Endoscopic examination of the heart. Endoscopy: types of studies, preparation for the procedure. X-ray research method

These methods allow you to visually examine hollow organs and body cavities using optical instruments equipped with a lighting device.

With the help of photography, video, and digital technologies, the results of an endoscopic examination can be documented. Endoscopic research methods have found wide application in many areas of medicine:

In gastroenterology (esophagoscopy, gastroscopy, duodenoscopy, colonoscopy, sigmoidoscopy, peritoneoscopy);

In otorhinolaryngology and pulmonology (laryngoscopy, bronchoscopy, thoracoscopy);

Urology and nephrology (cystoscopy, urethroscopy, nephroscopy);

Gynecology (colposcopy, hysteroscopy);

Cardiology (cardioscopy).

Endoscopy makes it possible to detect certain types of tumor and pre-tumor diseases, carry out differential diagnosis of inflammatory and tumor diseases, and identify the severity pathological deviation and its location. If possible, endoscopy is accompanied by a biopsy with further morphological study of the obtained material.

Endoscopic technology allows for such manipulations as local administration medicines, removal of benign neoplasms of various organs, removal of foreign bodies, stopping internal bleeding, drainage of the pleural and abdominal cavities. This is especially important for the elderly and old age, people suffering from various aggravating diseases, as it is possible to avoid complex traumatic surgical procedures.

The nurse should carefully prepare the patient for an endoscopic examination. Such preparation includes both psychological and medicinal influences.

Psychological preparation consists of explaining the tasks and basic rules of behavior during an endoscopic examination, medication preparation consists of relieving psycho-emotional stress, pain relief, reducing the secretory activity of the glands, and preventing the occurrence of pathological reflexes.

Devices used for endoscopic examination are complex devices equipped with auxiliary instruments, attachments for biopsy, insertion medicinal substances, electrocoagulation, laser radiation transmission.

Rigid endoscopic devices retain their shape during the examination. The operating principle of such devices is based on the transmission of light from a source (an incandescent lamp located at the working end of the device) through a lens optical system.

Flexible devices are capable of changing the configuration of the working part in accordance with the shape of the organ being examined. The optical system of plastic fiber endoscopes is similar to a lens one, but the supply of light and images is realized through fiber light guides. Thus, the lighting system is placed outside the endoscope, which allows for sufficient illumination of organs without heating the tissues.

Rigid endoscopes equipped with fiber optics (thoracoscope, mediastinoscope, laparoscope, cystoscope, rectoscope) are simplified in design, while increasing the safety of the examination.

After the examination, the working part of the endoscope and its channels must be washed, cleaned and dried. Endoscopes are sterilized in special chambers in vapors of certain drugs that have antimicrobial properties(ethylene oxide, formalin, etc.). Plastic endoscopes are subjected to special treatment in certain antiseptic substances (ethyl alcohol, formic alcohol and etc.).

Endoscopic devices are classified into the following categories:

By purpose (examination, biopsy, operating rooms);

Age modifications (for children and adults);

Structural features of the working part (rigid, flexible).

Examination of the esophagus, stomach and duodenum

It is carried out for diagnostic and/or therapeutic purposes for diseases of the esophagus, stomach, and duodenum.

Contraindications for this study:

Cicatricial changes in the esophagus;

Traumatic injuries:

Esophagus;

Stomach;

Duodenum.

The nurse instructs the patient in advance about the scheduled examination, the time and place of its conduct. The study is carried out on an empty stomach; you cannot take food, water, medicine, or smoke. A nurse accompanies a patient to the endoscopy room. The patient must have a towel with him.

Colon examination

Colonoscopy is performed for diagnostic and/or therapeutic purposes in the presence of probable pathologies of the large intestine. Contraindications may include traumatic injuries intestines, scar changes rectum.

The patient is instructed three days before the study:

Exclude foods rich in fiber from your diet (legumes, fresh milk, brown bread, fresh vegetables and fruits, potato dishes);

The day before the test, exclude solid foods;

Also, the day before the study, the patient is given laxatives (castor oil 60-80 ml, magnesium sulfate 125 ml of a 25% solution, senna decoction - 140 ml);

The night before, two cleansing enemas are performed with a volume of about 300 g at an interval of 1.5-2 hours;

In the morning, two cleansing enemas with a volume of 2.5-3 liters are also prescribed, but no later than 2 hours before the procedure.

Bladder studies

Cystoscopy is used for diagnostic and/or therapeutic purposes in diseases Bladder. Contraindications to this study: traumatic injuries to the urethra, cicatricial changes in the urethra.

