1 The concept of the procedure

FGS, or fibrogastroduodenoscopy, is a patient's stomach examination using a special medical probe - a gastroscope, which is injected through the oral cavity. Gastroscope allows you to assess the condition of the stomach and mucosa, and if necessary - to take a biopsy for a more in-depth study.

1. The root of the tongue is treated with lidocaine as a local anesthetic.
2. The patient lies down on his left side.
3. After the onset of anesthesia( after 5-10 minutes), a plastic mouthpiece is inserted into the patient's mouth and asked to clamp it with his teeth. This is a simple precautionary measure to avoid involuntary compression of the teeth during the procedure, which can damage the endoscope tube.
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4. An endoscope is inserted through the ring in the mouthpiece. For faster penetration of the device into the stomach at the time of its introduction, the doctor asks the patient to swallow.
5. When the endoscope reaches the stomach, air is supplied to it, helping the stomach to break;then the examination begins.
6. The procedure lasts a few minutes, after which the doctor extracts the endoscope.

2 Indications for

The FGS is assigned to clarify the diagnosis if there are suspicions of a disease that changes the state of the gastric mucosa. Indications for the following are the reasons:

• permanent pain in the stomach - a clear indication of the ongoing inflammatory process, peptic ulcer disease or erosion of the mucosa;Heartburn,
• , accompanied by acidic eructation - a sign of the rapid development of stomach ulcers;
• nausea;
• decreased or absent appetite;
• belching after eating - an ordinary companion of atrophic gastritis;
• difficult swallowing - observed in diseases of the cardiac part of the stomach and the cardiac sphincter( the junction of the esophagus with the stomach);
• anemia - low iron content in the blood, in the absence of other causes, indicates the development of gastritis, accompanied by B12-folic acid deficiency anemia;
• unexplained weight loss( FGS is necessary to exclude the development of gastric oncology);
• suspicion of gastric oncology and atrophic gastritis( simultaneously with FGS a biopsy is performed, and the material taken is sent for histological examination);
• control of the progress of treatment for mucosal erosion or gastric ulcers.

3 When it is impossible to do

Carrying out of FGS is forbidden in the absence of voluntary consent of the patient, and also if the person is in a dying condition.

In addition, in a number of diseases, the administration of FGS is also undesirable. The list of such diseases includes:

• postinfarction;
• hypertensive crisis, accompanied by a strong rise in blood pressure;
• impaired blood clotting, which is fraught with massive blood loss, even with a slight disruption of the integrity of the gastric mucosa;
• diseases of the esophagus - burns, the presence of scars, aneurysm of the aorta( conducting FGS is undesirable because of the high risk of perforation);
• stroke in acute phase;
• bronchial asthma - a gastroscopy introduced into the stomach can give an impetus to the development of asthmatic status( a complicated attack with respiratory failure);
• mental illnesses and disorders in the acute phase - are dangerous by the sudden occurrence in the patient of a strong uncontrolled motor excitation leading to traumatic damage to the gastric mucosa;
• the general or common serious condition of the person, without dependence from the put out diagnosis.

If from the conducted research the life of the person depends, it spend even at an acute myocardial infarction.

4 Simple rules

How to prepare for the FGS, so that the discomfort was as small as possible? Although many consider fibrogastroduodenoscopy quite unpleasant, discomfort can be minimized if the doctor's recommendations are strictly followed. In order to prepare for FGS of the stomach, the following rules should be observed:

1. To adhere to the hunger diet for 8-10 hours before EGF.Otherwise, the introduction of the probe can cause a vomiting attack, and the study will have to be rescheduled for another day.
2. Refuse from smoking, as it increases emesis and secretion of gastric mucus, which can delay the procedure.
3. Discard medicines, especially from tablets that need to be swallowed. It is better to discuss the possibility of taking medications beforehand with an endoscopist. Patients with ischemic heart disease and high blood pressure are often allowed to take medication to avoid deterioration of health.

Before FGS is permissible:

1. Take medicines that should not be swallowed. Most often these are drops or tablets for resorption.
2. Set injections necessary to maintain a normal state of health, such as injecting insulin.

5 Food intake

An important condition for a successful procedure is to withstand several hours of a hungry diet before it. Dinner on the eve of FGS is necessary until 18 hours. Food should be light and lean, quickly digestible and not burdensome for the stomach. It can be fish with vegetables or chicken breast with a small amount of buckwheat. Heavy, coarse, abundant food is completely excluded. Two days before the FGS, one should not eat spicy food or drink alcoholic beverages, and in 10-12 hours exclude chocolate and chocolate sweets, all kinds of seeds and nuts, as well as fresh vegetables - a source of coarse fiber.

