EGD through the nose (transnasal gastroscopy): indications, preparation, conduct, results
Endoscopic studies of the gastrointestinal tract are the most important procedures for accurate diagnosis and subsequent treatment appointments. The constant progress in medicine leads to a decrease in the invasiveness and improving the safety of diagnosis. One of the new methods of inspection of organs of the upper digestive system (esophagus, stomach and duodenum), transnasal gastroscopy is carried out through the nose and not through your mouth, in contrast to its classical counterpart. This allows to reduce the level of patient discomfort and the incidence of such negative symptoms, such as nausea and vomiting, which is significantly better affect the patient’s commitment to treatment.
Indications and contraindications to the procedure
Gastroscopy through the nose has the same indications for its purpose as conventional FGS, namely:
Conducting fibrogastroduodenoscopy through the nose can be used for differential diagnosis in complex cases, including, for suspected neoplastic disease.
Contraindications to study are as follows:
- Decompensated diseases of the internal organs of the respiratory and cardiovascular systems, as well as acute infectious diseases.
- Allergic reactions to General anesthetics when the need for esophagogastroduodenoscopy under conditions of General anesthesia.
- Diseases of the nasal cavity, in which it is impossible to hold a nasal endoscope in the oral cavity and the esophagus. In this case, it is recommended to use the standard esophagogastroscopy (endoscopy) through the mouth.
- Stenosis of the esophagus of varying severity, or complete absence of its lumen.
If patient has contraindications described, the treating physician is advised to choose another method to examine the digestive system.
An endoscopy through the nose is a little different from the same method with the introduction of an endoscope through the mouth. However, in all subsequent stages of examination are the same.
A nasal endoscope is a long flexible probe of very small diameter having at its end the camera for capturing video and lighting source, allowing for visual inspection of the internal shell bodies. The small diameter of the device and the procedure without General anesthesia allow the use of this survey at broad categories of people.
To do the procedure in a specially equipped endoscopy of the Cabinet in a medical facility.
The patient is placed on the couch on his left side, face to the doctor. If the age of the patient is small or he has a mental disease, the procedure may be performed with General anesthesia. In all other cases, no anesthesia is required. To reduce stress and speed up the examination the patient is asked to breathe deeply with the mouth and not to worry. Gently inserting the endoscope through the nose, the doctor achieves the ingress of the tool into the esophagus, which is a bit inflated with carbon dioxide to improve inspection. At this stage the inspection of the mucous membrane of the esophagus and then the stomach.
There is a possibility of biopsy to confirm the diagnosis and minimally invasive surgical interventions, such as resection of polyps or stop bleeding from small vessels of the mucous membrane.
The average duration of the survey 10-25 minutes, depending on the purpose and scope of the intervention.
How to prepare for transnasal EGD?
Preparation is a critical step in the implementation of diagnostic procedures, and transnasally kind gastroscopy no exception. The patient should consult with his doctor prior to her appointment.
Every patient are encouraged to take the General analysis of blood and urine for the detection of internal diseases, including infectious nature. In addition, it is recommended to make an electrocardiogram to exclude heart disease. A study of the haemostatic system of the blood helps to prevent the development of intraventricular hemorrhage in patients predisposed to it.
For 8-10 hours before examination the patient is not recommended. You can drink only plain water, in small portions. Excluded from the diet for 24 hours be spicy, fatty dishes with lots of spices and seasonings, and alcoholic drinks. Smoking before the procedure is not allowed.
Proper patient preparation is the key to high safety and efficiency of the survey.
Any specific measures to prepare for the patient are not required, as the test is minimally invasive and safe.
Nasal gastroscopy rarely leads to complications, however, they can still take place:
- Most often, patients have discomfort in the esophagus or stomach after the test that occurs in connection with irritation of the mucous membranes.
- Damage to the mucous membranes of the nasal cavity, esophagus or stomach.
- Intraventricular hemorrhage of various degrees of intensity.
- Perforation of organs with the development of mediastinitis or peritonitis.
With the development of dangerous complications, you must stop and immediately start treatment involving surgery.
Transnasally kind gastroscopy is a modern diagnostic method for the examination of the upper gastrointestinal tract. High information content, the possibility of biopsy and low risk of complications served as the wide dissemination of this procedure in clinical practice. However, it is important to use this type of survey in accordance with the indications and contraindications, and only after complete clinical examination of a patient.