Gastroscopy through the nose: features of transnasal examination

If there is something wrong with your digestion, the doctor will most likely prescribe not the most pleasant examination methods (in particular, gastro- and colonoscopy). But today these techniques have changed so much that you can no longer be afraid of them.

Our expert is an endoscopist at Moscow City Clinical Hospital No. 17 Igor Sadikov .

Gastro- and colonoscopy are two of the most important research methods used to assess the functioning of the digestive organs. Of course, they are not as comfortable as, say, ultrasound or CT and MRI, but they are very informative.

You'll have to be patient

Gastroscopy has virtually no alternative if you need to confirm or exclude diagnoses such as esophagitis, duodenitis, gastritis, gastric and duodenal ulcers, tumors of the stomach and esophagus. Unfortunately, such diagnoses cannot be established non-invasively.

In addition, gastroscopy lasts a matter of minutes (a little longer if you need to take a biopsy - a piece of mucous membrane for examination). And in order to minimize discomfort, the doctor first administers local anesthesia - irrigates the patient’s mouth and throat with a 10% lidocaine solution. But sometimes this is not enough and the procedure is still difficult to bear, and even turns out to be ineffective. This happens if the patient prepared incorrectly for it or behaved incorrectly during the study.

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For gastroscopy to go as quickly and smoothly as possible and give results, it is important:

• do not eat 10 hours, do not drink or smoke 2 hours before the examination (otherwise the production of gastric juice and mucus will interfere with the examination);
• If possible, refrain from taking medications before the procedure;
• warn the doctor about existing diseases (bronchial asthma, recent stroke, heart attack and other diseases are contraindications for gastroscopy);
• During the procedure, breathe only through your mouth, evenly and deeply. Such breathing in itself allows you to reduce the urge to vomit or even reduce it to zero. You need to fully concentrate on proper breathing and try not to think about anything else.

Complications

Complications of gastroscopy may be related to pain management or the technique of the study. In the first case, side effects usually occur as a result of intolerance to anesthetic drugs, aspiration of stomach contents, and severe concomitant background. These include allergies, anaphylaxis, aspiration pneumonia, respiratory and circulatory disorders.

Complications of technical gastroscopy are most often caused by rough, forced insertion of the endoscope or inappropriate behavior of the patient during the procedure. Forced insertion of a fiber gastroscope or the patient’s anxiety during gastroscopy can lead to wounds to the pharynx, rupture of the esophagus in the thoracic or abdominal sections, and gastric perforation. With such complications, the patient needs emergency surgery. For cracks and abrasions of the mucous membrane, conservative measures are taken: diet, rest, medicinal treatment of defects. In some cases, gastroscopy can cause bleeding.

Cost of gastroscopy in Moscow

In recent years, gastroscopy has become an extremely popular procedure. The study is widely used in the diagnosis and treatment of stomach diseases, and is carried out in many private and public clinics in the capital. Diagnostic gastroscopy has the lowest cost. When carrying out therapeutic measures or collecting tissue for histological examination, the price of gastroscopy in Moscow increases. The same thing happens when performing the procedure under anesthesia. When pricing, the qualifications of the specialist, the location and reputation of the medical organization, and the availability of additional services are taken into account.

For sissies

However, many people are simply unable to “swallow” the probe, even if they really need to. Most of them are people with a pronounced gag reflex. Another group is fearful patients, nervous and anxious. Fearing that swallowing the probe will deprive them of their ability to speak, they worry that they will not be able to control the progress of the study or interrupt it if suddenly necessary.

For such people there is an alternative - transnasal endoscopy. The examination is carried out not through the mouth, but through the nose. The device used - of a significantly smaller diameter compared to the traditional one - is inserted through the nostril, then passes along the back wall of the pharynx, but does not touch the root of the tongue. Accordingly, gagging does not occur (however, with a deviated nasal septum, there may be problems with the insertion of the device).

During a transnasal study, the patient is not given a mouthpiece, which is used in the traditional method to prevent the person from biting the device. Therefore, the patient can talk to the doctor and swallow saliva, which is highly not recommended during conventional gastroscopy, as this can provoke vomiting.

