What does barium swallow show. Barium Swallow: A Comprehensive Guide to Upper GI Tract Imaging

01.09.202329.06.2023 by alexxlab

What is a barium swallow. How does it work. What can it diagnose. How to prepare for the procedure. What are the potential risks. Who should avoid this test. What to expect during and after the exam.

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Understanding Barium Swallow: An Essential Diagnostic Tool

A barium swallow is a crucial imaging test that utilizes X-rays to examine the upper gastrointestinal (GI) tract. This procedure focuses on visualizing the pharynx (back of the mouth and throat) and the esophagus. By employing a special type of X-ray called fluoroscopy, healthcare providers can observe these organs in motion, offering invaluable insights into their structure and function.

The Role of Barium in Imaging

Barium, a contrast agent, plays a pivotal role in this examination. When ingested, it coats the inner lining of the upper GI tract, making it more visible on X-ray images. This enhanced visibility allows radiologists to detect abnormalities that might not be apparent on standard X-rays.

Barium Swallow vs. Upper GI Series

While a barium swallow specifically targets the pharynx and esophagus, it may also be part of a more comprehensive upper GI series. This extended examination includes the stomach and the initial section of the small intestine (duodenum), providing a more complete picture of the upper digestive system.

Indications for a Barium Swallow Examination

Healthcare providers may recommend a barium swallow for various reasons, primarily to investigate symptoms or conditions affecting the upper GI tract. Common indications include:

Persistent nausea and vomiting
Unexplained abdominal pain
Difficulty swallowing (dysphagia)
Unexplained weight loss
Suspected structural abnormalities in the pharynx or esophagus

Conditions Diagnosed Through Barium Swallow

This imaging technique is particularly effective in identifying and diagnosing several conditions:

Cancer of the head, neck, pharynx, or esophagus
Hiatal hernia
Structural problems such as diverticula, strictures, or polyps
Muscle disorders affecting swallowing
Achalasia
Gastroesophageal reflux disease (GERD)
Esophageal ulcers

Preparing for Your Barium Swallow Examination

Proper preparation is essential for a successful barium swallow examination. Here are the key steps to follow:

Fast for approximately 8 hours before the test, typically after midnight
Avoid chewing gum during the fasting period
Inform your healthcare provider about any allergies, especially to contrast agents or medications
Disclose any recent barium swallow or upper GI tests
Notify your provider if you are or might be pregnant

Is there anything else you should do to prepare? It’s advisable to wear comfortable, loose-fitting clothing and remove any jewelry or metal objects that might interfere with the X-ray images.

The Barium Swallow Procedure: What to Expect

Understanding the procedure can help alleviate anxiety and ensure a smooth examination. Here’s what typically happens during a barium swallow:

You’ll be asked to remove any clothing or jewelry that might interfere with the imaging.
You’ll be positioned on an X-ray table, usually standing or sitting.
The radiologist will give you a barium solution to drink.
As you swallow, the radiologist will take a series of X-rays to capture the barium’s movement through your upper GI tract.
You may be asked to change positions or hold your breath at times to get clear images.

How long does the procedure usually take? A typical barium swallow examination lasts about 30 minutes to an hour.

Potential Risks and Considerations of Barium Swallow

While barium swallow is generally considered safe, it’s important to be aware of potential risks:

Radiation exposure, although minimal
Allergic reactions to barium (rare)
Constipation or impacted stool if barium isn’t fully eliminated
Aspiration of barium into the lungs (in cases of severe swallowing difficulties)

Who Should Avoid Barium Swallow?

Certain conditions may contraindicate a barium swallow examination:

Pregnancy
Perforation of the esophagus or intestines
Intestinal blockage or severe constipation
Severe swallowing problems that increase aspiration risk

Can patients with allergies undergo this test? If you have allergies to medicines, contrast dyes, or latex, inform your healthcare provider beforehand to determine if alternative procedures are necessary.

After the Barium Swallow: Post-Procedure Care

Once the examination is complete, there are a few important steps to follow:

Increase your fluid intake to help flush the barium from your system
Be prepared for white-colored stools for a day or two
Watch for signs of constipation and inform your provider if it occurs
Resume your normal diet unless instructed otherwise

When can you expect the results? Typically, a radiologist will interpret the images and send a report to your healthcare provider within a few days. Your provider will then discuss the findings with you and recommend any necessary follow-up steps.

Advancements in Upper GI Tract Imaging

While barium swallow remains a valuable diagnostic tool, the field of medical imaging continues to evolve. Recent advancements include:

Digital fluoroscopy, which provides higher quality images with lower radiation exposure
3D imaging techniques that offer more detailed views of the upper GI tract
Combination studies that incorporate other imaging modalities for comprehensive evaluation

How do these advancements impact patient care? These technological improvements allow for more accurate diagnoses, potentially reducing the need for additional tests and enabling earlier detection of various conditions.

Alternatives to Barium Swallow Examination

In some cases, alternative diagnostic procedures may be recommended:

Endoscopy: Allows direct visualization of the upper GI tract
CT scan: Provides detailed cross-sectional images of the body
MRI: Offers high-resolution imaging without radiation exposure
Esophageal manometry: Measures muscle contractions in the esophagus

Which test is most appropriate for you? The choice depends on your specific symptoms, medical history, and the suspected condition. Your healthcare provider will recommend the most suitable option based on these factors.

Comparing Barium Swallow to Other Diagnostic Tools

Each diagnostic method has its strengths and limitations. Barium swallow excels in visualizing the structure and function of the upper GI tract in real-time, making it particularly useful for assessing swallowing disorders and structural abnormalities. However, it may not provide the detailed tissue information that an endoscopy can offer or the comprehensive view of surrounding structures that a CT scan might provide.

The Role of Barium Swallow in Cancer Detection

Barium swallow plays a crucial role in the early detection and staging of upper GI tract cancers. It can reveal:

Abnormal growths or masses in the pharynx or esophagus
Changes in the mucosal lining that may indicate early-stage cancer
Narrowing or obstruction of the esophagus due to tumors

How effective is barium swallow in detecting cancer? While it’s a valuable screening tool, it’s often used in conjunction with other diagnostic methods like endoscopy and biopsy for definitive cancer diagnosis.

Follow-up Procedures After Abnormal Findings

If the barium swallow reveals abnormalities, your healthcare provider may recommend additional tests such as:

Endoscopy with biopsy
CT or PET scans for more detailed imaging
Esophageal pH monitoring for suspected GERD
Manometry to assess esophageal muscle function

Barium Swallow in Pediatric Patients

Barium swallow examinations are also performed on children, though with some modifications:

The procedure is often tailored to the child’s age and size
Special techniques may be used to keep the child still during the examination
Parents or guardians are usually allowed to stay with the child for comfort

Are there any special considerations for pediatric barium swallow tests? The barium solution may be flavored to make it more palatable for children, and the radiation dose is carefully controlled to minimize exposure.

