and determine its location, size, anatomical shape and growth boundaries, as well as identify early, without clinical manifestations, cancer (tumor up to 0.5-1 cm).

Targeted biopsy during endoscopy allows for morphological verification of the diagnosis.

In some cases, endoscopic examination may be combined with therapeutic effects(for example, stopping bleeding from a tumor, removing a polyp, etc.). The study is carried out using special devices - endoscopes.

Depending on the design of the working part, endoscopes are divided into flexible and rigid. The most common are endoscopes with fiber optics, represented by fiber light guides with a diameter of several tens of microns, forming the fiber-optic system of the device. A single fiber transmits part of the image, and many fibers combined into a single bundle transmit a complete image of the object under study.

Endoscopic methods in oncology allow solving the following main problems:

1) primary and differential diagnosis of tumors of the thoracic and abdominal cavities;
2) clarifying diagnostics: determining the location, size, anatomical shape, boundaries of the tumor and its histological form;
3) identification of pre-tumor diseases and their dispensary monitoring;
4) dynamic monitoring of treatment effectiveness, diagnosis of relapses and metastases:
5) endoscopic therapeutic interventions;
6) identification early cancer using chromoscopy (0.2% indigo carmine, 0.25% methylene blue, Lugol's solution, Congo red, etc.) and laser puminescence using hematoporphyrin derivatives.

Collection of material for morphological research can be carried out in various ways. A targeted biopsy is performed using special biopsy forceps (farcept) from the areas most suspicious for a tumor for histological examination.

Its effectiveness increases in proportion to the number of pieces taken from the study area. Brush biopsy - sampling (scraping) of material for cytological examination using a special brush - is widely used in bronchoscopy. Needle biopsy- carried out using a special needle at the end of a catheter inserted through the biopsy channel of the endoscope.

Aspiration of the contents of hollow organs and/or washings from the surface of the affected area using a catheter allows one to obtain material for cytological examination. It is obvious that histological and cytological studies are not competing, but complementary diagnostic methods.

Thus, if a targeted biopsy allows one to examine only a small piece of the mucous membrane, then by scraping or washing off, material for examination is obtained from a much larger surface area of ​​the organ wall.

Therapeutic endoscopy is used in oncology to remove polyps gastrointestinal tract using a diathermy loop or laser therapy. The latter allows you to remove wide-based polyps (more than 2 cm), large polyps (creeping), for which loop polypectomy is usually contraindicated.

However, when laser coagulation complete evaporation of polypoid formations is achieved, which. naturally excludes their subsequent histological examination. Subject to strict instructions, it is possible endoscopic treatment early cancer (electrosurgical method, thermal and laser tumor destruction, photodynamic therapy, etc.).

Endoscopic methods are highly effective in diagnosis and treatment gastrointestinal bleeding, the source of which is often malignant tumors and polyps. With such bleeding, when to perform radical surgery immediately impossible or contraindicated, active conservative therapy.

Under visual endoscopic control, through the biopsy channel, the walls of the organ with the source of bleeding are washed with ice water, irrigated with hemostatic solutions, cryotherapy (chlorethyl carbon dioxide), and the mucous and submucosal layer in the area of ​​bleeding is infiltrated with vasoconstrictor and thrombus-forming drugs.

In some cases, diathermocoagulation of a bleeding vessel is performed with a special electrode or photocoagulation of the bleeding area using a laser and a quartz light guide. In this way, it is possible to stop bleeding in more than 90% of patients. In cases of bleeding from a benign polyp, the most radical treatment is polypectomy or laser coagulation.

Row endoscopic methods studies can be used in combination with x-ray (retrogradehy) or in combination.

Example complex diagnostics is transillumination of the walls of the abdominal organs (stomach, colon, bladder) using an endoscope inserted into the organ under study and a laparoscope inserted into the abdominal cavity.

When transilluminating the walls of organs, shadow images of tumors are revealed, their intraorgan boundaries and features of the blood supply are clearly visible. Most often, the need for transillumination occurs during operations when the tumor is small and cannot be detected by palpation by the surgeon.

Endoscopy in gastroenterology

Esophagogastroduodenoscopy is used when a tumor is suspected, to determine the cause of bleeding, assess the effectiveness of chemotherapy and/or radiation therapy and performing surgical endoscopic interventions.

The study is contraindicated in acute myocardial infarction, stroke, third degree cardiovascular decompensation, mental illness, severe kyphosis, lordosis, acute inflammation of the tonsils, hypertension Stage III, significant dilation of the esophageal veins. In some cases, 2-3% solutions of dicaine, lidocaine, xylocaine are used to anesthetize the pharynx and mouth of the esophagus, or even anesthesia is indicated.

The endoscopic picture of tumors of the gastrointestinal tract is quite diverse and is determined by the characteristics of the anatomical form of growth and the stage of the tumor process.

Esophagus

The early form of cancer is usually defined as a focal infiltrate or polypoid formation, the mucous membrane over them is unchanged or eroded (ulcerated). In the area where the tumor is localized, the wall of the esophagus loses elasticity and becomes rigid; with instrumental palpation, the tumor is easily injured and can bleed.

When the esophagus is inflated with air, its lumen appears asymmetrical and does not expand evenly in all directions, as is normal. As the tumor develops, the following endoscopic forms of cancer can be observed.

Saucer-shaped - characterized by a dense roll-shaped edge and the presence of gray or yellow necrosis in the center.

Ulcerative-infiltrative - is an irregularly shaped ulcer with unevenly thickened, dense, pale pink edges, covered with a fibrous-necrotic coating. The mucous membrane around the ulcer is infiltrated and rigid. Infiltrative-stenotic - there is a funnel-shaped circular narrowing of the lumen of the esophagus, with dense walls that bleed when touched.

