The technique of endoscopy of the stomach

When examining the stomach with a fibroendoscope with end optics, after the stomach is air-blown in after vision, a large curvature usually occurs, which is determined by the characteristic type of folds. In this case, the fibroendoscope should move in the direction corresponding to the direction of the longitudinal folds of the stomach. With this orientation, the small curvature will be determined at 12 o'clock, the large curvature at 6 o'clock, the front and back walls at 9 and 3 o'clock, respectively. Sequentially inspecting the stomach and moving the apparatus forward, achieve great curvature, after which, by increasing the angle of bending the distal end up, examine the small curvature and the angle of the stomach first at a distance and then close. Advancing the endoscope on a large curvature, lead it to the antrum unit, and then - to the gatekeeper. Inspection of the cardia and arch is possible only with a sharp bend of the distal end of the endoscope, which is performed after examination of the body of the stomach and the antrum. It is also possible to examine the small curvature well. The peloric section of the stomach is a smooth-walled cylinder, at the end of which it is easy to detect the pyloric canal.

A cardiac examination of the stomach with a fibroendoscope with end optics is not always informative. In such cases, an endoscope with side optics is used. The gastric examination is performed in a certain sequence after a clear orientation of the position of the distal end of the endoscope. Usually, the corner is used as a guide, and also the body of the stomach, along which the stomach axis is determined and the device is placed in a position in which the arc of small curvature occupies a horizontal and symmetrical position in the field of vision. This avoids excessive bending of the bent endoscope bend to a greater curvature and the appearance of pain.

First, examine the device, rotating the device around the axis, the small curvature, the subcardial zone and the adjacent anterior and posterior walls of the body of the stomach, as well as greater curvature. Bending the distal end up and back, inspect the bottom and the cardiac compartment. The color of the folds of the mucous membrane of small curvature is pale pink; towards the back wall it becomes dark pink. The angle of the stomach is represented by a transversely wide overhanging fold of bright pink color. The mucous membrane of the cardiac zone is gently pink, with low longitudinal folds with poorly developed folding, small blood vessels appear through the mucous membrane. The mucous membrane of the proximal part and the bottom of the stomach is pinkish-yellow, bumpy, the size of the folds in the bottom area considerably increases.

The next stage of gastroscopy is the examination of the body of the stomach. The endoscope is oriented for 12 hours and bent to a large curvature (the large curvature of the stomach is easily determined by the mucous "lake" and the folds running parallel to the output section), resulting in the entire body of the stomach in the field of view. After a panoramic view, the mucosa is inspected from a close distance. Particularly carefully examine the angle of the stomach and both its surfaces. When the endoscope moves forward due to the semicircular fold formed by the angle, the antral part of the stomach and the pyloric canal appear, which has a rounded shape. Orientation is the hole of the gatekeeper. Advancing the endoscope forward and bending in different directions, inspect the antral department and the pylorus around. In the region of great curvature, the folds are predominantly longitudinal, while in other places they are longitudinal and transverse.

The cavity of the stomach first has a slit-shaped form with pronounced longitudinal folds of the mucous membrane. On the large curvature the folds are sharply expressed and have the appearance of long, parallel and closely adjacent rollers. The mucous membrane of the antrum is smooth, shiny, the folds are soft, barely expressed and have an irregular shape. Even with moderate insufflation of air, the antral section acquires a conical shape, the folds are completely straightened. The gatekeeper is constantly changing his appearance, sometimes this is a pinhole, and then the area of the gatekeeper resembles a rosette. This form is attached to it by short, thickened folds that converge to the opening. When the peristaltic wave passes, the pylorus spreads, the surface of the mucous membrane is smoothed, and the entire pyloric canal, which is a cylinder up to 5 mm in length, can be inspected. The mucous membrane in the canal zone is smooth, shiny, sometimes collected in wide longitudinal folds. Here, you can find roll-like circular folds, which, when the pyloric aperture is opened, form a roll-like thickening around it. Through the gaping pyloric canal, which is more often observed in the atonic state of the stomach, you can see the bulb of the duodenum. When the gatekeeper closes under the influence of a peristaltic wave, the radially divergent convoluted folds frame its point hole, resembling a star.

The degree of folding decreases as air is injected. As the air is introduced, the folds of the front wall and the small curvature almost completely spread out. The folds of the greater curvature and the posterior wall of the stomach are more stable, although they also significantly flatten when inflated by air. In order to better assess the functional and organic changes, the stomach should be examined at various stages of expansion by air.