Both methods can be carried out free of charge, under compulsory medical insurance. But gentle transnasal endoscopy, in addition to its advantages, also has disadvantages. With her help:

• you cannot take a full biopsy (you can only pinch off very small pieces of tissue);
• it is impossible to see small details. This is due to the small size of the device and optics built into the gadget. Therefore, transnasal endoscopy is better suited not for detailed study, but for screening.

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Advantages and disadvantages

The advantages of nasal gastroscopy include:

• patient comfort, no urge to vomit, the patient breathes freely and can communicate with the doctor, report changes in condition in a particular area;
• the opportunity to additionally examine the organs of the nasopharynx and larynx;
• a runny nose will not be an obstacle to getting tested;
• Only local anesthesia based on lidocaine is used.

Although reviews on this matter can be found, some people prefer the classic method to the transnasal one. For many of them, the discomfort when introducing a foreign body into the nasopharynx was higher than with conventional gastroscopy. Therefore, it would be fair to highlight the disadvantages of the intranasal method:

1. Some painful sensations when inserting the endoscope and slight bleeding from the nose are still present.
2. Limited capabilities of the endoscope. Due to its small thickness, it is impossible to introduce additional equipment for examination.

Among the general contraindications, it can be noted that transnasal gastroscopy is not performed in cases of general weakness, severe bleeding and psychological non-acceptance of the method as a whole.

Important point: The anatomical features of the structure of the nasopharynx can become an obstacle to conducting an examination using the transnasal method. For example, if it is narrowed on both sides, the procedure can become difficult, if not completely impossible.

It was a dream?

The second option to avoid unpleasant sensations during endoscopy is to conduct it under the so-called medicinal sleep. Doctors call this intravenous anesthesia while maintaining spontaneous spontaneous breathing. This is not anesthesia, but sedation: a medicine is injected into a person’s vein, he calms down, falls asleep, feels nothing and, when he wakes up, does not remember what happened. This anesthesia is not enough to carry out serious abdominal surgery, but it is quite enough for many endoscopic interventions.

Some people come to their senses after a medicated sleep after 5 minutes; for the second, consciousness returns after half an hour; for the third, after an hour. But there is no reason to worry: the method does not cause complications. True, it can affect concentration and reaction. Therefore, doctors strongly recommend not to drive during the first 24 hours after the procedure.

Under such “sleep” you can perform not only a gastroscopic examination, but also a colonoscopy. True, such a service is already paid. However, many people prefer to endure the study “for profit” not out of savings, but because of the fear that during sleep the endoscope may damage the intestines, and the person himself will not feel it. In fact, such a risk is quite small (one hundredth of a percent), but it can still arise if the procedure is performed by an inexperienced doctor or if the patient has certain problems. For example, there is pronounced atrophy of the mucosa (this happens in very elderly people) or adhesions in the abdominal cavity, as well as large multiple diverticula in the colon (typical of Crohn's disease or severe ulcerative colitis). But an experienced endoscopist does not have such “punctures”.

Question answer

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Features of the procedure

FGDS using the new method has a number of features:

1. During the examination, the patient lies on his side. This rule does not change. The gastroscope will be inserted into one nostril. The second one remains free. This allows you to maintain normal breathing during the procedure. However, doctors recommend breathing through your mouth.
2. If necessary, the doctor will treat the nasal mucosa with a local anesthetic. Lidocaine spray is usually used. Many patients note that the use of an anesthetic during gastroscopy through the nose is not necessary. This is a virtually painless procedure.
3. To make insertion of the tube easier, the doctor injects a small amount of gel into the nostril. This minimizes the patient's discomfort.
4. The preparatory stage is practically no different. The procedure is performed on an empty stomach. Before the gastroscope is inserted, the patient takes Espumisan. This allows you to reduce the amount of foam. before intranasal gastroscopy, take Espumisan for a runny nose - not a contraindication to the procedure
5. A runny nose is not a contraindication. It is enough to clear the nasal passages of accumulated mucus immediately before the procedure.
6. During transnasal gastroscopy, the patient can freely communicate with the specialist.
7. The procedure is painless. The patient may experience discomfort when the doctor turns the tubes.

