What is FGS and how is it done: indications for FGS, preparation

For many people suffering from gastrointestinal diseases, the question arises, what is FGS and how is it done? Fibrogastroscopy means a manipulation by which the condition of the esophageal and gastric mucosa is assessed using a gastroscope inserted manually through the oral cavity. If necessary, a biopsy can be performed using FGS.

Indications for FGS

Basically, FGS is prescribed to study inflammatory processes in the esophagus and stomach. There is also the concept of FGDS - fibrogastroduadenoscopy, in which the examination area also extends to the duodenum.

The main indications for FGS:

• inflammation: esophagus, stomach, duodenum 12;
• ulcers;
• unspecified internal bleeding;
• tumors: good and malignant;
• anatomical changes in the esophagus: stenosis, diverticula;
• dysfunction of the sphincters of the stomach: especially the upper, in the case of gastroesophageal reflux;
• control examination;
• research for the diagnosis of diseases of other organs and systems, conditions: allergy, neurosis.

FGS is not prescribed in a row to all gastroenterological patients. The decision on the need to use a gastroscope to assess the mucous membrane is made only by a doctor. Based on clinic data and patient complaints.

The main symptoms, according to which the doctor may first raise the question of the need to prescribe FGS:

• soreness in the upper abdomen;
• prolonged heartburn;
• frequent urge to nausea and vomiting;
• swallowing disorder;
• sudden changes in appetite.

During any inflammatory diseases, especially of the respiratory tract, FGS is not performed. This is due to the fact that the patient will be uncomfortable breathing during the procedure. There is also a possibility of infection in the deep parts of the gastrointestinal tract.

Pregnancy is not an absolute contraindication to FGS. However, this intervention is carried out only if the potential benefit to the mother is greater than to the fetus and when other possibilities for diagnosis have been exhausted.

Contraindications:

• early post-infarction and stroke condition;
• pathology of hemostasis;
• decompensation stage;
• mental illness;
• bronchial asthma.

In such diseases, gastroscopy can be performed only under the supervision of drugs and general anesthesia. However, the need for such an examination is determined only by a doctor.

Preparation for FGS

Any interventions using a gastroscope should be carried out only after the initial examination of the patient and carrying out special measures a few days before the procedure:

Term before research	What to do
2-3 days	Restricted to: the use of baked goods (including pasta), mayonnaise and spicy foods high in fat. First of all, this applies to meat, fish, cheese and foods rich in fiber. It is not recommended to drink soda and other drinks with a high soda content. Taking medications only with the permission of a doctor. The patient should adhere to a diet: green salad, fresh vegetables, non-fatty meat (turkey, chicken) and cottage cheese in small quantities, buckwheat porridge.
1 day	The last meal is allowed 12 hours before the examination. You can not take products even half a day before gastroscopy: cocoa-based confectionery and seeds (pumpkin, sunflower), nuts, fresh vegetables. Dinner is light, low in calories. Basically, patients are advised to eat buckwheat porridge with stewed lean meat and fish. The entire appointment is no later than 4 hours before bedtime.
On the day of the study	You can take 1 glass of still water, 2 hours before FGS. Do not chew gum or brush your teeth.

The doctor should be aware of the presence of diseases and drug intolerance. It is obligatory to take blood tests for HIV and syphilis. FGS is performed in the operating room or an office equipped for the procedure.

The patient must follow the recommendations for preparation not only with regards to nutrition, but also the general rules of a healthy lifestyle:

• remove any training and physical activity;
• do not drink alcoholic beverages;
• no smoking;
• take medications only with the permission of your doctor. This is especially true for those medications that need to be swallowed.

Immediately before gastroscopy, the patient is injected with a local anesthetic and sprayed with an aerosol ("Lidocaine") on the root of the tongue. In some cases, the introduction of a sedative is allowed. These manipulations are needed to reduce the sensitivity of the mucous membrane and reduce the likelihood of a gag reflex on tube insertion.

Features of the procedure

The procedure is performed with a gastroscope. A gastroscope is a hollow flexible tube with a fiber optic system (fiber and endoscope) inside. Due to this system, it is possible to examine in detail the structure of the mucous membrane of the digestive tract and even take material for research.

The procedure is performed by a gastroenterologist or endoscopist. The order of the Ministry of Health of the Russian Federation dated 2.06.2010 decreed that each doctor's office must be equipped with at least 2 sets for gastroscopy, with all the necessary accessories for biopsy.

For the first time, the mucous membrane of the digestive tract began to be investigated in 1868. For the purpose of practice, Adolf Kussmaul introduced the tube to the patient and, based on the data obtained, made a decision on the need for treatment.

In the future, the scopy was improved. Using fiber optics, adding a panoramic view and finally broadcasting the procedure in real time with the possibility of recording on a carrier and printing, made it possible to use FGS as a universal and everyday procedure.

In 1961, a Japanese firm acquired a license to manufacture fiber optics. Gastroscopes of the brands: Olympus, Pentax, Fujinon are the most popular nowadays, not only in the territory of the Russian Federation, but also in the CIS countries. At the moment, video gastroscopy is the main type in FGS.

