Is it uncomfortable to do a gastroscopy? No matter how uncomfortable it is, these people have to do it!

Author: Wu Qi, Chief Physician, Peking University Cancer Hospital

Reviewer: Shang Zhanmin, Chief Physician, Beijing Chaoyang Hospital (West Campus), Capital Medical University

From a global perspective, my country is a high-incidence area for esophageal cancer. The number of new cases of esophageal cancer and the number of deaths from esophageal cancer each year account for more than 40% of the world's total, which is a huge number.

Esophageal cancer is a relatively malignant tumor with no obvious early symptoms. The cure rate is relatively low when it progresses to the middle and late stages, and the 3-year and 5-year survival rates are also relatively low.

Figure 1 Original copyright image, no permission to reprint

Therefore, early detection of esophageal cancer is particularly important. Only early screening, early diagnosis, and early treatment can lead to a better prognosis.

1. Which groups of people should undergo regular screening for esophageal cancer?

People with a family history of digestive tract cancer. A direct relative within two generations has suffered from esophageal cancer or digestive tract cancer;

People in areas with a high incidence of esophageal cancer. This high incidence may not be a general high incidence. We limit it to a certain county, or a very limited area, such as a few villages or a township. Its incidence rate is often very different from that of the area ten or twenty miles away.

People who have some bad habits, such as long-term drinking and smoking;

In previous examinations, people were found to have precancerous lesions of the esophagus, such as reflux esophagitis, esophageal polyps, esophageal ulcers, Barrett's esophagus, or mild to moderate atypical hyperplasia of the esophagus.

The incidence of esophageal cancer in the above-mentioned groups of people is relatively much higher than that in the general population. For these people, it is recommended to undergo esophageal cancer screening before the age of 40, so that esophageal cancer can be detected early and in time.

How often should we do it? From a doctor's point of view, of course, the higher the frequency of examination, the higher the chance of detection. However, China's medical resources are very limited, so it is recommended to do screening every three years or so.

If you do not belong to the high-risk groups mentioned above, when should you start screening?

The peak age of esophageal cancer is about 50-65 years old, or even 70 years old. From the perspective of tumor pathogenesis, 10 years ago is a good time point, so 40-65 years old is a good time period for screening in the general population. For example, if you have been screened once at the age of 40 and there is no problem, it may be cured for 5 years.

2. What examinations can be used to detect esophageal cancer early?

For early screening of esophageal cancer, gastroscopy is now the best screening method, especially standardized gastroscopy screening, which can maximize the detection of early esophageal cancer and the diagnosis rate can reach more than 90%.

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In the past, when gastroscopy was not very popular, gastrointestinal X-rays were first performed using barium sulfate, and later esophageal air-barium double contrast, which could detect very early tumors to a certain extent.

In the 1970s and 1980s, the method used was dragnet cytology. The patient swallowed something with a slightly rough surface, which was slowly pulled upwards from the stomach. The cells stuck to the net were washed out, and a microscope was used to see if there were any tumor cells inside. This method achieved very good results in those years.

However, both of the above methods may miss a large number of cases.

3. How long does it take to do a gastroscopy? Is it painful?

In the past, gastroscopes were relatively thick and uncomfortable to perform. In recent decades, with the advancement of medical equipment and technology, standard gastroscopy, which examines the esophagus, stomach, and duodenum, takes an average of about 8-10 minutes. During the examination, the movements are standardized and there will be no excessive nausea, vomiting, or pain, so most people can still accept it.

If you really cannot tolerate a gastroscopy, we do have some other options. There is now a painless gastroscopy. The so-called painlessness means that anesthetic drugs are injected into the vein, and the gastroscopy is completed while you sleep. There is no memory of the examination process and no painful experience. This is now considered a very good solution.

In addition, there is now a capsule endoscope. After swallowing a small capsule, specific parts can be observed through the capsule. The patient does not feel too uncomfortable and has no adverse experiences.

4. How to determine whether there is esophageal cancer through gastroscopy?

First, the local lesions seen under the endoscope have their own properties, such as what they look like and whether they are raised, flat, or sunken in morphology. Doctors will make a judgment on this.

Second, the tumor surface is different from normal mucosa. The morphological changes in the capillary loops in the surface mucosa, including changes in the microvessels, may give us very important clues.

Third, if lesions are found in the esophagus under gastroscopy, we can take a biopsy for pathological examination. Pathology is the gold standard for diagnosing esophageal cancer.