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How Much Time Does the Gastroscopy Last?

December 12, 2019

 

“Doctor, what are you looking at for such a long time there? Maybe, it’s already enough?” – a patient is asking with his eyes, who is passing through gastroscopy without sedation. And this is just a voiceless beginning of the dialogue, which will obligatory continue after the investigation with a sentence: “I have already been examined for 5/7/10 times, and always 2-3 minutes were spent for everything”.

 

The majority of the patients are sure that this is gastroscopy. Unfortunately, this is not like this.

 

I will share a secret with you that there is their own terminology in every unit or office. Even, I would say, not terminology but slang expressions. So, in our unit there is such a notion as “interesting” or “difficult” stomach.

 

There is a big group of patients with atrophic gastritis and spread intestinal metaplasia. Both are pre-cancerous states, requiring a qualitative detailed follow-up. It is easy to say but not easy to do. All the mucous consists of The entire mucous membrane consists of alternating bizarre shapes of spots of different sizes. Every 5-10 mm, the surface structure completely changes. The mucous is so mottled and heterogeneous that from afar it is simply impossible to isolate any separate suspicious areas. Namely, this is the key to identifying the early stages of cancer, or obligate (obligatory) precancer - dysplasia. So, one thing remains: centimeter by centimeter to examine the entire stomach in the hope of not getting lost in it completely and not missing out something, that in a year or two it can turn into an incurable malignant tumor.

 

Even after the completion of the study, which can sometimes take up to 20-25 minutes, there are doubts: “Have I examined everything?”, “Is the biopsy taken too little?”, “But there was no need to take a biopsy here and there, was not it?"

 

When you work at the equipment of high quality, you understand that there are a lot of such patients, but, unfortunately, the equipment of high quality does not exist everywhere. And that’s why the majority of endoscopists perform the reviews to such patients easily and quickly, because they just DO NOT see these changes. And their patients are sure that those 2-3 minutes were enough. In reality, in order to be sure in the quality of examination in such offices, it is enough to ask the doctor about the equipment, and you may draw the conclusion if such gastroscopy was necessary for you. Or ypu may just spend some time next to the office and see the speed of patients’ examination.

 

 Colleagues, I don’t want to offend anyone, but you’re unlikely to argue. But there’s no fault of the doctor either. This is all a matter of the security of this or that hospital).

 

Therefore, for a qualitative examination, people sometimes overcome hundreds, and sometimes thousands of kilometers, as a patient from the case I gave.

 

Every year he is coming from abroad for gastro- and colonoscopy. I do not investigate his colonoscopy today. But his stomach is really “difficult”.

 

That is why the examination is performed on the yearly basis.

 

Last year, apart from atrophy and intestinal metaplasia, nothing was found. And already this year, a 6 mm polypoid formation was detected, which was described as type 0-IIa neoplasia, removed by endoscopic mucosal resection (EMR), and after histological examination it turned out to be tubular adenoma with mild dysplasia (LGIEN).

 

Are there chances to find such a focus in the process of a 2 minutes examination? I doubt. Moreover, a standard fibrogastroscopy without a biopsy (how it is done most often) would more likely not recommend a yearly examination. fter all, the last time no polyps or ulcers were found. And what would happen to this polyp in 2-3-4 years? Guess?

 

Actually, therefore, such stomachs are really “heavy” only for those who see why they are “heavy”. In such situations, examinations cannot last 3 minutes, cannot end without a biopsy, and cannot remain without further observation.

 

Therefore, the phrase "no one has examined me for so long" is perceived as a compliment. And even if the patient gives it a negative connotation, we know that we did our job better than all our predecessors and did it for a reason.

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