Guidance expert: Department of Gastroenterology, Zhongshan Hospital Affiliated to Dalian University, Park Lian-sook, MD
Visits: Wednesday morning
Not long ago, an old patient with cirrhosis of the liver and upper gastrointestinal bleeding came to the Zhongshan Hospital affiliated to Dalian University for medical treatment. Doing a gastroscope found that there was a "big potato" at the bottom of the stomach that was bubbling with fresh blood! The situation is urgent! Patients with cirrhosis for many years have a "big potato" at the bottom of the stomach, and as long as an endoscopic doctor or gastroenterologist with a little experience in endoscopy will first think of "gastric varices".
However, the doctor touched a biopsy forceps and found it very hard. At this time, the doctor remembered that the patient had done an ultrasound endoscopy a year ago because of a small bag at the bottom of the stomach, and when the ultrasound endoscopy with a small probe saw a mass of the origin of the "intrinsic muscle layer" at the bottom of the stomach, which was considered to be an "interstitial tumor". After rapid multidisciplinary consultation with imaging department and hepatobiliary endoscopy, combined with intensive ct, gastrososcopy, and previous ultrasound endoscopy, the diagnosis was "gastric stromal tumor and bleeding". After surgical resection, the final pathology made it clear that the culprit of this bleeding was an "interstitial tumor".
Ultrasound endoscopy played an important role throughout the patient's examination and treatment. So --
What is endoscopy ultrasound?
Ultrasound endoscopy, simply put, is endoscopic + b ultrasound, the ultrasonic probe is placed in the front end of the endoscopy (gastroscopy, colonoscopy) or through the endoscopic introduction of a miniature ultrasound probe, through the body cavity direct endoscopic view of the digestive tract (esophagus, stomach, colon) tube wall or adjacent organs (pancreas, bile ducts, gallbladder, liver, etc.) for ultrasound scanning. Usually the digestive tract can be divided into 4 layers, from the inner layer to the mucosal layer, the submucosal layer, the muscle layer, and the serous layer. The mucosal layer is the place where the epithelial cells of the digestive tract adhere to, the mucosal layer is the site of most gastrointestinal diseases, which can be directly observed through endoscopy; the submucosal layer is rich in blood vessels and lymphatic vessels; the muscle layer is the thickest layer of the 4 layers of the digestive tract structure, which is the main structure of the digestive tract; the serous layer is the outermost layer of the gastrointestinal tract, which plays a restrictive and lubricating role, and can only see the most superficial layer of the digestive tract (mucosal layer), but some lesions originate from the mucosa (including the submensumal layer, the muscle layer, and the serous layer). Its surface is smooth, at this time ordinary gastrointestinal endoscopy can not be through the mucous membrane to diagnose the lesions under the mucosa; there are some lesions located outside the gastric cavity close to the stomach wall, ordinary gastroscopy is even more difficult to diagnose.
In order to solve this kind of situation, people cleverly combined the functions of endoscopy and ultrasound, so that ultrasound endoscopy can better observe and judge submucosal structures or lesions.
Why ultrasound endoscopy?
The indications for ultrasound endoscopy are extensive, and any lesion or suspected lesion of the digestive tract itself or adjacent organs can be diagnosed by ordinary endoscopy and body surface ultrasound.
For example, if we want to observe a room, we only need to enter the room, with our eyes can carefully observe the walls, floor, ceiling of the room whether there are flaws; at this time, ordinary gastroscopes can be; if a bag is protruding from the wall, and the wall is fine, we can't judge by our eyes: in the end there is a problem outside the wall, or a problem under the wallpaper? What is the reason and nature of this drum kit? At this time, ultrasound endoscopy can play a big role. Therefore, the endoscopic doctor calls it: "the gastroenterologist's clairvoyant eye" and "the third eye of the digestive endoscopy".
Indications for endoscopy ultrasound are:
1. Malignant tumors of the digestive tract, such as esophageal cancer, stomach cancer, colon cancer, stage to see which layer is violated;
2. Submucosal tumor, determine whether it is a lesion inside the wall of the tube or outside the wall of the tube, judge the origin level, nature, size, boundary, etc. of the lesion, and guide the choice of further treatment options.
What should I pay attention to before ultrasound endoscopy?
1. Fasting and drinking for 8 hours before surgery, and maintaining an empty stomach;
2. Patients with hypertension can take antihypertensive drugs 3 hours before examination, and it is recommended not to take other drugs. Patients who are taking anticoagulant drugs should always tell their doctor or nurse;
3. Due to the long examination time, patients should try to relax as much as possible and cooperate with the doctor.
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