Common Pediatric Indications for Barium Swallow

In children, barium swallow may be used to diagnose:

Congenital abnormalities of the upper GI tract
Swallowing difficulties (dysphagia)
Unexplained vomiting or reflux
Aspiration during feeding
Tracheoesophageal fistula

The Future of Upper GI Tract Imaging

As medical technology continues to advance, the future of upper GI tract imaging looks promising. Emerging technologies and techniques include:

Artificial intelligence-assisted image analysis for more accurate and faster diagnoses
Advanced 4D imaging techniques for even more detailed functional studies
Development of safer, more effective contrast agents
Integration of molecular imaging for early detection of cancerous changes

How might these advancements change patient care? These developments could lead to earlier detection of diseases, more personalized treatment plans, and potentially less invasive diagnostic procedures.

The Role of Patient Feedback in Improving Imaging Procedures

Patient experience and feedback play a crucial role in refining imaging procedures. Healthcare providers and researchers are continually working to:

Improve the taste and texture of barium solutions
Develop more comfortable positioning techniques during the examination
Reduce examination times while maintaining diagnostic accuracy
Enhance patient education and preparation materials

By incorporating patient feedback, the goal is to make barium swallow examinations and other imaging procedures more comfortable and less anxiety-inducing for patients.

Barium Swallow

What is a barium swallow?

A barium swallow is an imaging test that uses X-rays to look at your upper gastrointestinal (GI) tract. Your upper GI tract includes the back of your mouth and throat (pharynx) and your esophagus.

You may have just a barium swallow. Or this test may be done as part of an upper GI series. This series looks at your esophagus, stomach, and the first part of the small intestine (duodenum).

X-rays use a small amount of external radiation to create images of your body, its organs, and other internal structures. X-rays are most often used to find bone or joint problems, or to check the heart and lungs. A barium swallow is 1 type of X-ray.

Fluoroscopy is used during a barium swallow. Fluoroscopy is a special kind of X-ray “movie” that shows the organs in motion.

The test also uses barium. Barium is a substance that makes certain areas of the body show up more clearly on an X-ray. The radiologist will be able to see the size and shape of the pharynx and esophagus. They will also be able to see how you swallow. These details can’t be seen on a standard X-ray. Barium is used only for imaging tests for the GI tract.

Why might I need a barium swallow?

A barium swallow can help your provider find the cause for nausea and vomiting, pain in your belly (abdomen), unexplained weight loss, or problems swallowing. It may be done to look for and diagnose problems in the pharynx and esophagus. You may need a barium swallow if your healthcare provider thinks that you have:

Cancer of the head, neck, pharynx, or esophagus

Hiatal hernia. This means that your stomach has moved up into or alongside the esophagus.

Structural problems, such as pouches (diverticula), narrowing (strictures), or growths (polyps)

Muscle disorders, such as trouble swallowing (dysphagia) or spasms

Achalasia. This is a condition in which the lower esophageal sphincter muscle doesn’t relax and allow food to pass into the stomach.

GERD (gastroesophageal reflux disease)

Ulcers

Your healthcare provider may have other reasons to advise a barium swallow. Talk with your healthcare provider about the reason for your test.

What are the risks of a barium swallow?

You may want to ask your healthcare provider about the amount of radiation used during the test. Also ask about the risks as they apply to you.

Consider writing down all X-rays you get, including past scans and X-rays for other health reasons. Show this list to your provider. The risks of radiation exposure may be tied to the number of X-rays you have and the X-ray treatments you have over time.

Tell your provider if:

You are pregnant or think you may be pregnant. Radiation exposure during pregnancy may lead to birth defects. You should not have this test if you are pregnant.

You are allergic to or sensitive to medicines, contrast dyes, local anesthesia, iodine, or latex

You may have constipation or impacted stool after the test if all of the barium does not pass out of your body.

You should not have a barium swallow if you have:

A tear or hole in your esophagus or intestines (perforation)

Blockage in your intestines or severe constipation

Severe problems with swallowing. This makes it more likely that barium would accidentally go into your lungs (aspiration).

You may have other risks depending on your specific health condition. Be sure to talk with your provider about any concerns you have before the procedure.

How do I get ready for a barium swallow?

Your healthcare provider will explain the procedure to you. Ask them any questions you have about the procedure.

You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is not clear.

You will need to stop eating and drinking for about 8 hours before the test. You should also avoid chewing gum. Generally, this means after midnight.

Tell your provider if you are pregnant or think you may be pregnant.

Tell your provider if you are sensitive to or are allergic to any medicines, latex, tape, or anesthetic medicines (local and general).

Tell your provider if you have had a recent barium swallow or upper GI test. This may make it harder to get good X-rays of the lower GI area.

Tell your provider about all medicines you are taking. This includes prescriptions, over-the-counter medicines, and herbal supplements. You may need to stop taking these before the test.

Follow any other instructions your provider gives you to get ready.

What happens during a barium swallow?

You may have a barium swallow as an outpatient or as part of your stay in a hospital. The way the test is done may vary depending on your condition and your healthcare provider’s practices.

Generally, a barium swallow follows this process:

You’ll be asked to remove any clothing, jewelry, or other objects that may get in the way of the test.

You may be asked to remove clothing. If so, you will be given a gown to wear.

You will lie on an X-ray table that can move you from a horizontal to an upright position. You may also be asked to change positions during the test. For example, you may need to lie on your side, back, or stomach.

The radiologist may take X-rays of your chest and belly (abdomen) first.

The radiologist will ask you to take a swallow of a thick, chalky barium drink that resembles a shake. The barium is usually flavored like strawberry or chocolate, but it may not taste very good. The barium coats the lining of your GI tract.

As you swallow the barium, the radiologist will take single pictures, a series of X-rays, or fluoroscopy to watch the barium moving through your mouth and throat.

You may be asked to hold your breath at certain times during the test.

The radiologist will use X-rays or fluoroscopy to watch the barium go down your esophagus and then through the rest of your GI tract. You may also be asked to swallow a barium tablet. This is a small pill that can help to show certain problems in the esophagus. The technician may put pressure on your belly to help move the barium through your GI tract.

Once the radiologist has taken all of the X-rays, you’ll be helped from the table.

What happens after a barium swallow?

You may go back to your normal diet and activities after a barium swallow, unless your healthcare provider tells you otherwise.