The mucous membrane in the affected area is hyperemic, edematous, and non-displaceable. Submucosal (periesophageal) - the mucous membrane may not be externally changed, and a characteristic endoscopic sign of a malignant process in this case will be rigidity of the esophageal wall.

Benign tumors (leiomyomas, fibromas, lipomas) are localized in the submucosal layer and are endoscopically detected as a protrusion of the mucous membrane (usually on one of the walls), the surface of which is usually smooth, and mild hyperemia is rarely observed.

The same forms of benign submucosal tumors are found in the stomach and duodenum, but there they are much more likely to become infected (peiomyo-fibro-liposarcoma). In addition to mesenchymal tumors, endothelial tumors (hemangiomas, lymphangiomas, endotepiomas, etc.) and less commonly cysts, dermoids, and hamartomas are also often found in the gastrointestinal tract.

Stomach

Endoscopic semiotics of gastric cancer depends on its stage and anatomical form. There are exophytic (polypoid and saucer-shaped). transitional (ulcerative cancer) and endophytic tumors (ulcerative-infiltrative, flat-infiltrative and diffuse-infiltrative).

Polypoid cancer from 0.5 to 10 cm in diameter are most often found in the antrum and body, usually round in shape, have a lobulated or villous structure with an eroded, easily bleeding surface. Tummy-shaped cancer measuring from 0.5 to 15 cm is usually localized in the antrum and body, somewhat more often along the anterior wall.

The tumor borders are represented by pronounced ridge-like edges; an area of ​​necrosis is usually observed in the center. Ulcerative form cancer from 0.5 to 4 cm in diameter is most often localized in the area of ​​the angle and the lower third of the body along the lesser curvature. It is an ulcer with uneven borders without convergence of folds to its edges, one of which is usually lumpy, the other flat.

The bottom of the ulceration is uneven, often covered with a dirty gray or brown coating, rigid and bleeds profusely during a biopsy from the edge of the ulcer. Ulcerative-infective cancer has the same endoscopic signs as ulcerative cancer, only the size of the ulceration is larger and there is a complete absence of the inflammatory shaft.

The edges of the ulceration immediately transform into the mucous membrane infiltrated by the tumor with smoothed rigid folds. The bottom of the ulceration is deep, sometimes ingrowth into a neighboring organ is visible. Excessive contact bleeding often occurs. There is no peristalsis in the tumor area.

Flat infiltrating cancer is most often localized in the antrum along the lesser curvature and posterior wall. It is very difficult for endoscopic diagnosis, as it appears as flat areas of the mucous membrane gray, somewhat pressed into the wall of the stomach due to the absence of folds that break off at the edge of the tumor.

Grayish-white glassy mucus often accumulates over the tumor, sometimes imitating fish scales. There is no rigidity of the stomach wall, since tumor infiltration spreads throughout the submucosal layer and only in advanced cases affects the muscular layer.

Therefore, this form of tumor can be detected only when the stomach is completely inflated with air. The diffuse-infiltrative form is equally common in all parts of the stomach and is very difficult for endoscopic diagnosis, since tumor development occurs in the submucosal layer.

In the early phase of its development, it appears in the form of a plaque, rising 3-5 mm above the level of the mucous membrane, with foci of submucosal hemorrhage, sometimes necrosis and depressions. With further growth, the mucous membrane above it becomes uneven, lumpy, grayish-pink in color, with erosions and numerous hemorrhages. The folds do not straighten when inflated with air, the walls of the stomach are rigid, and there is no peristalsis.

Sarcomas of the stomach are relatively rare (0.5-5%) and their endoscopic appearance resembles hyperplastic gastritis (Menetrier's disease), benign ulcers, and submucosal tumors. Polyps are most often hemispherical or spherical in shape with a smooth, smooth surface of the mucous membrane of orange, pale pink or bright red color, the base of the polyps is wide or pedunculated. Dimensions benign polyps most often do not exceed 1 cm.

Lymphogranulomatosis most often appears in the form of multiple ulcers in various parts of the stomach.

Gastric stump cancer

In case of relapses, endophytic forms of tumor growth predominate, most often localized in the area of ​​the anastomosis and spreading mainly in the submucosal layer of the wall of the gastric stump. Endoscopic semiotics in general does not differ from that of carcinoma of the unoperated stomach and is determined mainly by the anatomical shape of the tumor.

It should be noted that fibrogastroscopy allows more often than other research methods to identify early forms of relapse and primary cancer of the gastric stump and in this regard it can be considered as a screening method for examining patients who have undergone gastrectomy.

Duodenal cancer is rare (0.3-0.5%), its diagnosis does not cause any particular difficulties, and only in advanced cases in the presence of obstruction of the organ is it difficult to distinguish it from a pancreatic tumor. In these cases, morphological examination of the biopsy material helps.

Sigmoidoscopy is the leading and most effective method for diagnosing cancer of the rectum and distal part of the sigmoid colon. The study makes it possible to give a reliable visual assessment of the nature and extent of the tumor process along the mucous membrane, to perform a targeted biopsy or take material for cytological examination over a distance of up to 30 cm from the anus.

Sigmoidoscopy is used to monitor the effectiveness of treatment and to remove polyps. Despite the simplicity and good tolerability of the method, complications are possible with sigmoidoscopy. Trauma to the tumor with the distal end of the instrument can cause bleeding. The danger of perforation of the pathologically altered intestinal wall cannot be excluded due to careless insertion of a proctoscope or excessive air insufflation. Anoscopy is a technique for examining the anal canal and lower rectum using special tool- anoscope. It is a tube 8-12 cm long with a diameter of 2 cm with a handle and an obturator. The anoscope is convenient for performing small-scale diagnostic manipulations: examination of the anal canal and biopsy in its area, performing medical procedures.