The nurse prepares a sterile kit for cystoscopy in advance:

Cystoscope;

Syringe Janet;

Rubber catheters;

Napkins;

Towel;

Two pairs rubber gloves;

Vaseline oil or glycerin;

Two trays;

Gauze swabs;

Oilcloth;

Antiseptic solution;

Anti-shock kit;

Containers with disinfectant solution.

The patient is notified in advance about the time and place of the study.

The procedure technique is as follows:

The nurse puts on sterile gloves;

Antiseptic solution treats the patient's external genitalia;

Removes gloves and places them in a container with a disinfectant solution;

Performs bladder catheterization;

Drugs used:

Endoscopy - research method internal organs using special devices - endoscopes. The term "endoscopy" comes from two Greek words (endon - inside and skopeo - look, examine). This method is widely used for diagnostic and therapeutic purposes in surgery, gastroenterology, pulmonology, urology, gynecology and other areas of medicine.

Depending on the organ being studied, there are:

bronchoscopy (endoscopy of the bronchi),
esophagoscopy (endoscopy of the esophagus),
gastroscopy (stomach endoscopy),
intestinoscopy (endoscopy small intestine),
colonoscopy (endoscopy of the large intestine).
Gastroscopy Have you been prescribed an esophagogastroduodenoscopy?

(EGD) is an endoscopic research method in which upper sections gastrointestinal tract: esophagus, stomach and duodenum.

Gastroscopy is performed by qualified endoscopists. At the patient's request, gastroscopy during sleep (medicated sleep) is possible.

An endoscope is a long, thin, flexible tube with a lens at the end. Operating the endoscope, the doctor, under visual control, safely, carries the instrument into the upper sections digestive tract to carefully examine its inner surface.

Gastroscopy will help make the correct diagnosis for many conditions, including stomach pain, bleeding, ulcers, tumors, difficulty swallowing and many others.

It is very important in preparation for gastroscopy that you should not eat for 6-8 hours before the examination.

During the gastroscopy, everything possible will be done to make it as easy as possible for you. Your condition will be closely monitored medical staff. If gastroscopy scares you, it can be done in your sleep.
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Tracheobronchoscopy (often used more than short name- bronchoscopy) is an endoscopic method for assessing the mucous membrane and lumen of the trachea and bronchi (tracheobronchial tree).

Diagnostic tracheobronchoscopy is performed using flexible endoscopes that are inserted into the lumen of the trachea and bronchi.

How to prepare for bronchoscopy?
Tracheobronchoscopy is performed on an empty stomach to avoid accidental entry of food or liquid into the Airways when gagging or coughing, therefore last appointment food should be no later than 21 hours on the eve of the study.
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Colonoscopy is an endoscopic examination during which the condition of the colon mucosa is visually assessed. Colonoscopy is performed with flexible endoscopes.

Sometimes, before a colonoscopy, an X-ray examination of the colon is performed - irrigoscopy. Colonoscopy can be performed 2-3 days after irrigoscopy.

How to prepare for a colonoscopy?

In order to examine the mucous membrane of the colon, it is necessary that there is no feces in its lumen.

The success and informativeness of a colonoscopy is determined mainly by the quality of preparation for the procedure, so pay the most serious attention to the implementation the following recommendations: If you do not suffer from constipation, that is, the absence of independent stool within 72 hours, then preparation for a colonoscopy is as follows:
On the eve of the colonoscopy at 16:00 you need to take 40-60 grams castor oil. Other laxatives (senna preparations, bisacodyl, etc.) lead to pronounced increase colon tone, which makes the study more labor-intensive and often painful.
After independent bowel movements, you need to do 2 enemas of 1-1.5 liters each. Enemas are given at 20 and 22 hours.
On the morning of the colonoscopy, you need to do 2 more of the same enemas (at 7 and 8 o'clock).
There is no need to fast on the day of the test.

Endoscopy – medical method research human body, which is considered one of the most informative instrumental diagnostic methods various diseases 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 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 (tissue sampling 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, examine internal organs without surgical intervention it was impossible, so medical examinations were limited to palpation, percussion (tapping) and auscultation (listening). The first attempts to conduct endoscopic examinations date back to the end of the 18th 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 we used local anesthesia cocaine.