Barium may cause constipation or impacted stool after the procedure if it isn’t completely cleared from your body. You may be told to drink plenty of fluids and eat foods high in fiber to help the rest of the barium leave your body. You may also be given a laxative to help with this.

Your bowel movements may be white or lighter in color until all the barium has left your body.

Call your healthcare provider right away if any of these happen:

Your healthcare provider may give you other instructions, depending on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:

The name of the test or procedure

The reason you are having the test or procedure

What results to expect and what they mean

The risks and benefits of the test or procedure

What the possible side effects or complications are

When and where you are to have the test or procedure

Who will do the test or procedure and what that person’s qualifications are

What would happen if you did not have the test or procedure

Any alternative tests or procedures to think about

When and how you will get the results

Who to call after the test or procedure if you have questions or problems

How much you will have to pay for the test or procedure

Online Medical Reviewer:
Neil Grossman MD

Online Medical Reviewer:
Raymond Turley Jr PA-C

Online Medical Reviewer:
Stacey Wojcik MBA BSN RN

Date Last Reviewed:
4/1/2021

Patient Education Library | Star Medical Associates

Introduction

An Upper Gastrointestinal (GI) Series or Barium Swallow provides a set of X-rays showing the esophagus, stomach, and small intestine. Before the X-rays are taken, barium, a chalky substance, is swallowed. The barium provides an image of the upper gastrointestinal structures on the X-ray images. A barium swallow is commonly used to determine the cause of pain, swallowing problems, blood stained vomit, and unexplained weight loss. A barium swallow is an outpatient procedure that does not require sedation or anesthesia.

Anatomy

When you eat, your tongue moves chewed food to the back of your throat. When you swallow, the food moves into the opening of the esophagus. Your esophagus is a tube that moves food from your throat to your stomach. Muscles in your esophagus wall slowly squeeze the food toward your stomach.

A ring of muscles located at the bottom of the esophagus is called the lower esophageal sphincter (LES). The LES opens to allow food to enter the stomach. The LES closes tightly after the food enters. This prevents stomach contents and acids from backing up into the esophagus.

Your stomach produces acids to break down food for digestion. Your stomach processes the food you eat into a liquid form. The processed liquid travels from your stomach to your small intestine.

The small intestine is a tube that is about 20-22 feet long and 1 ½ to 2 inches around. The duodenum is the first part of the small intestine. It is a short C-shaped structure that extends off of the stomach. The jejunum and the ileum are the middle and final sections of the small intestine.

Your small intestine breaks down the liquid even further so that your body can absorb the nutrients from the food you ate. The remaining waste products from the small intestine travel to the large intestine.

Your large intestine, also called the large bowel, is a tube that is about 5 feet long and 3 or 4 inches around. The first part of the large intestine, the colon, absorbs water and nutrients from the waste products that come from the small intestine. As water is absorbed, the product becomes more solid and forms a stool. The stool moves through the large intestine and passes out of your body when you have a bowel movement.

Causes

TEST USES

A barium swallow is used to view the structures of the upper gastrointestinal system. The test is helpful for determining the cause of swallowing difficulties, pain, vomiting, and bleeding. It can detect and diagnose conditions including polyps, tumors, cancer, ulcers, abnormalities of the esophagus, and hiatal hernia.

PREPARATION

A barium swallow is an outpatient procedure that can be performed at your doctor’s office, an outpatient radiology center, or a hospital’s radiology department. The test does not require sedation or anesthesia. You doctor will provide you with specific instructions to prepare for the test.

Generally, the instructions include eating a restricted diet for a few days before your test and not eating or smoking for a period of time before the test. You will need to remove all jewelry, dentures, metal hair clips, body piercing jewelry, and other items that might show up on an X-ray before your procedure.

THE PROCEDURE

You will wear an examination gown for your barium swallow procedure. X-rays of your heart, lungs, and abdomen are taken before you swallow the barium. You will drink 16 to 20 ounces of a barium solution. Barium is a chalky substance that is about as thick as a milkshake. It may take an hour or more for the barium to fill your stomach.

You will lie on your back and be secured to a table. The table will tilt to reposition your body for the X-rays. You may be asked to drink more barium as the process takes place. The test may take several hours to complete. An X-ray is a painless procedure and simply requires that you remain motionless while a picture is taken.

After your test, you should drink lots of fluids and eat foods that are high in fiber, such as raw vegetables and fruits, to prevent constipation. Your stools may be light in color for a few days because the barium is a white substance. Your doctor will discuss unexpected symptoms related to the test that may occur and a plan to address them.

A radiologist will read your X-rays and report the results to your doctor. This process may take a few days. Your doctor will contact you or schedule a follow-up appointment when the results are received. If any abnormal results were found on your test, your doctor will discuss treatment plan options with you.

This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

Protocols for description of radiographs of abdominal organs – Rentgen.

info

0012

Antral gastritis, pyloric stricture
Billroth-2
Gastritis, bulbitis, reflux
Gastritis, def. bulbs, reflux, HH
Gastroptosis, diverticulum
POD hernia, fixed
POD hernia, axial
POD hernia, bulb deformity
Hernia, gastritis
Hernia, cascading stomach
Cardiospasm 9001 4
Pancreatic cyst
Normal
Normal (passage)
Operated stomach
Repulsion of the duodenum
Penetration of the pylorus
Barrett’s esophagus, hernia, stricture
Cancer of the stomach
Cancer of the cardia, fornix
Cicatricial deformity of the esophagus, stomach
ERCP
Urographin
Chronic gastritis, duodenitis
Esophagocardiomyectomy
Duodenal ulcer
Pyloric ulcer

Antral gastritis, pyloric stricture

Swallowing is not disturbed. The esophagus and cardia of the stomach are freely passable. The vault and gas bubble are not changed. The stomach is of normal size and shape, hypotonic, displaced, on an empty stomach contains a large amount of mucus. The contours of the walls of the stomach are clear and even. The mucosal folds are expanded, deformed, smoothed in the output section. Peristalsis is sluggish. The evacuation of the barium suspension from the stomach is slow, the filling of the duodenal bulb occurs 40 minutes after the intake of the barium suspension. The pylorus canal is narrowed, located in the middle, no contour streaks of contrast were reliably detected.
The shape of the duodenal bulb is correct, its dimensions are not changed. Bulb contours are clear. The passage of barium through the loop is not disturbed. The relief of the duodenal mucosa is pinnate. In the Trendelenburg position and tension of the abdominal muscles, there is no pathological displacement of the esophagus and stomach.
Conclusion: Signs of severe antral gastritis. Data for the presence of a hernia of the esophageal opening of the diaphragm is not received. Decreased evacuation function of the stomach, subcompensated pyloric canal stricture (inflammatory? cicatricial?). FGDS is shown.