Examination with a rectal mirror - examination of the anal canal and rectum to a depth of 12-14 cm. A biopsy or therapeutic manipulations may be performed.
Fibercolonoscopy allows you to visually examine the condition of the mucous membrane of all parts of the colon and establish the nature of the pathology in 90-100% of cases through targeted biopsy and/or collection of material for cytological examination.

However, a total colonoscopy is possible only in 53-75% of cases. The reasons for possible failures of carrying out a colonoscope to the dome of the cecum may be the peculiarities of the anatomical structure of the large intestine (pronounced looping, sharp bends in the splenic and hepatic angles, significant sagging of the transverse colon), adhesions in the abdominal cavity, negative reaction patient for the study, unsatisfactory bowel preparation.

Contraindications to fibrocolonoscopy can be absolute and relative, due to both general and local reasons. Absolute contraindications are severe general condition of the patient, coagulopathy, mental illness, cardiac decompensation, acute heart attack myocardium and stroke, long-term pregnancy, the presence of obvious signs of inoperability of the patient, acute inflammatory processes and severe stenosis of the anus, the immediate period after surgery on the rectum and colon, acute inflammatory and adhesive processes in the abdominal cavity, severe forms of ulcerative colitis and Crohn's disease.

Relative contraindications include senility and childhood, cardiac and pulmonary failure, pronounced neurasthenia, severe post-radiation atrophy of the intestinal mucosa, severe diverticulitis.

Among the complications of colonoscopy, the most serious are intestinal perforation and massive intestinal bleeding (0.1-0.2% of cases). Other complications include acute dilatation of the colon due to excessive introduction of air, collapse of the colonoscope in the intestine, and intussusception of a section of the intestine during its rapid removal.

Colonoscopy is successfully performed endoscopic removal colon polyps for diagnostic and therapeutic purposes. Such operations are low-traumatic, organ-saving and safe, provided that contraindications to them are observed: coagupopathy of various origins, associated with the threat of bleeding; the presence of a pacemaker in patients; the size of the polyp is more than 4 cm and its base is more than 1.5 cm.

Of all the methods of colonoscopic removal of polyps, the most preferable is loop electroexcision, which makes it possible to preserve their entire mass for morphological examination.

In this case, the most common complications are bleeding from the bed of the removed polyp and perforation of the intestine directly during coagulation or later due to transmural necrosis of the wall in the area of ​​the base of the polyps. Such complications occur in 0.5-0.8% of cases.

Endoscopy of the respiratory tract

Endoscopic methods for studying the upper respiratory and alimentary tract make it possible to diagnose the pathological process and collect material for morphological examination. If the tumor formation is completely removed, then if it is benign, the biopsy in this case will be curative.

Examination of the oral cavity, middle and lower parts of the pharynx. First of all, the vestibule of the oral cavity is examined, alveolar processes, and then the floor of the mouth, hard palate, and anterior tongue. After pressing the tongue down with a spatula, the tonsils, arches, soft palate, lateral and posterior walls of the pharynx.

The most common sign of tumor and pre-tumor diseases of the oral cavity and pharynx is the presence of superficial or deep ulcerations, whitish or grayish plaque on the mucous membrane, asymmetry of the pharynx and pharynx, the presence of tuberous growths that bleed easily upon probing.

Laryngoscopy (mirror endoscopy of the larynx)

Most often, malignant tumors of the larynx are localized on the vocal folds, somewhat less often - in the vestibular and, rarely, in the subglottic regions. Appearance laryngeal cancer in early stages not much different from chronic non-tumor and pre-tumor processes. Therefore, the final diagnosis is made after histological examination.

Posterior rhinoscopy - mirror endoscopy of the nasopharynx and posterior sections of the nasal cavity - is one of the most technically difficult manipulations performed using small mirrors. In the nasopharynx, neoplasms with a lumpy surface and pink coloration varying intensity most often localized in the arch and on the lateral walls.

On instrumental palpation they bleed easily. IN posterior regions nasal cavity tumors are most often located on the nasal turbinates or in the posterior parts of the ethmoid labyrinth, protruding into the lumen of the nasopharynx and sharply narrowing or completely closing the passages.

Anterior rhinoscopy is performed using a nasal speculum. Most often, tumors are found in the area of ​​the middle nasal passage in the form of tuberous or papillary growths of a grayish-pink color, narrowing or completely obstructing the nasal passages.

Fibropharyngoparyngoscopy is the most advanced method of endoscopy of the upper respiratory and alimentary tract. The flexibility of the device, the small diameter of its distal end, convenient for carrying out in any of the studied sections, and good illumination greatly facilitate the examination of all hard-to-reach places.

Bronchoscopy (FBS)

An endoscopic examination is carried out with a fiber-optic bronchoscope, which allows one to examine the bronchi up to the subsegmental bronchi inclusive, as well as perform a pinch or brush biopsy and targeted washings from small bronchi, which allows in 93% of cases to clarify the nature of the pathological process in the lungs.

In addition, the condition of the carina and tracheobronchial angle on the affected side is assessed. Rigidity, hyperemia and swelling of the mucous membrane, expansion of the carina, flattening of the slopes of these anatomical structures indicate a widespread tumor process and are usually caused by metastatic lesions of the tracheobronchial or paratracheal lymph nodes. If such pathological changes are detected, transtracheal or transbronchial puncture biopsy is indicated.

The endoscopic picture of lung cancer depends on the form of growth of the lung tumor. Endobronchial tumors (6%) have the appearance of a tuberous polyp with clear boundaries, often grayish-brown in color, often with necrotic deposits. With a mixed growth form (14%), the tumor spreads both into the pulmonary parenchyma and into the bronchial lumen.