All these features indicate the convenience of the new FGS technique for the patient. Gastroenterologists also note the benefits of the procedure. Research time is reduced. You can get the full picture in just 15 minutes.

Spy inside

Finally, there is a third option to avoid any discomfort during endoscopy. This opportunity is provided by a new generation device - a video capsule.

Preparation for the study is the same as for traditional endoscopy: you need to cleanse the intestines in a special way. Then - swallow a capsule slightly larger than a tablet, wash it down with water, put on a special belt or sensors, after which you can go about your business. And at this time, the capsule makes its journey through the gastrointestinal tract, simultaneously collecting a detailed video report about everything that comes across its path, and then, through a system of antennas, transmits information to a recording device, and from it to the doctor’s computer. The capsule itself comes out naturally after a few hours or days. It cannot be reused: the capsule is disposable.

Despite the obvious advantages, this technology also has disadvantages: a high price and the doctor’s inability to stop and take a closer look at something and take a biopsy. So, if the video capsule detects a problem in the intestines, you will still have to perform a classic colonoscopy (at least to take fragments for a biopsy or remove polyps). But there is no longer any need to endure this unpleasant procedure unless there is an urgent need. Now scientists are working to make the capsule controllable. Then it will be able to completely replace traditional research options.

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Indications

Diagnosis of the stomach through the nose is prescribed for the same pathologies as with standard fibrogastroscopy. These include:

• suspicion of the presence of a malignant or benign tumor in the gastrointestinal tract;
• vomiting for no apparent reason;
• unusual bitter taste in the mouth;
• acute stomach pain that does not go away with standard drug treatment;
• gastritis, stomach or duodenal ulcer;
• presence of polyps.

Transnasal gastroscopy can also be prescribed if the patient has a hypersensitive tongue root, that is, increased sensitivity to the gag reflex.

An examination of the stomach can identify any pathologies even in the initial stages. Manipulation through the nasal passages helps to examine the condition of the gastric mucosa, detect any neoplasm and, if necessary, perform a biopsy.

By the way

The German physician Adolf Kusmaul was the first to introduce gastroscopy into medical practice in 1868. The device that Kusmaul used was a metal tube with a flexible conductor.

Since the time of Kusmaul, gastroscopes have been constantly improved. In the middle of the 20th century. A new type of gastroscope has appeared - a fibrogastroscope, which helps study images through bundles of glass fibers, their thickness is the size of a human hair.

There are contraindications. Be sure to consult your doctor

What is the best way to insert the probe?

Transnasal endoscopy is increasingly used as an alternative to the traditional FGDS technique. Their main advantages and disadvantages are summarized in the following table:

Preparation for gastroscopy

• gastroscopy is performed strictly on an empty stomach, preferably in the morning - you should not drink, eat or smoke in the morning
• if gastroscopy is necessary urgently, the interval after eating should be at least 6 hours
• in emergency conditions, for example bleeding, gastroscopy is performed after gastric lavage
• The endoscopist must be informed about the presence of chronic diseases (for example, diabetes mellitus or diseases of the cardiovascular system) and the presence of allergies to medications, especially anesthetics

How is gastroscopy performed?

The procedure is performed by an endoscopist. At the Alfa Health Center clinic in Moscow, gastroscopy under anesthesia is additionally supervised by an anesthesiologist, who prepares the patient for sedation and helps to safely emerge from drug-induced sleep.

A thin fiber optic tube with a camera and light is inserted into the patient's esophagus. The device is sterilized after each procedure. As it moves through the esophagus and stomach, the camera transmits the image to the monitor. Based on the picture he sees, the doctor can make a diagnosis. Sometimes, to clarify the information, a colonoscopy is prescribed, which is also performed under anesthesia, or fibrogastroscopy (FGS), during which the doctor can take a biopsy or perform other therapeutic and diagnostic procedures.

The examination takes on average 15-20 minutes. Gastroscopy during sleep is performed faster, since the patient is in a relaxed state.

After the examination, discomfort in the throat is possible, which quickly passes. If gastroscopy is performed under anesthesia, doctors recommend refraining from driving for several hours after the examination.