Billroth-2

The act of swallowing is not impaired. The esophagus is freely passable with even elastic walls, the cardia is passable. The stomach stump corresponds to the volume of resection of at least 2/3 of the body, with the formation of a gastro-intestinal anastomosis by the end-to-side method (according to Billroth-2). The stump of the stomach has a characteristic shape and position. The contours of the stomach stump are clear and even. Mucosal folds can be traced continuously. The area of the anastomosis without deformation. Evacuation of barium from the stomach with a slight delay into the efferent colon. The adductor colon is contrasted for 1.5 cm. The adductor colon is usually located. The contrast passes freely through the small intestine.
In the projection of the stuffing box drainage tube.
Conclusion: Condition after surgery-resection of the stomach, formation of a gastro-intestinal anastomosis using the end-to-side method. The evacuation function of the stomach is not disturbed.

Gastritis, bulbitis, reflux

Swallowing is not disturbed. The esophagus and cardia of the stomach are freely passable. The vault and gas bubble are not changed. The stomach is of normal size and shape, hypotonic, displaced, on an empty stomach contains a large amount of mucus. The contours of the walls of the stomach are clear and even. The folds of the mucosa are dilated, traced all the way to the exit section continuously. Peristalsis is sluggish, medium wave. Evacuation of barium suspension from the stomach is free and timely. Retrograde anti-peristaltic waves and reflux of the contrast mass into the lumen of the stomach from the duodenum were recorded.
The shape of the duodenal bulb is irregular, its contours are clear, the contractions are symmetrical. The passage of barium through the loop is not disturbed. The relief of the duodenal mucosa is pinnate, the folds are thickened. In the Trendelenburg position and tension of the abdominal muscles, there is no pathological displacement of the esophagus and stomach.
Conclusion: Signs of chronic gastritis, bulbitis. Data for the presence of a hernia of the esophageal opening of the diaphragm is not received. The evacuation function of the stomach is not disturbed. Duodeno-gastric reflux.

Gastritis, def. bulbs, reflux, HH

The act of swallowing is not disturbed. The esophagus and cardia of the stomach are freely passable. The vault and gas bubble are not changed. The stomach in the upper third is moderately bent backwards with the formation of a cascade, which straightened out during the study. The stomach is of normal size and shape, normotonic, displaced, on an empty stomach contains some mucus. The contours of the walls of the stomach are clear and even. The folds of the mucosa are smoothed out, traced all the way to the exit section continuously. Peristalsis is sluggish. Evacuation of barium suspension from the stomach is free and timely.
The shape of the duodenal bulb is incorrect, with deformation of the distal parts of the bulb and narrowing of the bulbous segment of the duodenum, the size of the bulb is reduced. The contours of the bulb are clear, the bulb is tightly filled. Horseshoe duodenum 12 is not changed. The relief of the mucous membrane of the horseshoe of the duodenum 12 is not changed, the passage through the small intestine is not disturbed.
Conclusion: Signs of cicatricial deformity of the duodenal bulb.

Gastroptosis, diverticulum

The act of swallowing is not violated. Passability of a gullet is saved. Cardiac sphincter in a vertical position closes quite tightly. The stomach on an empty stomach is empty, hook-shaped, its lesser curvature is located at the level of the scallop line. The relief of the mucosa is represented by longitudinal, not expanded folds, traced all the way to the exit section continuously. Intestinal pneumatosis is noted, the displacement of the stomach by overinflated colonic loops. Examination in the Trendelenburg position revealed no pathological displacement of the abdominal esophagus and stomach.
Peristalsis of the stomach of medium wave, evacuation of barium suspension is free. The bulb of the duodenum is of normal size and shape, its contours are clear and even. The passage of contrast along the loop of the duodenum 12 is not disturbed. In the descending section, a diverticulum of small size is determined, freely emptying, in its neck there are unchanged mucosal folds. The loop is of normal size, the duodenal “window” is not expanded.
Conclusion: gastroptosis. Duodenal diverticulum without signs of diverticulitis.

Fixed hernia

Swallowing is not disturbed. The esophagus and cardia of the stomach are freely passable. The abdominal part of the esophagus is located above the diaphragm, the cardial part of the stomach is located below the diaphragm. The Hiss angle is straightened. The stomach is of normal size and shape, hypotonic, displaced, contains liquid on an empty stomach. The contours of the walls of the stomach are clear and even. The folds of the mucosa are smoothed out, traced all the way to the exit section continuously. Peristalsis is sluggish. Evacuation of barium suspension from the stomach is free and timely.
The shape and dimensions of the duodenal bulb are normal. The contours of the bulb are clear, even. The passage of barium through the loop is not disturbed. The relief of the duodenal mucosa is pinnate.
When transferred to the Trendelenburg position, the supradiaphragmatic location of the abdominal esophagus is preserved, there is no pathological displacement of the stomach into the chest cavity.
Conclusion: R-signs of fixed hiatal hernia of the 1st stage, chronic gastritis. The evacuation function of the stomach is preserved.

Axial POD hernia

The act of swallowing is not impaired. Passability of a gullet is saved. The stomach on an empty stomach contains mucus, opens according to the normotonic type, not a sharp bend of the upper third of the stomach posteriorly. The relief of the mucosa is represented by longitudinal expanded folds. When examining in the Trendelenburg position, gastroesophageal reflux is noted with prolapse through the esophageal opening of the diaphragm of the abdominal segment of the esophagus expanded to 2 cm with the formation of a small hernia (3 * 4 cm). Thickened gastric-type folds in the supraphrenic region in the amount of three. Moderate peristalsis of the stomach, timely evacuation, duodenogastric reflux. The bulb of the duodenum is without deformation, the horseshoe is not changed. The passage of contrast through the small intestine is free.
Conclusion: Axial hiatal hernia of the 1st degree.
Reflux esophagitis. Chronic gastritis. Duodenogastric reflux.

POD hernia, bulb deformity

The act of swallowing is not disturbed, the esophagus is free to pass, the cardiac sphincter does not close completely on inspiration. The gas bubble is not changed. The angle of His is straightened, the cardial section is located under the dome of the diaphragm. The stomach is of normal size and shape, hypotonic, displaced, empty on an empty stomach. The contours of the walls of the stomach are clear, even. The folds of the mucosa are somewhat dilated, traced throughout, to the outlet section continuously. Peristalsis is deep, in symmetrical waves, the evacuation of barium suspension is free, timely. The bulb of the duodenum is not permanently deformed, straightens out during the study. The passage of contrast along the loop is not disturbed. Palpation of the pyloroduodenal zone is painless
When transferred to the Trendelenburg position, there is no pathological displacement of the stomach by tension of the abdominal muscles.
Conclusion: Fixed hiatal hernia of the first degree. Slightly pronounced cicatricial deformity of the duodenal bulb, the evacuation function of the stomach is preserved.