Examination of FGS can only be performed by a gastroenterologist or an endoscopist specially trained in this area. It is not allowed to perform the procedure by unqualified personnel, as this can lead to the risk of harm to the patient's health.

FGS implementation:

1. Lying on the left side, head on a pillow, knees tucked to the thighs, the patient clamps a mouthpiece in his mouth.
2. The gastroscope is installed in the mouthpiece.
3. The tube is slowly inserted: the patient should relax the muscles of the larynx, breathe calmly and deeply. On inhalation, the gastroscope passes into the esophagus. Air is introduced through the tube, allowing each section of the mucous membrane to be opened. The doctor is in direct contact with the patient and, if necessary, explains what he is doing.
4. Direct examination of the mucous membrane, illuminating with a light bulb. Photo registration, video broadcast. Recording on media.
5. If necessary, a biopsy or pH determination is performed at 9 points of the digestive tract to assess acidity. Tissue biopsy is performed with forceps located at the end of the gastroscope.
6. Performing therapeutic manipulations according to indications: stopping bleeding, treatment with drugs, administration of medications, removal of polyps and other measures.
7. Removing the gastroscope.

The time for the entire FGS procedure is up to 5-10 minutes. Examination is lengthened in the case of pH metry (on average, another 5 minutes).

Video - FGS: features of the procedure, preparation, process

How often can you do

FGS is the most informative procedure for evaluating mucous membranes. Absolutely safe gastroscopy for the patient can only cause unpleasant sensations from setting and holding the gastroscope through the digestive tract. However, these symptoms disappear in 1-2 days.

Initially, FGS is performed after preparation for the procedure. If no pathology is detected, then there is no need to re-conduct it. If the disease of the digestive tract is confirmed, a dispensary examination is performed after the course of treatment, and then once a year.

However, in the case of a tumor, severe ulcerative lesions and other conditions that pose a threat to the patient's condition, FGS is performed every 3-6 months. The frequency of procedures decreases when the patient is transferred to a state of remission.

Do children do this procedure

FGS in children is necessary in the absence of reliable data on pathology after performing tests, ultrasound, CT, MRI. The complexity of the implementation is associated with the child's panic and frequent bouts of nausea on the introduction of the gastroscope.

There are no age restrictions for FGS. It can even be used in babies.

The indications for examination in children are slightly different than in adults:

• chemical burn: intake of acids and alkalis;
• congenital anatomical disorders: pyloric stenosis, hernia of the diaphragm are transmitted by heredity;
• peptic ulcer;
• gastritis;
• inflammation of the stomach and duodenum;
• gastroesophageal reflux disease: a dangerous condition in terms of the psyche of the child. The acidic contents of the stomach, thrown back into the oral cavity, injure the mucous membrane, causing ulcers with frequent repetitions. Food trauma, pain create fear of vomiting in the child. As a result, he can refuse to eat, thereby leading to the formation of anorexia;
• foreign bodies: more typical for children up to 1-1.5 years old, as they try all new objects in their mouths. FGS allows you to assess the degree of damage to the mucous membrane and remove the object itself.

It is impossible to carry out FGS when:

• failure of the heart and lungs;
• dilated veins of the esophagus in children under 1 year of age;
• strictures of the esophagus;
• aortic aneurysm.

In terms of preparation in children, it is very important to carry out psychological adaptation to the introduction of the probe. For children of younger preschool age, fairy tales, games with food (association with the installation of a gastroscope) are well suited. The more calmly the parents explain to the child what FGS is for and what the result will be, the easier it is for the child to psychologically accept this procedure.

Learn about possible symptoms acute gastritis in children, as well as how to properly approach the treatment of the disease?

On the day of the examination, you must bring a change of clothes and water with you. This is especially true for children under 6 years old, since they are more inherent in the urge to vomit and nausea.

Features of the survey:

1. Up to 6 years old, with the permission of the parents, sedation is performed: for 10-15 minutes, the child is put into half-sleep. In other cases, the use of local and application anesthesia is indicated to reduce the urge to vomit.
2. Lying on its side, a gastroscope is inserted through the mouthpiece.
3. Research, biopsy, performing treatment manipulations.
4. Photo and video recording.
5. Removal of the gastroscope.

Children are more sensitive to various procedures and after FGS may appear:

• sore throat symptoms: a few hours after gastroscopy, the child feels dry and painful in the mouth. It passes in 5-6 hours;
• mucosal wounds: the mucous membrane of the child's digestive tract is very sensitive to any kind of apparatus coming from outside. To normalize the condition, the child is given decoctions based on medicinal herbs (chamomile, sage, calendula), which have an anti-inflammatory effect. It is recommended to eat food of a creamy consistency, in a warm form;
• vomiting and release of blood: a symptom of damage to the mucous membrane and the opening of ulcers. Requires urgent medical attention;
• redness under the eyes and slight swelling of the face: against the background of psycho-emotional stress. Levels out after 2-3 hours.

FGS is performed using a gastroscope. The endoscopy method has established itself as the best for assessing the condition of the mucous membrane of the digestive tract. Use is possible in both adults and children.