Identified on the basis of direct (presence of a tumor in the lumen of the bronchus) and indirect (rigidity, narrowing, bleeding of the mucous wall of the bronchus) signs tumor growth. Peribronchial tumors (over 80%) grow predominantly in the pulmonary parenchyma around the affected bronchus, which is often compressed by this node.

The bronchoscopic picture is characterized only indirect signs tumor growth. In case of peripheral tumors, bronchoscopically reveals them only in cases where there is tumor growth into an accessible bronchus (cancer with centralization).

X-ray negative cancer (occult carcinoma) is lung cancer, in which there is only cytological verification of the tumor process obtained by examining sputum. In this situation, bronchoscopy on both sides with separate sampling of material (washes or brusn biopsies) from all segmental bronchi is the only method to determine the localization of the tumor.

Endoscopy in gynecological oncology

Endoscopic diagnostic methods with sampling of material for morphological examination are the main ones in identifying dysplasia. pre- and microinvasive cervical cancer.

For this purpose, colloscopy with targeted biopsy with a conchotome is used, since the final diagnosis can only be established after histological examination. IN special training The patient does not need to be examined.

Colposcopic examination can be performed at 15-30x magnification. Colpomicroscopy is an original intravital pathohistological study intended for intravital study of tissues of the vaginal part of the cervix.

Hysteroscopy is used to diagnose pathology (tumors, polyps, endometriosis) of the uterine body and perform therapeutic procedures.

Endoscopy in oncourology

All departments can be examined using endoscopic methods urinary tract For primary diagnosis neoplasms (or tumors growing in them), monitoring during chemotherapy and radiation therapy and timely recognition of tumor relapses after radical treatment.

The use of endoscopy in oncourology also makes it possible to perform numerous transurethral operations: biopsy, diathermocoagulation, electroresection, cryodestruction of affected areas of the bladder, prostate and urethra.

Cystoscopy

Conditions for performing endoscopic examinations in urology significantly depend on the gender and age of the patient. In women, cystoscopy, as a rule, does not present technical difficulties, while any transurethral manipulation in men can lead to urethritis, prostatitis, epididymitis, and urinary retention.

With cicatricial strictures of the urethra, sclerosis of the bladder neck, prostate adenoma, inserting the instrument into the bladder is sometimes impossible. In such cases, cystoscopy is preceded by urethral dilation or internal urethrotomy.

Cystoscopy is most often performed to clarify the source of hematuria both at the time of bleeding and after it has stopped. The most common finding is bladder tumors.

The discharge of blood from the mouth of the ureter observed during cystoscopy gives reason to assume the presence of a tumor of the kidney, renal pelvis or ureter and determine the side of the lesion.

Inspection of the bladder is carried out after filling it with liquid, which straightens the folds of the mucous membrane and ensures that the required distance is maintained between the bladder wall and the optical system of the cystoscope. Usually used to fill the bladder warm solution furatsilin or 3% boron solution acid (250 ml).

With a bladder capacity of less than 80 ml, cystoscopy is almost impossible. In women, cystoscopy can be performed without anesthesia. In men, passing an instrument through the urethra is often painful. Therefore, inspection of the bladder and other endoscopic manipulations in men should be performed under local anesthesia (instillation of a lidocaine solution into the urethra).

To perform lengthy and painful endoscopic interventions, the use of anesthesia or epidural anesthesia is indicated. During cystoscopy, catheterization of the ureters can be performed with a diagnostic (retrograde ureteropyelography, obtaining urine from the kidney for cytological examination) and therapeutic (drainage of the pelvis) circuit.

Cystoscopy makes it possible to determine the anatomical form of growth and size of the tumor, to clarify the degree of involvement of the most functionally important formations in the process (Lietaud's triangle, ureteral orifices, bladder neck area). There are exophytic (papilloma and papillary cancer) and endophytic tumors.

In papillary (villous) cancer, the tumor has short, thick and opaque villi. Villous forms during cystoscopy appear as tuberous formations, slightly protruding into the lumen of the organ and covered with edematous infiltrated mucosa, often with areas of ulceration and necrosis.

The wide base of tumors indirectly indicates infiltration deep layers bladder walls. Primary endophytic bladder cancer does not have strictly pathognomonic endoscopic signs. The mucous membrane looks hyperemic, edematous, without clear boundaries of the lesion.

Characterized by a significant decrease in the capacity of the bladder, due to the rigidity and wrinkling of its walls. Such changes must be differentiated from pathological processes similar in endoscopic picture (chronic and radiation cystitis, tuberculosis).

Chromocystoscopy is used to evaluate excretory function kidneys and identifying violations of the passage of urine through the ureters. Intense discharge from the ureteric orifices observed through a cystoscope 3-6 minutes after intravenous administration of indigo-carmine (5 ml of 0.4% solution) indicates the free outflow of urine from well-functioning kidneys.

Weakening or complete absence of dye release on one side indicates a decrease in the function of the corresponding kidney or obstruction of the ureter (tumor or stone), compression by scar tissue, pathologically altered lymph nodes or a tumor of the retroperitoneal space.

Urethroscopy

Endoscopic examination of the urethra in oncourological practice is used relatively rarely and more often in men (in women, the urethra is short and accessible for palpation through the vagina along its entire length). Primary urethral cancer is endoscopically determined either in the form of a villous exophytic tumor or in the form of a tuberous infiltrating formation with significant swelling of the mucous membrane and areas of ulceration.

Mediastinoscopy

Mediastinoscopy [E. Carlens, 1959] - method of operational endoscopic examination anterior mediastinum for visual assessment and biopsy of paratracheal and tracheobronchial (upper and lower) lymph nodes, trachea, initial parts of the main bronchi, large vessels.