Hernia, gastritis

Swallowing is not disturbed. Passability of a gullet is saved. Cardiac sphincter in a vertical position closes quite tightly. The stomach is empty on an empty stomach. The relief of the mucosa is represented by longitudinal, moderately widened folds, traced all the way to the exit section continuously. When examining in the Trendelenburg position: through the esophageal opening of the diaphragm expanded to 1.5 cm, the abdominal segment of the esophagus prolapses into the chest cavity with the formation of a small axial hernia.
Peristalsis of the stomach of medium wave, evacuation of barium suspension is free. The bulb of the duodenum is of normal size and shape, its contours are clear and even. The passage of contrast along the loop of the duodenum 12 is not disturbed. The loop is of normal size, the duodenal “window” is not expanded. In the projection of the gallbladder, the shadow of metal staples is the state after cholecystectomy
Conclusion: Signs of gastritis. Axial hernia of the esophageal opening of the diaphragm 1st degree.

Hernia, cascading stomach

The act of swallowing is not impaired. Passability of a gullet is saved. When the contrast mass passed through the esophagus, small peristaltic waves were recorded. Cardiac sphincter in a vertical position closes quite tightly. The stomach on an empty stomach is empty, has a cascade shape. The relief of the mucosa is represented by longitudinal, moderately widened folds, traced all the way to the exit section continuously. When examining in the Trendelenburg position: through an enlarged, up to 1.5 cm, esophageal opening of the diaphragm, the abdominal segment of the esophagus and the mucosa of the cardia prolapse into the chest cavity with the formation of a small axial hernia.
Peristalsis of the stomach of medium wave, evacuation of barium suspension is free. The bulb of the duodenum is of normal size and shape, its contours are clear and even. The passage of contrast along the loop of the duodenum 12 is not disturbed.
Conclusion: 1st degree hiatal hernia. Cascading stomach. Organic changes in the esophagus were not detected. Signs of dyskinesia by hypermotor type.

Cardiospasm

Swallowing is not disturbed. With the passage of a liquid barium suspension through the esophagus, a persistent stable spasm of the cardia is determined. The evacuation of barium suspension from the esophagus is slow. The thoracic esophagus was expanded to 4.5 cm, the terminal esophagus had smooth contours and was conically narrowed. Peristalsis of the esophagus in the form of pronounced uncoordinated segmental contractions. A small portion of the contrast immediately passed into the stomach, the delay of the contrast in the esophagus was more than 20 minutes.
Conclusion: X-ray picture of cardiospasm 2-3 degrees.

Pancreatic cyst

Swallowing is not impaired. The esophagus and cardia are freely passable. The stomach is of normal size, the body of the stomach is pushed forward and upward by a volumetric formation of a rounded shape, located posterior to the stomach, ~ 11 cm in diameter. The contours of the walls of the stomach are clear and even. The folds of the gastric mucosa of medium caliber are traced all the way to the outlet section continuously. Peristalsis is sluggish. Evacuation of barium suspension from the stomach is free and timely.
The duodenal bulb is usually located, along the greater curvature it has a persistent area of retraction. The passage of barium along the loop is slow, duodenostasis is noted in the lower horizontal branch of the duodenum 12, duodenogastric reflux.
Conclusion: R-signs of volumetric formation of the abdominal cavity pushing the stomach forward.

Norm

The act of swallowing is not impaired. The esophagus and cardia of the stomach are freely passable. The vault and gas bubble are not changed. The stomach is of normal size and shape, hypotonic, displaced, contains mucus on an empty stomach. The contours of the walls of the stomach are clear and even. The folds of the mucosa are somewhat dilated and can be traced all the way to the exit section continuously. Peristalsis is sluggish. Evacuation of barium suspension from the stomach is free and timely.
The shape and size of the duodenal bulb are not changed. The contours of the bulb are clear, even. The passage of barium through the loop is not disturbed. The relief of the duodenal mucosa is pinnate.
Conclusion: R-data for the presence of organic changes in the esophagus, stomach, duodenum 12. The evacuation function of the stomach is not disturbed.

Norm (passage)

The act of swallowing is not disturbed. The esophagus and cardia of the stomach are freely passable. The vault and gas bubble are not changed. The stomach is of normal size and shape, hypotonic, displaced, on an empty stomach contains a small amount of mucus. The contours of the walls of the stomach are clear and even. The folds of the mucosa are somewhat dilated and can be traced all the way to the exit section continuously. Peristalsis is sluggish. Evacuation of barium suspension from the stomach is free and timely. The shape and size of the duodenal bulb were not changed. The contours of the bulb are clear, even. The passage of barium through the loop is not disturbed. The relief of the duodenal mucosa is pinnate.
1 hour after taking the contrast, part of it in the lumen of the stomach, a uniform distribution of the barium suspension in the small intestine is determined. Contrast depot, pathological accumulations, levels were not revealed. The pattern of mucosal folds is not changed, it has a feathery appearance.
After 2 hours – promotion of contrast through the loops of the small intestine – the ileum is filled. After 3 hours, the contrast is completely evacuated into the large intestine.
Conclusion: R-data for the presence of organic changes in the esophagus, stomach, duodenum 12. The evacuation function of the stomach is not disturbed. There were no disturbances in the passage of barium through the small intestine.

Operated stomach

Swallowing is not disturbed. The esophagus and cardia are freely passable. The stomach is not large, the condition after surgery, resection of at least 2/3 of the body of the stomach, the formation of a gastro-intestinal anastomosis by the end-to-side method (Billroth-2). The contours of the stomach stump are clear, even, of a characteristic shape and position. The mucosal folds are thickened. Evacuation with the first sips of barium into the efferent colon. The afferent colon does not fill tightly. The efferent colon is usually located, the contrast freely passes through the small intestine.
Conclusion: Operated stomach. The evacuation function of the stomach is not disturbed.