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 capable of converting optical signals into electrical impulses was created. 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 the research results and study the dynamics pathological processes for timely and effective treatment of 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. IN Lately fiberscopes are being replaced by video endoscopes - devices equipped with a miniature video camera located at the distal end. Video endoscopes have a small tube diameter and transmit information electronically, which allows you to obtain detailed images of the organs being examined 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 technology is used to remove the appendix, gallbladder, tumors, lymph nodes, intervertebral hernias, to eliminate sclerotic vascular pathology and heart bypass surgery. Endoscopic surgery allows surgical intervention without abdominal 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 secondary differential diagnosis for the purpose of studying clinical picture diseases. Detailed images of organs and cavities make it possible to record pathological processes on initial stages and facilitate analysis of treatment effectiveness.

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	Colon
Colposcopy	Vaginal walls
Laparoscopy	External side of organs abdominal cavity 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 refuse 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, local anesthesia is used. To do this, the mucous membranes are lubricated or irrigated with anesthetic solutions. General anesthesia used in cases where operational research dangerous to human health and life or requires surgical intervention. 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 (EGD) is one of the most basic areas endoscopic studies, which arose in early XIX 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 electronic images High Quality 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. Maybe intramuscular injection sedatives, general anesthesia 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. About availability 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 within 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 biopsies 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. Colonic examination is not recommended in active Crohn's disease and ulcerative colitis to avoid damage to the intestine. Colonoscopy has no other contraindications.

Endoscopy of the rectum and sigmoid colon

Sigmoidoscopy is a type of endoscopy intended for diagnosing pathologies of the rectum and distal part. 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 under study 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 (ureteroscopy) is an instrumental research method designed to diagnose diseases of the urinary tract and bladder, which is also an auxiliary method for recognizing 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.

Using 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 allow you 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 simple removal of 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 gastrointestinal tract along the entire length and with high accuracy, 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 on early stages Therefore, 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.

The negative aspects of endoscopy include the need to prepare for the examination and the limited scope of 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.

History of endoscopy

In its development, endoscopy went through several stages, characterized by the improvement of optical instruments and the emergence of new diagnostic and treatment methods. Until a certain time, examination of internal organs without surgical intervention was impossible. Doctors had access to only such non-invasive methods of studying internal organs as palpation, percussion and auscultation. The first attempts to use endoscopy were made already at the end of the 18th century, but these were dangerous and unrealistic attempts. Only in the year, Philip Bozzini (Ph. Bozzini), currently considered the inventor of the endoscope, designed an apparatus for examining the rectum and uterine cavity. The device was a rigid tube with a system of lenses and mirrors, and the light source was a candle. This device, unfortunately, was never used for research on humans, since the author was punished by the medical faculty of Vienna “for curiosity.” Subsequently, the candle in endoscopes was replaced by an alcohol lamp, and instead of a rigid tube, a flexible conductor was inserted. However, the main complications of the examination remained burns, which doctors partially got rid of only with the invention of miniature electric lamps, which were attached to the end of the apparatus inserted into the cavity. In closed cavities that have no natural connection with external environment, the device was inserted through a hole created (a puncture in the wall of the abdomen or chest). However, endoscopic diagnosis was not widely used until the advent of fiber optic systems.

The capabilities of endoscopy have expanded significantly since the 2nd half of the 20th century with the advent of glass fiber light guides and fiber optics devices based on them. Almost all organs became accessible for inspection, the illumination of the examined organs increased, conditions for photography and filming appeared (endophotography and endocinematography), and it became possible to record black-and-white or color images on a video recorder (modifications of standard photo and film cameras are used). Documenting the results of an endoscopic examination helps to objectively study the dynamics of pathological processes occurring in any organ.

Use of endoscopy methods in medicine

Currently, endoscopic research methods are used both for diagnosis and treatment of various diseases. Modern endoscopy plays a special role in recognizing the early stages of many diseases, especially oncological diseases (cancer) of various organs (stomach, bladder, lungs). Most often, endoscopy is combined with targeted (under visual control) biopsy, therapeutic measures(administration of drugs), probing.

Types of endoscopy

Bronchoscopy - examination of the bronchi
Gastroscopy - examination of the stomach
Hysteroscopy - examination of the uterine cavity
Colonoscopy - colon mucosa
Colposcopy - vaginal opening and vaginal walls
Laparoscopy - abdominal cavity
Otoscopy - external ear canal and eardrum
Sigmoidoscopy - rectum and distal sigmoid colon
Ureteroscopy - ureter
Cholangioscopy - bile ducts
Cystoscopy - bladder
Esophagogastroduodenoscopy - examination of the esophagus, stomach cavity and duodenum

Endoscopic surgery

Progress in the development of endoscopic equipment and the creation of microscopic instruments has led to the emergence of a new type of surgical technology - endoscopic surgery. During such an operation, special manipulator instruments are inserted into hollow organs or into the abdominal cavity through an endoscope and flexible fiber devices, controlled by a surgeon who monitors his work on a monitor.