With a healthy stomach, these foods are easily digested in 8 hours, but since FGS is usually applied to people with digestive problems, there may not be enough time to digest food and the study will either have to be postponed or it will give an incomplete or distorted picture of the patient's condition. That is why it is so important to scrupulously implement the medical recommendations for the preparation for FGS.It is unlikely that someone will want because of his mistake to undergo this unpleasant procedure the next day, so do not neglect the advice of a doctor.

6 Activities before the

survey One of the exciting questions of patients who are undergoing the procedure of the FGD: is it possible to drink water before the procedure and is there. In the morning on the day of the procedure, you can not eat breakfast, do not brush your teeth or smoke, as this can cause increased mucus production in the stomach, which will make the procedure more prolonged. No later than 2 hours before the procedure, you can drink mineral water without gas, for 4 hours - sweet, not very strong black tea. You can not drink milk or tea with milk, as it is considered a food intake. It is optimal to completely refrain from drinking for 4 hours before the study.

You have to capture with yourself:

1. Documents:
   • passport;
   • medical policy;
   • insurance pension certificate( if necessary);
   • outpatient card;
   • referral to the examination, signed by the attending physician, which should indicate the purpose of the study, the concomitant diseases and so on;
   • data from previous FGS studies( to observe the dynamics of the disease) and biopsy( to determine the need for a repeat biopsy);
   • results of pre-submitted tests.
2. Regularly taken medicines. Tablets that need to be swallowed are taken after examination, a tablet for resorption or a spray that alleviates the condition with bronchial asthma and ischemic heart disease - before the examination.
3. A large towel with a good absorbency and a sheet or just a towel( know in advance in the treatment room).
4. Sterile gloves.
5. Shoe covers, change shoes( alternatively, take off at the entrance to the office).

7 Recommendations

In order to minimize the unpleasant sensations during the procedure, you should follow some recommendations:

1. To avoid the feeling of lack of air, to release clothing from the clothing of the neck: unbutton the upper button, loosen the gate.
2. To avoid the feeling of squeezing, loosen the belt on trousers or jeans.
3. If you are allergic to certain medications, be sure to tell your doctor.
4. Remove removable dentures, as they can scratch the probe or, jumping off, break it.
5. Do not use strongly smelling perfume and cologne.
6. If possible, as much as possible to relax and calm down the excitement.
7. Breathe the mouth slowly, smoothly and deeply.
8. Try to avoid swallowing movements, although this is not easy.
9. To get distracted from what is happening, remember something pleasant.

8 When an

narcosis is used It is necessary to appear on the procedure no later than 5 minutes before the beginning, being prepared emotionally. Such, at first glance, a trifle, as a timely appearance, in fact is very important. During the research, it is necessary to be in the most relaxed state, and for this it is best to sit a little at the office and try to calm down. If you are late, nervous stress will exacerbate muscle tension, it will not be possible to relax, and the procedure can take longer and will be more difficult.

Indications for the use of general anesthesia are:

• lidocaine intolerance;
• is the condition of the patient, which, with local anesthesia, can lead to any disturbances, for example, high blood pressure, panic attack and so on;
• high sensitivity to pain, in this case conducting FGS under general anesthesia is the only possible option.

9 Psychological attitude of

Before swallowing the probe many people are nervous, and the most impressionable are afraid, especially after listening to those who passed the examination, about the sufferings suffered. Therefore, the psychological preparation for gastric emptying in some cases is no less important than physical preparation. The patient should understand that FGS is an unpleasant, but absolutely harmless for the body procedure. The main thing is to be able to relax and trust the doctor, then everything will go much faster, and the sensations will be quite tolerable. Usually, the doctor explains in detail the patient the course of the forthcoming study. If the patient is worried about some points that the doctor did not light up, it is necessary to clarify them. The more informed the patient is, the calmer the medical event will be for him. If the parameters of the homeostasis of the respiratory and cardiovascular system are disturbed during FGS, complications may arise. If the patient suffers from angina, arrhythmia, respiratory failure, a mandatory pre-correction is indicated.

10 Local audit of

It is necessary to prepare for the EGDF locally. Local training consists of the following activities:

1. Examination of the skin and mucous membranes. It is used in the case of colds, the presence of seizures and cracks. When identifying such problems, it is first necessary to undergo a course of treatment and only after that to conduct FGS.
2. Elimination of foaming in the digestive tract. The doctor can prescribe Espumizan for 5 minutes.before the procedure.
3. Reduction of discomfort. To reduce the sensitivity of the throat before the procedure is treated with a spray containing lidocaine. Competent preparation for FGS procedure is the most important factor of a full and safe endoscopic research, which allows to minimize unpleasant sensations and to conduct the procedure as efficiently and efficiently as possible.