Rejection of the duodenum

The act of swallowing is not disturbed. The esophagus and cardia of the stomach are freely passable. The vault and gas bubble are not changed. The stomach is of normal size, cascading, hypotonic, displaced, empty on an empty stomach. The contours of the walls of the stomach are clear and even. Mucosal folds of medium caliber are traced all the way to the exit section continuously. Peristalsis is sluggish. Evacuation of barium suspension from the stomach is free and timely.
The shape and size of the duodenal bulb are not changed. The contours of the bulb are quite clear, even. The passage of barium through the loop is somewhat slower. There is an anterior displacement of the descending branch of the duodenum, the intestinal lumen is restored during the passage of the barium suspension. The relief of the duodenal mucosa is pinnate.
In the Trendelenburg position, tension of the abdominal muscles, there are no data for a hiatal hernia.
Conclusion: R-data for the presence of organic changes in the esophagus, stomach, duodenum 12. To clarify the cause of the displacement of the descending part of the duodenum 12 recommended ultrasound of the liver, pancreas.

Pylorus penetration

Swallowing is not disturbed. The esophagus and cardia are freely passable. The vault and gas bubble are not changed. The stomach is of normal size and shape, normotonic, displaced, empty on an empty stomach. The contours of the walls of the stomach are clear and even. The folds of the mucosa are somewhat dilated and tortuous. Peristalsis is sluggish. The outlet section of the stomach is deformed, circularly narrowed, but, despite this, it is freely passable for barium suspension. In the pylorus, along the lesser curvature, there is a deep niche (up to 15 mm deep), which is hardly filled with contrast during the study.
The bulb of the duodenum is significantly deformed and appears as a thin tube with clear, uneven contours. The passage of barium in the polobulbar zone is accelerated. The relief of the duodenal mucosa is represented by thickened folds.
Conclusion: R-signs of a penetrating ulcer of the pyloric stomach, cicatricial deformity of the duodenal bulb. The evacuation function of the stomach is not disturbed.

Barrett’s esophagus, hernia, stricture

Swallowing is not impaired. The esophagus is shortened, in a vertical position, the supradiaphragmatic location of the abdominal segment of the esophagus and part of the cardia is determined. The esophagus in the upper third has a diameter of up to 25 mm, at the level of Tn6-7 there is a “short” stenosis up to 5.5 mm in diameter, up to 10 mm long, the elasticity of its walls is preserved, the internal contour is clear, filling defects and contrast depots were not detected. The post-stenotic segment of the esophagus is dilated, freely passable for barium suspension, appears to be elastic.
The stomach is of normal size and shape, the contours of its walls are clear and even. Evacuation saved.
Conclusion: Barrett’s esophagus. Fixed axial hiatal hernia of the 2nd stage. Subcompensated “short” stricture of the esophagus in the middle third.

Stomach cancer

Nasogastric tube installed. The act of swallowing is not disturbed. The esophagus and cardiac section are freely passable. The gas bubble of a stomach is not changed. The stomach is not large, hypotonic, inactive. The antrum of the stomach appears to be circularly narrowed, deformed, which significantly hinders the study of mucosal folds. Palpation of this area, dosed compression is somewhat painful. The evacuation of barium suspension from the stomach is slow, occurs ~ 20 minutes after the start of the study.
Bulb of the duodenum of small size with flattening of the contour along the greater curvature. The upper horizontal branch of the duodenum 12 seems to be firmly pushed down due to a semicircular impression from the outside for ~ 5 cm. The passage of barium along the loop is slow.
Conclusion: R-signs of cicatricial deformity of the antrum of the stomach with subcompensated stenosis of the gastric outlet. Displacement of the upper horizontal branch of the duodenum due to external pressure.

Cancer of the cardia, fornix

The act of swallowing is not disturbed. The esophagus and cardia of the stomach are freely passable. During the passage of contrast, unevenness of the left contour of the distal esophagus is noted. The cardial section and the fornix of the stomach appear deformed, the relief of the mucosa is in the form of chaotically located, thickened folds. During the study, with a change in the position of the body – the arch of the stomach is rigid. The contours of the body of the stomach along the greater curvature are not even. Evacuation of barium suspension from the stomach is free and timely.
Bulb and loop of duodenum without features.
Conclusion: Taking into account the data of previous research methods: infiltrative cancer of the proximal stomach, abdominal esophagus.

Cicatricial deformity of the esophagus, stomach

Swallowing is not disturbed. The esophagus is freely passable for aqueous barium suspension, the walls of the esophagus appear rigid in the middle and lower thirds, the lumen of the esophagus is somewhat narrowed. There is no pronounced suprastenotic expansion of the esophagus. The gas bubble of a stomach is reduced. The stomach is not large, the body of the stomach up to the outlet section appears to be permanently deformed, its lumen is circular, unevenly narrowed to 5 mm. Evacuation of barium suspension from the stomach is free.
Duodenal bulb of normal size and shape. The passage of barium through the loop is not disturbed.
Conclusion: R-signs of cicatricial deformity of the esophagus, body of the stomach, the evacuation function of the stomach is not disturbed.

ERCP

Retrograde contrast enhancement of the pancreatic and bile ducts was performed under R-TV control. Wirsung’s duct is not dilated, can be traced fragmentarily. The intrapancreatic part of the common bile duct is not expanded, up to 25 mm long, the retroduodenal part of the common bile duct is steadily narrowed to 1.3 mm over a length of 8.5 mm. Proximal to the diameter of the choledochus is wider up to 18 mm, X-ray non-contrast concretion is visualized in the form of a filling defect with a diameter of up to 8 mm. Cystic duct stump up to 40 mm long. The intrahepatic bile ducts are moderately dilated.
Conclusion: R-picture of the stricture of the retroduodenal choledochus. Choledocholithiasis.

Urografin

Examination of the esophagus and stomach with a water-soluble contrast agent (urografin) was performed under R-scopy control. The act of swallowing is not disturbed, the esophagus is freely passable. There is a defect in the subcardial part of the stomach, through which a part of the contrast agent enters the abdominal cavity, being distributed parallel to the lesser curvature of the stomach in the form of a linear streak. The contrast agent that has entered the abdominal cavity is captured and drained outward by a drainage tube. There is no convincing data for the presence of a defect in the subcardial part of the stomach with the left pleural cavity.
In the posterior-outer part of the left pleural cavity, air entrapment above the horizontal level of the liquid is determined, a drainage tube is also installed here. In the right pleural cavity is not high, oblique fluid level.

Chronic gastritis, duodenitis

Swallowing is not disturbed. The esophagus and cardiac section are freely passable. The vault and gas bubble are not changed. The stomach is of normal size and shape, hypotonic, displaced, on an empty stomach contains a small amount of mucus. The contours of the walls of the stomach are clear and even. The folds of the gastric mucosa are somewhat expanded, tortuous, and can be traced all the way to the outlet section continuously. Peristalsis is sluggish. The evacuation of barium suspension from the stomach is slowed down (not within 10 minutes).
The shape and dimensions of the duodenal bulb are normal, the contours are clear, even. The passage of barium along the loop is accelerated in the form of a thin stream, the relief of the mucosa is “smeared”.
In the Trendelenburg position, tension of the abdominal muscles, there is no pathological displacement of the stomach.
Conclusion: R-signs of chronic gastritis, duodenitis.

