Reduce missed diagnosis and misdiagnosis, and clarify the key points of gastroscopy operation in one article

It is only for medical professionals to read and refer to the experience summary of clinicians.

Recently, the International Agency for Research on Cancer (IARC) of the World Health Organization released the latest global cancer burden data for 2020, which counts the latest incidence, mortality, and cancer development trends of 36 cancer types in 185 countries around the world.

Among them, 4.
57 million new cancers occurred in China, accounting for 23.
7% of the world.
The new cancers ranked first in the world, and the top three were lung cancer, colorectal cancer, and gastric cancer.

It can be seen that gastrointestinal tumors tend to remain high, and endoscopy is currently the best inspection method for discovering gastrointestinal tumors.

In the process of endoscopy, there may be missed diagnosis and misdiagnosis due to factors such as preoperative preparation, patient cooperation, and the technical ability of the endoscopy examiner.
Therefore, the standardized operation of endoscopy is very important.
The following editor combines the actual clinical operation to introduce Let's look at the standardized operation of upper gastrointestinal endoscopy.

1.
Preparing gastroscopy before gastroscopy is an invasive procedure, and there are certain risks.
It is necessary to improve the cardiopulmonary function such as electrocardiogram and other tests.
At the same time, fasting and drinking water after dinner the day before the examination.
A digestible liquid diet is recommended for dinner, which can reduce or prevent Occurrence of gastric retention due to gastroparesis or pyloric obstruction.

The stomach normally secretes about 1.
5-2.
5 liters of gastric juice per day.
Even if fasting for 4-6 hours, there will still be residual gastric juice in the gastric cavity.
Routine application of simethicone (or simethicone) and pronase can effectively remove foam and mucus and increase The visibility of gastroscopy can improve the early diagnosis rate of upper gastrointestinal tumors.
Statistics show that simethicone combined with pronase can effectively improve the clarity of gastroscopy and the detection rate of small lesions [1].

Patient preparation: Ask the medical history and medication history in detail to determine whether the patient has contraindications to endoscopic examination; comfort the patient before the examination, eliminate their nervousness, and improve the degree of cooperation of the patient.

During the examination, the patient was in a left position, with knees bent and back, head tilted back moderately, too shallow, and the airway could not be opened, affecting breathing.
The back was too deep, especially for those who were thin, with excessive traction of the esophageal entrance tissue and a narrow entrance.
, Endoscope is not easy to pass.

Equipment preparation: In the preparation process, check the endoscope and host system, first confirm that the equipment used is in normal working condition, including adjusting negative pressure suction, air and water supply; setting parameters, adjusting white balance; adjusting the angle of the endoscope, Select an endoscope with a suitable bending angle for inspection or surgery; prepare in advance the preparation of medicines and accessories needed during the inspection process.

2.
Pigment endoscopy Pigment endoscopy is a method that can improve the detection rate of gastric mucosal lesions.
80% of early gastric cancer cases can be detected by white light + pigment endoscopy.

Lugo's iodine solution (1.
5%), which is commonly used in the esophagus, can not only help detect early esophageal cancer, but also further determine its scope and depth of invasion (the principle of iodine staining is that normal mature non-keratinized squamous epithelial cells contain a large amount of glycogen.
It becomes brown when exposed to iodine.
When the esophagus becomes inflamed or cancerous, the glycogen content in the cell decreases or even disappears.
Therefore, the corresponding part of the iodine stained area is lightly stained or non-stained.
The common staining method for the stomach is indigo carmine staining (0.
2%~0.
4 %), the principle is that the pigment is deposited in the gastric pit due to gravity.
Due to the difference between the structure of the lesion and the background mucosal gastric pit, the contrast of the pigment outlines a clear boundary of the lesion, and the lower gastrointestinal tract is mostly stained with crystal violet (0.
05%) ).