Endoscopic surgery now avoids extensive abdominal operations for diseases of the gallbladder, appendicitis, removal of lymph nodes, tumors, for eliminating sclerotic pathology in blood vessels, for bypass surgery in case of

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Endoscopic studies

Endoscopic examination is an examination, “endo” means inside, so “endoscopy” is an examination inside organs that have at least a minimal space - a cavity. These organs include the esophagus, stomach and intestines, gallbladder, bronchi. There is an abdominal cavity, a pleural cavity, and a joint cavity. Modern technical means make it possible to examine all these cavities and characterize those tissues that are visible during examination.

The diagram below shows the organs of the abdominal cavity and the endoscopy methods that are used to study them.

endoscopic examination

For endoscopic examinations, two types of devices are used - “rigid” and “flexible”. The first are metal tubes of short length and different diameters, at one end of which there is a lighting bulb or an internal fiber illuminator, and at the other an eyepiece that allows you to magnify the image. Rigid endoscopes are short because they can be inserted over short distances without distorting the image. Using “hard” instruments, the rectum, bladder, and abdominal cavity are examined. A real revolution in medicine was brought about by “flexible” endoscopes. In them, the image is transmitted through a bundle of special optical fibers. Each fiber in a bundle provides an image of one point of the organ mucosa, and a bundle of fibers provides an image of an entire area. At the same time, the image remains clear when bending the fibers and is transmitted over a greater length. The use of flexible endoscopes has made it possible to examine almost the entire gastrointestinal tract - the esophagus, stomach, small and large intestine, as well as the bronchi and joints.

Objectives of the study. With the help of endoscopic research methods it is possible to recognize tumor and inflammatory diseases stomach, colon, liver and bile ducts, bronchi, joints, bladder. During the study, it is possible to perform a biopsy of areas of the mucous organs that are suspicious for a tumor. During endoscopic examination, surgical interventions can be performed. Increasingly, endoscopic examination methods are used to carry out preventive examinations, since they allow us to identify early signs diseases. These methods also make it possible to monitor the effectiveness of disease treatment.

How the research is performed. The general principle of performing endoscopic examinations is the introduction of an endoscopy apparatus through the natural openings of the body. When examining the esophagus, stomach, or small intestine, the endoscope is inserted through the mouth. During bronchoscopy, the device is inserted through the mouth and further into the respiratory tract. The rectum and colon are examined by inserting endoscopes through anus. The exceptions are laparoscopy, arthroscopy - studies of the abdominal cavity and joints - here artificial holes are created by puncture for the insertion of devices. Naturally, these procedures create subjective inconvenience for patients and require the use of certain manipulations for pain relief; most often this is not very burdensome for patients. After the endoscopes are inserted, they move towards the organ or area of the organ being examined. The cavity and mucous membranes are examined; in most cases, photographs can be taken of those areas that “interested” the doctor. With the progress of technology, it became possible to record the entire research process on videotape. During the examination, especially if a tumor process is suspected, a biopsy is performed (taking a small piece of tissue for examination).

Possibilities of endoscopic examinations for recognizing diseases, their reliability and possible complications.

Esophagoscopy - examination of the esophagus. Redness (hyperemia) and swelling of the mucous membrane, minor hemorrhages, superficial ulcerations (erosions) and ulcers of the mucous membrane are detected, which is characteristic of inflammatory changes. Polyps and tumors of the esophagus are detected, and they can be detected at the earliest stages. Eat characteristic changes for hernias hiatus diaphragm. Less reliable information is provided by the recognition method movement disorders esophagus, X-ray and some other special methods are more helpful here.

Gastroduodenoscopy - examination of the stomach and duodenum. Erosion, ulcers, polyps, tumors, signs characteristic of chronic gastritis. The information value of gastroduodenoscopy for identifying these diseases is close to 100%. At the same time, diverticula of the stomach and duodenum, such a complication peptic ulcer, as narrowing of the gastric outlet is better recognized using fluoroscopy.

Using devices for endoscopy of the esophagus, stomach and duodenum, stomach polyps are removed and bleeding from the ulcer is stopped.

Complications during esophagoscopy and gastroduodenoscopy in modern conditions are very rare. During the examination, perforation, rupture of the organ being examined, and bleeding may occur.

Anoscopy - examination of the final segment of the rectum.

Sigmoidoscopy - examination of the rectum and sigmoid colon at a distance of no more than 30 cm from the anus.

Colonoscopy is an examination of almost the entire colon.