Esophagocardiomyectomy

Swallowing is not impaired. The esophagus is freely passable for contrast suspension, it closes completely. On an empty stomach in the lumen a small amount of mucus. The upper third of the esophagus was expanded to 30 mm, the lower segment was freely passable, the elasticity of its wall was somewhat reduced, the cardiac section was passable, and no retention of barium mass during passage into the stomach was recorded. The shape and size of the stomach is not changed. Medium wave peristalsis. Barium passage is not disturbed. Evacuation of barium suspension from the stomach is free. The bulb of the duodenum is without features, the loop is usually located, its mucosa is not changed.
Conclusion: Condition after surgery – esophagocardiomyectomy. Signs of esophagitis.

Duodenal ulcer

The act of swallowing is not disturbed, the esophagus is freely passable, the cardiac sphincter closes completely on inspiration. The gas bubble is not changed. The stomach is of normal size and shape, on an empty stomach contains a small amount of mucus. The folds of the mucosa are somewhat dilated and can be traced throughout. Peristalsis is sluggish. The antrum is spasmodic, there is no contrast evacuation for ~ 15 minutes.
The study was continued under conditions of artificial hypotension – 1 ml of 0.1% atropine solution sc.
The antrum of the stomach is straightened, the folds of the mucosa are twisted. Bulb duodenum on the anterior-upper wall has a persistent filling defect, in the condition of double contrasting, a shallow ulcerative niche up to 1 cm in diameter, surrounded by an infiltration shaft, is determined. The passage of contrast along the loop is not disturbed, the relief of the mucosa is usually pinnate.
When translating in the Trendelenburg position, tension of the abdominal muscles, there is no pathological displacement of the stomach.
Conclusion: R-signs of duodenal ulcer. Antral gastritis.

Pyloric ulcer

Swallowing is not disturbed. The esophagus and cardia are freely passable. The vault and gas bubble are not changed. The stomach is of normal size and shape, hypotonic, displaced, contains mucus on an empty stomach. The contours of the walls of the stomach are clear and even. The folds of the mucosa are thickened, convoluted Peristalsis is sluggish. In the pyloric region, along the lesser curvature, an ulcerative niche ~ 1 cm deep, surrounded by an infiltration shaft, is determined. Evacuation of barium suspension from the stomach is free and timely.
The dimensions of the duodenal bulb are normal, its contour along the lesser curvature is deformed, it does not straighten out during the examination. The passage of barium through the loop is not disturbed, duodenogastric reflux.
Conclusion: R-signs of an ulcer of the lesser curvature of the pyloric part of the stomach.

Endoscopist Orlov spoke about the risk of serious injury during the study of the stomach

Health

Many people are afraid of gastroscopy, even though this study is often prescribed for diagnosing stomach diseases. How justified are the fears, especially against the background of the news about the death of three in St. Petersburg after the “stomach examination”?

January 28, 202212

Source:: Getty Images

Siqueiros tragedy

In St. Petersburg, several people were injured after a “medical examination of the stomach” in the diagnostic center of the Vyborg district. This was reported the day before in the regional Sledkom. At first, it was known about two dead and two hospitalized in serious condition. Later there was information about another deceased. Investigators opened a criminal case under the article “infliction of death by negligence”, and Roszdravnadzor began checking in GKDTS No. 1 for Siqueiros. The website of the supervisory authority also notes that “the circulation of the drug used in the procedure” has been suspended.

“This study has been carried out since the opening of the center, there have never been any complications. Now the study has been stopped, the investigation is under investigation, the used drug has been sent for examination, the actions of doctors are also being checked, ”commented the head doctor of the State Clinical Center Evgeny Popov on the incident. Tonight the head of the center was detained. According to investigators, a counterfeit chemical preparation was used in the center for a long time, which did not meet the requirements for the safety of life and health.

Many immediately decided that it was a gastroscopy of the stomach, but later details appeared – an X-ray of the stomach was performed using barium sulfate ( contrast gastrography ). There were also opinions that barium sulfate is also used in gastroscopy. According to Oleg Orlov, head of the endoscopic department of the Elizabethan Hospital, this does not happen.

– Barium sulfate is never used for FGDS and even for CT of the stomach – only for x-rays of hollow organs (stomach, esophagus, large or small intestine). Barium salts or the so-called barium suspension is a contrast agent that has been used in medicine since the middle of the last century. When cooked, it looks like whitewash, which is used to paint walls or ceilings: the powder is diluted with water, and then shaken. This suspension is also called “Barium porridge”.

The study proceeds as follows. The patient is put behind the screen of the X-ray unit, they give him a glass with a suspension and, at the command of the radiologist, he drinks it – at the moment of swallowing, the doctor turns on the X-ray. The device records the passage of a contrast agent through the gastrointestinal tract, and several pictures are taken. They allow you to evaluate, for example, the peristalsis of the esophagus, stomach, intestines. And for X-ray studies of the colon (irrigoscopy), the drug is administered with an enema, – explained Oleg Orlov.

As noted by the endoscopist, barium sulfate is considered an inert substance, it is not absorbed anywhere, does not have a systemic effect and is excreted naturally. Recently, however, X-ray studies of the gastrointestinal tract with barium sulfate are carried out less and less.

– They are replaced by endoscopic examination methods. There has been a major technological breakthrough in this area – there are much more diagnostic capabilities. And not only diagnostic. During endoscopy, you can take a biopsy, remove the polyp, and the x-ray only shows “shadows”. Computed tomography is also a relatively new research method, and without any barium it provides information on the state of the digestive tract. But not always. Each type of diagnostics has its own indications,” adds Oleg Orlov.

8 patient fears for EGD

Although it is clear that the latest deaths are not related to fibrogastroduodenoscopy, cases of serious complications after this type of study have been reported before. Many people are still afraid of EGD, although less than colonoscopy.

“Doctor Peter” asked Oleg Orlov how justified the fears of patients and whether the risks of undesirable consequences during gastroscopy are great.

Fibrogastroduodenoscopy (FGDS) – endoscopic examination of the upper gastrointestinal tract (esophagus, stomach and part of the duodenum). It is considered one of the most accurate and detailed methods for diagnosing diseases of the digestive system. On average, the procedure lasts 5-10 minutes, the maximum can take up to 30-40 minutes.