Mediastinoscopy is indicated to clarify the spread of the tumor process in the lung, when there are assumptions about the presence of metastases in the lymph nodes of the mediastinum and roots of the lungs, to clarify the nature and cause of adenopathy of the intrathoracic lymph nodes with radiographic expansion of the mediastinal shadow of unknown etiology (sarcoidosis, lymphomas and other systemic diseases).

The mediastinoscopy technique is as follows: A transverse skin incision is made above the jugular notch, the trachea is bluntly and sharply exposed, a canal is formed with a finger into which the mediastinoscope is inserted. The paratracheal areas, the tracheal bifurcation zone are examined, and lymph nodes are taken for examination.

At the end of the study, the wound is sutured. Mediastinoscopy can be accompanied by quite severe complications, so it is contraindicated in the general serious condition of the patient, severe cardiovascular and respiratory failure, acute inflammatory process in the mediastinum or lung. The operation is performed under general anesthesia using a non-explosive drug.

In the absence of a mediastinoscope, parasternal mediastinotomy can be used to diagnose mediastinal lymphadenopathy located anterior to the superior vena cava or in the area of ​​the “aortic window” [E. Stemmer, 1965].

In this case, by making a skin incision from the 1st to 3rd ribs, the subperichondrial cartilage of the 2nd rib is exposed and resected for 2.5-3 cm, the posterior layer of the perichondrium and intercostal muscles parallel to the sternum are dissected, the internal mammary vessels are ligated and transected, after which a revision and biopsy is performed.

Thoracoscopy

Thoracoscopy - a method of endoscopic diagnosis of malignant tumors of the thoracic cavity - is performed with a fiber thoracoscope passed through the trocar sleeve into the pleural cavity in the fourth intercostal space anterior to the mid-axillary line.

In oncology, thoracoscopy is indicated for:

1) suspicion of the presence of a primary (meeothepioma) or metastatic tumor pleura and the impossibility of their verification using transthoracic punctures;
2) the presence of disseminated changes in the visceral pleura or tumor formations localized subpureurally;
3) empyema arising after pneumonectomy or lobectomy pleural cavity, to assess changes in it, the condition of the bronchial stump and subsequently decide on treatment tactics.

Laparoscopy

Endoscopic examination of the abdominal cavity using an optical instrument allows for examination, biopsy and surgical interventions. Laparoscopy (peritoneoscopy) in oncology is indicated in cases where, based on clinical, radiological and laboratory data, it is not possible to establish the true nature of the process in the abdominal cavity.

Contraindications to the study are the general serious condition of the patient, the presence of diffuse peritonitis or severe intestinal bloating, and pustular lesions of the anterior abdominal wall.

Laparoscopy is performed both under local anesthesia and general anesthesia. The study begins with the application of pneumoperitoneum (oxygen, air, nitrous oxide) using a trocar at one of the classic points. Then the abdominal organs are examined using standard methods. After examination, the air is evacuated and sutures are placed on the skin incision. Failures and complications during laparoscopy occur in 2-5%, mortality is about 0.3%.

Laparoscopy can reveal tumor dissemination throughout the peritoneum (carcinomatosis); establish the initial signs of ascites; diagnose primary cancer and metastases in the liver when they are located close to the surface; identify pathological changes in the pancreaticoduodenal zone, stomach, and intestines. However, in common cases, it is not always possible to determine the source of the primary tumor.

Laparoscopy is informative in the diagnosis of genital tumors (uterine fibroids, cysts, primary and metastatic ovarian tumors). Currently, laparoscopic operations on almost all organs of the abdominal cavity have become widespread.

Uglyanitsa K.N., Lud N.G., Uglyanitsa N.K.

Endoscopy – medical method research human body, which is considered one of the most informative instrumental methods for diagnosing various diseases of internal organs and cavities. Endoscopy allows, with minimal invasiveness, a real journey into the inner world of a person and visualization from the inside of almost all hollow organs in real time and on a large scale.

Endoscopic examinations are carried out using special devices - endoscopes, which are metal or plastic tubes of varying flexibility. Depending on the organs being examined and the need for certain medical procedures, the design of endoscopes can vary significantly. As a rule, endoscopes are equipped with a lighting and optical system. Undistorted images of internal organs are recorded using photo and video cameras.

The endoscope is inserted into natural openings or into specially made punctures of small diameter. The examination is performed by specialist doctors under local or general anesthesia, designed to minimize the patient’s discomfort and reduce the risk of complications. Often the diagnostic process is combined with targeted biopsy (taking tissue samples for further research), probing and drug administration. The technique is actively used in gastroenterology, pulmonology, urology, gynecology and surgery.

Endoscopy: description of the method

Endoscopy refers to instrumental methods for examining internal organs and cavities, which are characterized by relative safety and low invasiveness.

More than 200 years have passed since the invention of the first endoscope, during which the method went through four stages of development, called the rigid, semi-flexible, fiber-optic and electronic periods.

Before the advent of endoscopy, it was impossible to examine internal organs without surgery, so medical examinations were limited to palpation, percussion (tapping) and auscultation (listening). The first attempts to conduct endoscopic studies date back to late XVIII century, the first endoscope was designed in 1805 by physician F. Bozzini. The device was a metal tube with a system of lenses and mirrors, in which a candle was used for lighting. The inventor was punished for excessive curiosity, and the device was not used in clinical practice.

Due to the danger of injury during the examination, burns and serious complications, until the mid-19th century, endoscopy was extremely rarely used to examine people. After the invention of the Edison lamp, a controlled endoscope with electric lighting was designed, which found application in rectoscopy and gastroscopy. A device for studying the digestive tract with photographic recording of observations was called a gastrocamera. During the examination, local anesthesia with cocaine was used.

