What kind of gastroscope is considered an "effective gastroscope"?

Only for medical professionals to read and reference.
Quick collection! China is a country with a high incidence of upper gastrointestinal tumors.
According to 2016 data, the incidence of upper gastrointestinal tumors (gastric cancer + esophageal cancer) in China has exceeded that of other tumors, ranking first
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Early gastroscopy screening can significantly reduce the incidence of gastric cancer
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However, there are still some subjects who develop gastric cancer within a short period of time after gastroscopy, and some of them are caused by "ineffective gastroscopy" due to improper operation during the first examination
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Figure 1 The patient underwent gastroscopy several times, and the lesion was found to have no biopsy in July 2020.
When it was re-examined in April 2021, it was already advanced gastric cancer
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Therefore, improving the quality of gastroscopy can help improve the early screening of gastric cancer.
At the 21st National Conference on Digestive Diseases of the Chinese Medical Association (CGC 2021) this year, Professor Bai Yu from Changhai Hospital of Naval Military Medical University Xiang Guangda Shared 5 key points of quality control of upper gastrointestinal endoscopy
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Let's study together
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1 Clear concept: "Effective gastroscopy" requires the joint efforts of doctors and patients.
"Effective gastroscopy" not only requires the efforts of doctors, but also the cooperation of patients
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Patients follow the doctor’s instructions for preoperative preparations to ensure that they are “clearly visible” during the gastroscopy, and the doctors are skilled in the operation and can be “visible” when encountering lesions
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Figure 2 Methods to improve the quality of gastroscopy 2 Sharpening the knife without accidentally cutting wood-Quality control before gastroscopy, Professor Bai told us that the quality control of gastroscopy should start as early as before the gastroscopy
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As the so-called "knife sharpening does not accidentally chop wood", good preparation before gastroscopy is the basis of "effective gastroscopy"
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Professor Bai referred to domestic and foreign guidelines and summarized the quality control before gastroscopy into the following four points: ①Comprehensively evaluate the patient's overall condition, inform the patient of the risks and complications of gastroscopy, and obtain the patient's informed consent and signature
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Figure 3 ESGE recommends ② 2 hours before gastroscopy, fasting for 6 hours and delayed gastric emptying (gastroparesis) should extend the fasting time
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③Pre-use of mucus and defoaming agents can help to improve the field of vision during gastroscopy
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Figure 4 Asian consensus ④The risk assessment of upper gastrointestinal cancer should be performed before diagnostic gastroscopy
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Patients who are at high risk of cancer of the upper gastrointestinal tract can prompt the endoscopist to observe more carefully and take more active biopsy
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3 A few key figures to teach you how to standardize gastroscopy.
The endoscopist is the leader in gastroscopy
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Standardized endoscopic operation is the basis and guarantee of "effective gastroscopy"
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So, how do endoscopists regulate gastroscopy in clinical work? Professor Bai provided us with these key figures
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①100-200 cases: Before independent gastroscopy, the endoscopist should independently complete at least 100-200 cases of smooth insertion of the endoscopy to the descending part of the duodenum without assistance
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The success rate of insertion lens should be more than 95%-98%
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②20 minutes and 7 minutes: The British Gastroenterology Society (BSG) guidelines recommend that the overall time of each gastroscope should be at least 20 minutes
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The European Association of Gastrointestinal Endoscopy (ESGE) guidelines recommend that the operation time of each initial gastroscopy is at least 7 minutes
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Figure 4 Research results ③20-40 sheets: For the number of images required for each gastroscope, the Japanese guidelines recommend that 20-40 sheets be retained
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And the pictures left should include pictures of the main papilla of the duodenum
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④6 blocks, 5 blocks and 4 blocks: ESGE guidelines recommend that patients with suspected eosinophilic esophagitis should take 3 biopsies each from the proximal esophagus and the distal esophagus; according to the updated Sydney protocol, at least 5 biopsies for atrophic gastritis should be taken.
Including 1 piece of greater curvature of gastric antrum, 1 piece of lesser curvature of gastric antrum, 1 piece of gastric horn, 2 pieces of gastric body; patients with suspected celiac disease should take at least 4 biopsies of the duodenum, including 1 bulb biopsy
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4 One push of anesthetics will add extra points to the effect in many countries.
Sedation and pain relief are inseparable from digestive endoscopy
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In the United States, 98% of endoscopists choose sedation during upper and lower gastrointestinal endoscopy
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In recent years, painless digestive endoscopy has become more and more popular in China
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Painless digestive endoscopy can reduce patient anxiety and discomfort, reduce the risk of physical injury during examination, and provide an ideal examination environment for endoscopists
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Professor Bai introduced to us the advantages of painless gastroscopy through a systematic review
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The systematic review included 36 clinical studies with a total of 3918 patients.
The results showed that sedation can significantly improve patient satisfaction (RR 2.
29) and the rate of repeated gastroscopy (RR 1.
25)
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At the same time, Professor Bai also reminded endoscopists that they should do a good job in patient evaluation before painless gastroscopy, intraoperative monitoring and postoperative evaluation
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In 2010, the consensus on the operation of painless digestive endoscopy in China proposed that the criteria for allowing discharge after anesthesia endoscopy are: (1) vital signs (respiration, pulse, blood pressure) stable for at least 30 minutes; (2) there is no new or examination after surgery Treatment of complications related to anesthesia; (3) No bleeding or oozing; (4) No nausea and vomiting for at least 30 minutes; (5) Sober and able to answer questions clearly and accurately; (6) Changing clothes and standing for 10 minutes without any problems Only a little dizzy
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5 Reviewing the past and learning the new-Quality control after gastroscopy The end of gastroscopy does not mean that the quality control is also over
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Professor Bai Yu pointed out that the BSG guidelines recommend that endoscopy centers should review and analyze the occurrence of gastroscopy complications every year, and review the missed diagnosis of upper gastrointestinal cancer regularly (up to every 3 years)
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Gastric cancer discovered within 3 years after gastroscopy is considered to be a gastric cancer that has not been diagnosed early
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Retrospective studies have shown that the incidence of gastric cancer that cannot be diagnosed early is between 4.
6% and 14.
4%
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Each endoscopy center should ensure that the incidence of gastric cancer that cannot be diagnosed early does not exceed 10%
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Through regular review and analysis of gastroscopic complications and missed diagnosis of upper gastrointestinal cancer, on the one hand, we can explore the causes of gastric cancer or complications that have not been diagnosed early, and take effective measures to reduce the occurrence of gastric cancer and complications that have not been diagnosed early.
; On the other hand, enough cases of gastric cancer that have not been diagnosed early can be obtained and compared with the existing standards, which is conducive to perfecting the relevant consensus and updating the standards
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Summary: At the end of the meeting, Professor Bai concluded for us that an "effective gastroscopy" needs to do the following 5 points: 1.
Preoperative preparation: diet management and mucus removal
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2.
The success rate of endoscopists for inserting the lens is more than 98%
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3.
The observation time is at least 7 minutes
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4.
Observation technique: pay attention to flushing, gas injection, inhalation, inverted mirror observation and biopsy during the inspection
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5.
Review the endoscopy data, and do a good job in popular science education for endoscopy
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