Fear 1. It hurts

EGD is not a pleasant procedure, it can cause discomfort, but not pain. In some clinics, before the study, they offer to do superficial anesthesia – they spray a spray with lidocaine on the root of the tongue. By and large, such anesthesia does not make any sense and does not affect the tolerability of the procedure: with and without an anesthetic, it is about the same.

Contact of the mucous membrane of the pharynx with the endoscope does not cause pain. It does not hurt a person, for example, when he swallows a piece of meat. Still sometimes, as an argument for local anesthesia, they say that it allegedly reduces the gag reflex when the endoscope is inserted into the esophagus. The root of the tongue is indeed a reflexogenic zone, but even here the anesthetic does not help and does not completely eliminate the reflex. In this case, superficial anesthesia gives more of a psychological effect, as a kind of ritual action – it simply calms those who are especially anxious.

At the same time, we must remember that such anesthesia may have side effects – allergic reactions up to Quincke’s edema and anaphylactic shock. After all, when a person comes to the study, he may not even be aware of the possible risk. If in his life there has not yet been an experience of meeting with the same lidocaine, such ignorance is quite real.

However, there are people who are intolerant to gastroscopy – about 10% of them. They can not cope with their emotions, they are too afraid. In such cases, it is recommended to perform EGD under general anesthesia – for it, the drug with the active ingredient propofol is now used almost everywhere. Other 90% of patients, as a rule, calmly endure all manipulations without any anesthesia.

By the way, people are less tolerant of colonoscopy – there the proportion of those who can only undergo an examination “in their sleep” reaches 20%. Much depends on the qualifications of the endoscopist and his ability to find contact with the patient. If you explain to a person what is happening, that burping with air during gastroscopy is normal (with EGD, the stomach is slightly inflated with air or carbon dioxide, which gradually comes out), calm him down – all this ultimately helps a person cope with fears and anxiety.

Fear 2. Through the endoscope, you can “catch” some infections

Hypothetically, this is possible, since the endoscope is a reusable instrument – before you, hundreds and even thousands of people could be examined with it. But in practice, this is unlikely, unless we are talking about obvious and gross violations of the rules of disinfection.

Some people remember the scandal in the US a few years ago: it was reported that purely technically, even with complete disinfection, endoscopes cannot be completely cleaned, dangerous bacteria can remain on them. But then it was about a certain type of endoscopes – duodenoscopes, which are used in operations on the bile and pancreatic ducts ( ERCP – retrograde cholangiopancreatography ). The fact is that they have a special design with a lateral arrangement of optics, a working tool and a special lift (elevator), which complicates disinfection.

Endoscopes for EGD and colonoscopy are designed differently. Their processing after each patient is strictly regulated at the legislative level – it is described in detail by what means to carry it out, for how long, and so on. Moreover, they do not require sterilization – this is a general concept. Like, for example, anesthesiologists have anesthesia and sedation.

Gastrointestinal endoscopes are treated with HLD, a high-level disinfection that allows the instrument to be completely cleaned. HLD can be manual, but now almost all clinics use washer-disinfectors (WDM) for this. That is, the human factor during processing is actually reduced to zero.

Fear 3. You can get infected with coronavirus

You cannot get infected with coronavirus through endoscopic equipment, if again you do not violate the processing rules. Coronavirus is not a bacterium, it is transmitted mainly by airborne droplets. And gastroscopy is a contact research method. Of course, hypothetically, it can be assumed that if you do not disinfect the endoscope and leave traces of the previous patient’s mucus on it, you can become infected. But this is only hypothetical.

I repeat, the process of processing instruments after the study is strictly prescribed and controlled. And in the doctor’s office, this instrument also does not hang somewhere on a carnation in the public domain – it is stored in special cabinets that create a sterile atmosphere. According to the rules, endoscopes can stay in these cabinets for up to 3 days, and then they go through the disinfection cycle again. The doctor takes the instrument out of the cabinet just before the examination.

Fear 4. If a biopsy is taken during the examination, it will hurt

There will be no pain. A person, even being conscious, will not feel that a piece of tissue has been “plucked off” from him for histology. Inside the gastrointestinal tract – on the mucous membrane of the esophagus, stomach, duodenum, a fragment of which is taken for biopsy – there are no pain receptors. Therefore, you should not be afraid of a biopsy with FGDS.

Fear 5.

You can suffocate

Some patients say they can’t get tested because they suffocate. In fact, this feeling is caused more by psychological attitudes that are characteristic of people with a hysterical personality type. The endoscope is inserted into the esophagus, not into the airways. Against the background of phobias, fears, people begin to unconsciously take deep breaths and exhale, it seems to them that there is not enough air. But what is shortness of breath? An increase in the frequency of breathing, which everyone already knows about in a pandemic. So, if you measure the respiratory rate in such patients during the procedure, it will be normal – there is no shortness of breath.

Fear 6. You can scratch the mucosa

There is no such thing as “scratching” in endoscopy. When a biopsy is taken, a piece of the mucous membrane is “pinched off” with special forceps, for example, to test for the presence of Helicobacter pylori. A biopsy can be taken in several places or in different parts of the gastrointestinal tract. Imagine, each such mucosal defect is about 3-4 millimeters in diameter. But you should not worry about this – the mucous membrane heals quickly enough and does not even require any control. Taking a piece of tissue also does not threaten any long-term negative health effects. Complications during biopsy are extremely rare and in general cannot be a reason for refusing such a study.

Fear 7. There may be bleeding

There are such complications. Patients with gastrointestinal bleeding that occurred after biopsy in the clinic were admitted to our hospital. But this happens rarely and directly during the procedure, and not some time after. And here the point is not that they “bit off” too much piece of fabric or somehow wrong. The patient may have a change in the wall of the intestine or stomach – too thin, atrophied. This increases the likelihood of complications, including perforation (the formation of a through hole – in fact, a hole in the wall). Such complications during a biopsy are possible, but once again, very rarely.

Fear 8. An endoscope can pierce the wall of the intestine or esophagus

Theoretically, damage to the wall is possible. Still, EGD, like any other endoscopic procedure, refers to invasive interventions – a foreign body (endoscope) is inserted inside. And although the device is located inside the natural cavities of the body (oral cavity, stomach cavity or duodenum), there may be anatomical features that are not known in advance by either the doctor or the patient himself. It can be various developmental anomalies, tumors.

In particular, there are so-called variants of diverticula – protrusion of the wall of a hollow organ. This presents a certain problem for the endoscopist when inserting the instrument. But in general, the risk of perforation is controllable – it can be minimized. Still, the doctor conducts a study under video control.

If we talk about statistics, the probability of perforation during EGD is approximately 1 case in 15-20 thousand studies in clinics where experienced doctors work and a large flow of patients.