3.
Gastroscopy 1.
The method of holding the mirror: place the left-handed endoscope operating part in front of the chest, keep the back arm close to the body, use the strength of the hand and wrist to control the endoscope, and avoid opening and closing the arm with the ring finger of the left hand.
The little finger is in a natural state to hold the operation part; adjust the size knob with the thumb, middle finger and ring finger, the middle finger controls the air and water injection, and the index finger controls the suction button.
Check the water injection, air injection and suction before operation.
Do not keep pressing the middle finger during the operation.
The insufflation button is over-aspirated.
You can control the two buttons with your index finger and place your index finger on the suction button. 2.
Observation sequence through endoscopy: not only observe the stomach and esophagus during endoscopic observation, but also pay attention to the observation of the hypopharynx, enter the endoscopy through the cavity, and advance and retreat in an orderly manner; observe without blind spots and take pictures without leakage; focus on the cardia and gastric body The lower part and the posterior wall of the gastric horn, the greater curvature of the gastric body and other parts that are easily missed; through the collection of pictures of different parts, the observation changes and observation order of different parts under white light and NBI mode are displayed, and the endoscope is finally completed.
Observe the order.

Image source: Internet 3.
Endoscopic flushing: Even if simethicone (or simethicone) and pronase are taken before the examination, a small amount of mucus may remain in the stomach.
In order to keep the visual field clean, you can use clean water from high to low Rinse in order to detect early lesions in time.

4.
Endoscope photographing method: take pictures after fixing the picture, and it is forbidden to take pictures directly; taking pictures must be a combination of close-up and long-distance, and a combination of local and overall; each picture must have a landmark part; after the lesion is found, first ordinary observation, far away Distance, middle distance, short distance, from the whole to the part, and pay attention to aspiration at the same time (at the same time, observe the full and moderate air volume).

5.
Endoscopic staining technology: before staining, the lesion should be washed repeatedly to ensure that the stain is in full contact with the lesion; after the staining, the stain in the stomach should be sucked clean; especially after the esophagus is stained with iodine, due to iodine's effect on digestion The tract has a strong stimulating effect, which will cause obvious discomfort to the patient, and it should be fully sucked up immediately after finishing the relevant staining.

6.
Biopsy under endoscopy: In order to clarify the nature of the lesions seen by endoscopy, biopsy of the local mucosa of the lesion can be selected.

Biopsy of raised lesions at the top (congestion, erosion, etc.
) and its base (erosions, unevenness, color changes, etc.
); flat lesions are biopsied at the periphery or center of the lesion and at the interruption of mucosal folds; ulcerative lesions are in the mucosa at the edge of the ulcer Multi-point biopsy of the top or medial mucosa of the bulge; local mucosal lesions can also be biopsied for the most suspicious or most typical lesions based on the results of staining and magnifying endoscopy [2].

Make it a good habit to keep photos before, during, and after the biopsy.

7.
Hemostatic treatment: Bleeding caused by biopsy can generally be stopped by itself, or norepinephrine saline can be used to wash the wound, endoscope compression, hemostatic clip and other methods. Standardized gastrointestinal endoscopy to help patients find early lesions earlier, save a life for patients, and reduce the incidence and mortality of gastrointestinal tumors in China is the responsibility of digestive endoscopy doctors in this era.

References: [1] A multi-center randomized controlled study of pronase particles for removing gastric mucus during gastroscopy.
Chinese Journal of Digestive Endoscopy, 2013, 11, 30 (11) [2] Chinese Digestive Endoscopy Biopsy norms and pathology expert consensus .
Chinese Journal of Practical Internal Medicine Sep, 2014,34 (9) This article source: medical digestion liver disease channel author: Yang Jialong review article: Deputy Director Yang Weisheng Jingdezhen City second people's hospital physician editor ：Mary’s copyright statement If you need to reprint the original article, please contact authorization-End -Submission/reprint/business cooperation, please contact: xh@yxj.
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