The beginning of a new stage in the development of endoscopy was marked by the invention of a semi-flexible endoscope and numerous publications devoted to its practical application. In the post-war period, a fibrogastroscope model was proposed, in which the lens system was replaced by optical fiber. This device made it possible to conduct research in real time with image transmission to a television screen and perform therapeutic manipulations, which significantly expanded the scope of endoscopy.

In the second half of the 20th century, the first electronic endoscope was created, capable of converting optical signals into electrical impulses. Electronic endoscopes had high resolution, thanks to which it was possible to enlarge the image, transfer it to a computer screen and save it on electronic media. This made it possible to objectively analyze research results and study the dynamics of pathological processes for timely and effective treatment diseases.

In modern clinical practice, improved models of rigid and flexible endoscopes are used. Flexible endoscopes (fiberscopes) are fiber optic devices and consist of glass fibers through which the image is transmitted. Recently, fiberscopes are being replaced by video endoscopes - devices equipped with a miniature video camera located on the distal end. Video endoscopes have a small tube diameter and transmit information to electronic form, which allows you to obtain detailed images of the examined organs in high resolution.

The most common types of modern endoscopes and their areas of application:

The device is inserted into the cavity through a natural anatomical opening or a small diameter puncture specially made at the required location. In addition to biopsy and drug transport, endoscopy can be combined with surgery. To do this, using an endoscope, miniature manipulative instruments, controlled by the body, are introduced into the body.

Endoscopic techniques are used to remove the appendix, gallbladder, tumors, lymph nodes, intervertebral hernias, to eliminate sclerotic vascular pathology and heart bypass surgery. Endoscopic surgery allows you to perform surgery without cavity incisions, which minimizes the likelihood of complications in the postoperative period.

Endoscopy: varieties

Endoscopy is a universal procedure that is suitable for both primary and differential diagnosis in order to study the clinical picture of the disease. Detailed images of organs and cavities make it possible to record pathological processes in the initial stages and facilitate analysis of the effectiveness of treatment.

Diagnostic and therapeutic capabilities of endoscopy:

  • early diagnosis of diseases of hollow organs with photo and video recording of changes;
  • detection of tumors, inflammations, ulcers, erosions, polyps, diverticula, hemorrhoids and other pathologies;
  • local administration of medications, rinsing with antiseptics and antibiotics;
  • physical exposure to cryogen and laser radiation;
  • performing a biopsy (tissue collection for research);
  • catheter installation, shunting and minimally invasive surgical operations for the removal of tumors, polyps, nodes.

Depending on the organs examined and the therapeutic procedures performed, the following types of endoscopy are distinguished:

Types of endoscopy Areas of study
Angioscopy Blood vessels
Arthroscopy Joints and joint capsules
Ventriculoscopy Ventricles of the brain
Bronchoscopy Airways, trachea, bronchi
Hysteroscopy Uterine cavity
Cardioscopy Heart cavity (heart chambers)
Colonoscopy Large intestine
Colposcopy Vaginal walls
Laparoscopy The outer side of the abdominal organs and pelvis
Nasopharyngoscopy Mucous membrane of the nose and larynx
Otoscopy Outer ear and eardrum
Sigmoidoscopy Rectum, sigmoid colon
Thoracoscopy Cavity chest and the outside of her organs
Urethroscopy Urinary tract
Cholangioscopy Bile ducts
Cystoscopy Bladder
Esophagogastroduodenoscopy Digestive tract (esophagus, stomach, duodenum)

It is important to prepare properly for an endoscopic examination. As a rule, all preparatory measures are aimed at maximally cleaning the organs being examined before diagnosis and maintaining them in a state of rest. 2-3 days before the procedure, you must give up junk food and switch to a slag-free diet. Preparation for endoscopy is discussed with the specialist who conducts the examination.

To reduce the pain of the examination and minimize discomfort after its completion, use local anesthesia. To do this, the mucous membranes are lubricated or irrigated with anesthetic solutions. General anesthesia is used in cases where surgical research is dangerous to human health and life or surgical intervention is necessary. Intravenous or inhalation anesthesia during endoscopy is also indicated for children under 4 years of age, people with an unbalanced psyche and ongoing internal bleeding.

Endoscopy of the digestive tract

Esophagogastroduodenoscopy (EGDS) is one of the most basic areas of endoscopic research, which arose at the beginning of the 19th century. Gastroscopy consists of a visual non-invasive examination of the mucous membranes of the esophagus, stomach and duodenum. A gastroscope is a flexible tube equipped with an optical system or a miniature video camera. The results of the examination using photographs and videos are recorded in the form of high-quality electronic images and stored in a computer database.

Indications for EGDS:

  • pain of an unknown nature in the gastrointestinal tract;
  • tumors and inflammation of the mucous membranes of the esophagus, stomach and duodenum;
  • peptic ulcers, gastritis, colitis, duodenitis and esophagitis;
  • the need to perform a biopsy or cauterization of ulcers;
  • gastrointestinal bleeding.

Gastroscopy is performed strictly on an empty stomach; food intake should be stopped 8-10 hours before the procedure. The gastroscope is inserted into the esophagus through the mouth and larynx, after pre-treating the throat with a lidocaine solution to reduce discomfort. Possible intramuscular administration sedatives, general anesthesia is used extremely rarely. If necessary, a biopsy and acidity level measurement are performed.

The patient is advised to remain calm and breathe deeply to avoid gagging. A simple study without additional manipulations takes only 2-3 minutes. The presence of diabetes mellitus and intolerance to the drugs used must be reported to the endoscopist.