All these methods reveal signs of inflammation (swelling of the folds of the mucous membrane or their thinning, redness of the mucous membrane, hemorrhages), as well as erosion, ulcers, tumors, polyps. The limitations of anoscopy and sigmoidoscopy relate only to the length of the examination. In this regard, colonoscopy is the most informative. In 80-90% of cases, the entire colon is examined using colonoscopy. Colonoscopy should be used if colon tumors are suspected. It helps identify tumors and polyps minimum sizes. The method provides significant information in patients ulcerative colitis, Crohn's disease, intestinal bleeding, colon obstruction, foreign bodies. In the same time endoscopic techniques inferior to radiological ones in recognizing diseases such as colon diverticulosis and an increase in the size of individual sections of the intestine. Colonoscopy is not performed in patients with acute myocardial infarction, perforation of the colon, or inflammation of the peritoneum. The procedure is prescribed with caution to patients with diverticulitis, severe forms of ulcerative and ischemic colitis, acute phase chemical damage colon. It is difficult to perform colonoscopy in patients with diseases of the rectum with severe pain, for example, with thrombosis of hemorrhoids.

Complications of sigmoidoscopy and colonoscopy - perforation, rupture of the intestine, bleeding. They develop very rarely.

Using a sigmoidoscope and colonoscope, intestinal polyps are removed and bleeding from ulcers is stopped.

Laparoscopy is an examination of the abdominal cavity. Tumors of the liver, gall bladder, and other abdominal organs are identified, the shape and size of the abdominal lymph nodes, and changes in the shape of organs due to inflammatory and other diseases are assessed. Laparoscopy is used in situations where doctors have difficulty recognizing diseases, and other research methods do not provide reliable information. Most often, laparoscopy is necessary to determine the causes of liver enlargement, if tumors of the liver, gall bladder, or pelvic organs - uterus, ovaries are suspected. For some types of jaundice, laparoscopy can also help identify the cause. Laparoscopy is not performed for bleeding disorders, inflammation of the peritoneum, serious illnesses heart and lungs.

Laparoscopy opens up great opportunities for treating patients. These possibilities are constantly expanding. Currently, a whole new field of surgery has emerged - laparoscopic surgery. A miniature video camera is built into the laparoscope, which allows you to see all the organs of the abdominal cavity on the TV screen. Through additional small incisions in the abdominal cavity next to the laparoscope, surgical instruments are inserted and operations are performed, for example, removal of the gallbladder in patients with bladder stones. The number of operations performed in this way is constantly growing.

Complications are rare - bleeding, perforation of abdominal organs, inflammation of the peritoneum (peritonitis).

Bronchoscopy - examination of the bronchi. Currently, it is performed mainly with the help of flexible devices - fiber-optic bronchoscopes. They are less burdensome for patients; with their help, you can examine the mucous membranes of not only large bronchi, but also bronchi of a smaller diameter. Bronchoscopy reveals signs inflammatory process in the bronchi, lung tumors, sources and causes of hemoptysis, prolonged cough, enlarged lymph nodes.

The design of modern devices for bronchoscopy is such that they allow a number of additional manipulations in addition to examination - suction of bronchial secretions, biopsy of the bronchial mucosa, and also, after puncture of the bronchus, biopsy lung tissue, lymph nodes. A number of medical procedures are carried out - lavage of the bronchi, administration of medications, suction of pus and blood from the bronchi.

Arthroscopy - examination of joints. Traumatic or degenerative changes menisci, articular ligaments, different kinds damage to articular cartilage, internal, synovial membrane joints. It is possible to perform a biopsy of the synovial membrane and suction of synovial intra-articular fluid. It is performed in patients with inflammatory and dystrophic changes in the joints to determine the nature of the disease.

Currently, with the help of arthroscopy, a number of joint operations are performed, in particular, removal of the meniscus, without opening the joint cavity.

Complications are rare - the main one is the development of inflammation of the joint.

Preparing for the study. Preparation for esophagoscopy, gastroduodenoscopy, bronchoscopy consists of prohibiting eating for 12 hours before the study. A more complex study is performed before colonoscopy. The main goal of the study is to cleanse the colon of contents and gases. 2-4 days before the study, the patient is recommended to eat a diet with a reduced amount of waste (meat broth, boiled meat and fish, protein omelet, white crackers). The day before the study, after the second breakfast, the patient is given 30-40 ml of castor oil, and in the evening a cleansing enema is given. Dinner is cancelled. On the day of the study, a cleansing enema is given 2-2.5 hours before the colonoscopy. Some institutions prescribe special drugs to cleanse the intestines.

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