Gastroscopy is contraindicated in severe pathologies of the heart and lungs, aortic stenosis, and anemia. Patients with poor blood clotting and older adults are at risk for complications after the procedure. Unpleasant sensations in the throat usually disappear 24 hours after the examination.

Colon endoscopy

Colonoscopy is another of the most common endoscopic methods, which is aimed at examining the large intestine. The examination is performed using a flexible endoscope and allows you to identify various diseases and neoplasms, perform a biopsy and surgical procedures.

Indications for colonoscopy:

  • recurrent pain of unknown etiology;
  • gastrointestinal bleeding;
  • intestinal polyps, tumors, inflammations and other neoplasms;
  • ulcers, ulcerative colitis, Crohn's disease;
  • intestinal obstruction, constipation.

When performed skillfully, colonoscopy is safe, painless and causes minimal discomfort, so the examination is performed without anesthesia. Colon examination is not recommended in active Crohn's disease and ulcerative colitis to avoid intestinal damage. Colonoscopy has no other contraindications.

Endoscopy of the rectum and sigmoid colon

Sigmoidoscopy is a type of endoscopy designed to diagnose pathologies of the rectum and distal sigmoid colon. Examination of these parts of the intestine is carried out using a special device - a rectoscope, which is a tube containing a lighting device and an air supply device. In this way, you can make a visual inspection of the intestines at a distance of 20-25 cm from the anus.

Indications for sigmoidoscopy are suspicions of various neoplasms in the area of ​​interest and the need to take a biopsy. Sigmoidoscopy is not recommended if there is acute inflammation and anal canal fissures, bleeding and congenital pathologies rectum.

Diagnosis of urinary tract diseases

Cystoscopy (urethroscopy) is an instrumental research method designed to diagnose diseases of the urinary tract and bladder, which is also auxiliary method to recognize various kidney diseases. Cystoscopy existed before the advent of ultrasound and made it possible to detect bladder tumors and foreign bodies in its cavity, remove and extract them through natural means.

With the help of cystoscopy, you can assess the performance of the kidneys, determine the localization of the pathogenic process, and identify pathologies of the ureters and bladder. Modern technologies make it possible to combine the process of cystoscopy with taking a biopsy and installing a catheter in the urinary tract.

Endoscopic examination of the abdominal cavity

Laparoscopy is an endoscopic examination of the abdominal and pelvic organs. Laparoscopy is one of the few endoscopic techniques that involves invasive intervention due to the need to create a special hole in the area being examined. The diameter of the hole through which the laparoscope is inserted is 0.5-1.5 cm, so the procedure can be classified as low-traumatic.

A laparoscope is a telescopic tube with an optical system or video camera to which a lighting cable is attached. Modern laparoscopes are equipped with digital matrices, which allows obtaining high-quality images in high resolution. During the procedure, the abdominal cavity is filled with carbon dioxide to facilitate examination.

The scope of application of laparoscopy is not limited to the diagnosis of diseases. The range of surgical procedures performed using a laparoscope is very wide: from easy removal polyps to complex surgical interventions. Laparoscopy has had a strong influence on the development of modern surgery, as miniature surgical instruments are inserted with the laparoscope through a small incision.

The use of laparoscopy in surgery has many advantages: low trauma, reduced patient recovery time and hospital stay, no need for sutures and reduced risk of postoperative complications.

Capsule endoscopy

A video capsule endoscope is a miniature electronic device that allows you to examine the gastrointestinal tract along its entire length and accurately record detected changes in the form of digitized images. Today, capsule endoscopy is the safest and most informative way to examine hard-to-reach parts of the small intestine.

The video capsule measuring 10x25 mm is equipped with a battery and a video camera that takes up to 3 frames per second and transmits the image to a special device - a receiver. All that is required from the patient is to swallow the capsule under the supervision of an endoscopist. Sensors are attached to the abdomen, which transmit images to a receiver worn by the patient.

Indications for video capsule study:

  • ulcers, tumors, acute bleeding in the small intestine;
  • suspected Crohn's disease;
  • the need to diagnose polyps and celiac disease;
  • pathologies of the small intestine;
  • pain in the small intestine, the origin of which cannot be determined in any other way.

Capsule endoscopy also requires preparation and is performed on an empty stomach; 3-4 hours after the capsule enters the intestines, the patient needs to eat. The duration of the examination is 10-12 hours, during which the patient is in the hospital. The capsule is excreted from the body naturally.

Contraindications to video capsule examination are stenoses, strictures and diverticula of the intestine, dysphagia, epilepsy and acute intestinal obstruction. The procedure is not recommended for pregnant women and patients with installed pacemakers.

Advantages and disadvantages of the method

Endoscopy has a number of advantages that set it apart from research methods that require surgical intervention. Modern endoscopes make it possible to detect and treat various diseases in the early stages, so endoscopy is practiced in such areas of medicine as gastroenterology, pulmonology, urology, gynecology and surgery.

Positive aspects of endoscopic diagnosis:

  • low invasiveness, relative safety and painlessness of the procedure;
  • high accuracy of research, obtaining digital images in high resolution;
  • detection of tumors, ulcers, inflammations, polyps and other neoplasms in the early stages;
  • compatibility with biopsy, drug administration and surgical procedures of varying complexity;
  • the ability to monitor in real time and save information on electronic media for subsequent analysis.

TO negative points endoscopy includes the need to prepare for the examination and limited areas application of the method.

Endoscopes can only examine hollow organs and internal cavities. During the examination without anesthesia and after its completion, the patient feels severe discomfort.

Carrying out endoscopy is a process that requires appropriate qualifications from a specialist, because careless insertion of the endoscope is fraught with injuries and complications.

To perform laparoscopy and thoracoscopy, surgery is required. Before endoscopic examination, consultation with a specialist is required.

Almost all types of endoscopic examinations are carried out at the Yusupov Hospital. Modern high-precision devices used in our clinic allow us to examine the internal organs in detail and detect the smallest pathological changes. During an endoscopy, some treatment procedures can be performed.

We employ experienced endoscopists, and studies are carried out in comfortable rooms. In order to relieve the patient from unpleasant sensations, during the procedure he is immersed in a state light sedation – « medicated sleep" To do this, we use modern safe drugs.

With us you can quickly, at a time convenient for you, undergo screening tests: colonoscopy, gastroscopy.

Our specialists

Prices for diagnostic tests

*The information on the site is for informational purposes only. All materials and prices posted on the site are not public offer, determined by the provisions of Art. 437 Civil Code of the Russian Federation. For accurate information, please contact the clinic staff or visit our clinic.

Endoscopic diagnostics

In modern surgery, endoscopic examination methods are widely used. They are minimally invasive and suitable for both the treatment of various diseases and diagnostics. The endoscope is optical instrument, which is equipped with a light source and manipulators. Modern models of endoscopes are equipped with a micro-video camera, which transmits a higher-quality image. The endoscope is inserted into the human body through natural openings or small incisions (4-5 mm). Specialists at the Yusupov Hospital conduct high-quality endoscopic examinations, which allows them to choose the most appropriate treatment tactics for patients.

When is endoscopic examination necessary?

Endoscopic examination is prescribed to patients to establish or confirm a diagnosis when non-invasive diagnostic methods have proven to be uninformative. Modern endoscopy allows you to obtain examination results, even if ultrasound, MRI and CT were ineffective.

During a diagnostic examination using an endoscope, you can take additional research tissue sample of a suspicious lesion or abnormality. Further histological analysis will allow the precise choice of treatment method. If a pathology is detected, treatment can be performed during endoscopy without additional hospitalization of the patient. Endoscopic examination can replace a major strip operation, which significantly reduces the patient’s rehabilitation time and eliminates many postoperative complications.

Most often, an endoscope is used to diagnose the following pathologies:

  • uterine fibroids,
  • neoplasms in the abdominal cavity and pelvic area,
  • diseases of the gastrointestinal tract,
  • diseases of the respiratory system.

In addition, endoscopic examinations are performed during differential diagnosis to exclude pathological processes that have common symptoms.

Types of endoscopic examinations

There are two main types of endoscopes: flexible and rigid. Flexible endoscopes are fiber optic devices. With their help, you can study hard-to-reach organs (for example, the duodenum).

Rigid endoscopes are equipped with gradient, lens or fiber image translators. Rigid endoscopes include the laparoscope. The choice of endoscopic examination and appropriate equipment will depend on the organ or system being diagnosed.

Among the most common endoscopic examinations are the following:

  • colposcopy – examination of the vagina and vaginal walls;
  • hysteroscopy – examination of the uterine cavity;
  • colonoscopy – examination of the colon;
  • esophagogastroduodenoscopy - examination of the duodenum, stomach cavity and esophagus;
  • sigmoidoscopy – examination of the rectum and anus;
  • cystoscopy – examination of the bladder;
  • ureteroscopy – ureter;
  • laparoscopy – examination of the abdominal cavity;
  • bronchoscopy – examination of the bronchi;
  • Otoscopy – examination of the ear canal and eardrum.

The Yusupov Hospital uses modern endoscopic equipment from leading global manufacturers. This allows you to obtain the most accurate diagnostic results. Video recording endoscopic examination makes it possible to discuss the results obtained at a consultation of doctors in a complex case.

How is an endoscopic examination performed?

Diagnosis and treatment using an endoscope are carried out in a hospital setting. Despite the fact that this is a minimally invasive operation, in some cases the patient will require short-term hospitalization. Patients of the Yusupov Hospital are accommodated in comfortable rooms with round-the-clock service from medical staff. Upon admission to the Yusupov Hospital, the patient will be provided with everything necessary for a comfortable stay during the entire period of hospitalization.

Endoscopic examination is performed using local anesthesia or complete anesthesia. This will depend on the diagnostic area. In some cases, the patient may be given general anesthesia if it is necessary to eliminate the pathological process during the study. For example, during hysteroscopy, tumors may be detected that require removal, which will be done.

To prepare for endoscopy, cleansing of the hollow organ that will be examined is required. For example, for a colonoscopy, laxatives or an enema are prescribed. When performing esophagogastroduodenoscopy, you must not eat for 8 hours before the endoscopy. Colposcopy does not require any preparatory measures.

If the examination being carried out may require the administration of anesthetics, you must not eat for 6-8 hours before the procedure. The attending physician informs the patient in advance about the need for anesthesia.

After all the preparations, the endoscope is inserted into the patient’s body and the examination is carried out using an optical device and manipulators. The endoscope transmits a magnified image of the area being examined onto a monitor, so the surgeon can see all the details.

The rehabilitation period after endoscopy takes from a couple of hours to several days. It all depends on the scale of the intervention. In any case, recovery is much easier and faster than after invasive intervention.

When contacting the Yusupov Hospital, you will receive a full consultation from the attending surgeon about the upcoming study. The examination will be completed as quickly as possible and as efficiently as possible. To schedule a consultation with specialists, please call.

References

  • ICD-10 (International Classification of Diseases)
  • Yusupov Hospital
  • "Diagnostics". - Brief Medical Encyclopedia. - M.: Soviet Encyclopedia, 1989.
  • “Clinical assessment of laboratory test results”//G. I. Nazarenko, A. A. Kishkun. Moscow, 2005
  • Clinical laboratory analytics. Fundamentals of clinical laboratory analysis V.V. Menshikov, 2002.