Among the top 10 malignant tumors in China, the proportion of digestive tract malignant tumors is far ahead. Source: China Cancer Registration Annual Report 2017.
The incidence of digestive tract malignant tumor ranks in the forefront of the incidence of malignant tumor. But many early digestive tract tumors have no symptoms, and the best way to diagnose them is gastrointestinal endoscopy. Experts believe that only the physical examination including gastrointestinal endoscopy is a comprehensive and scientific physical examination.
Our reporter Ma Aiping Intern reporter Yu Ziyue
There is a saying circulating on the Internet: "A physical examination without a gastrointestinal mirror is not called a physical examination!" But when it comes to colonoscopy and gastroscopy, many people will think of unpleasant words such as "nausea" and "pain".
In recent years, many doctors are calling on people to have a regular physical examination of their stomachs and intestines and keep an annual gastrointestinal endoscopy. Recently, Weibo, the official of Beijing Municipal Health and Health Commission, announced the list of 128 medical institutions for gastrointestinal endoscopy in Beijing, and once again stressed that gastrointestinal endoscopy is the "gold standard" for the diagnosis of many gastrointestinal diseases. In addition, in order to reduce the discomfort of inspectors, the inspection mode is constantly upgrading.
Good stomach and intestines can’t be numb.
"Gastric cancer, esophageal cancer, colorectal cancer and other digestive tract malignant tumors occupy cancer ‘ Half the country ’ The incidence rate is increasing. Early digestive tract malignant tumors are often asymptomatic, and the main diagnostic method is gastrointestinal endoscopy. " Jia Shujuan, director of the Department of Gastroenterology, Peking University Shougang Hospital, said in an interview with the Science and Technology Daily reporter.
"Many people feel that they usually have a good gastrointestinal tract and do not need to be examined. But it is very easy to be careless, and it is too late to wait until the digestive tract has symptoms. For tumors, early detection, early diagnosis and early treatment are the main strategies to reduce cancer mortality and improve survival rate. " Ling Huenqiang, chairman of the Digestive Endoscopy Branch of the Chinese Medical Association and director of the Department of Gastroenterology of the General Hospital of the Chinese People’s Liberation Army, said.
Ling Huenqiang introduced that the significance of gastrointestinal endoscopy lies not only in "discovery" and "observation", but also in "resection" and "rooting". Gastrointestinal endoscopy can not only find early gastrointestinal cancer and make patients get timely and effective treatment, but also minimally invasive treatment of adenomatous polyp and other precancerous lesions under endoscope, so as to eliminate intestinal cancer before it sprouts. "Most digestive tract cancers originate from precancerous lesions, and canceration can often take a long time, some of which can last for more than 10 years, which gives us the opportunity to intervene."
Gastrointestinal endoscopy can usually be divided into two types: ordinary and painless. What scares people in life is generally ordinary examinations. Jia Shujuan told reporters that gastroscopy will be anesthetized, but there is a difference between local anesthesia and general anesthesia. Ordinary gastroscope is a gastroscopy after taking local anesthetic, and the patient is awake during the whole process. When the gastroscope enters the esophagus through the pharynx, locally sensitive people may feel nausea and discomfort. General anesthesia is through intravenous injection of anesthetic, which makes people fall asleep. When they wake up, the examination has been completed, and there is no pain or discomfort during the examination.
General colonoscopy generally does not require anesthesia, and there may be some abdominal distension and abdominal pain during the examination. Painless colonoscopy is similar to painless gastroscopy, so "sleep" is enough.
If the examiner is sensitive to the pharynx, has poor tolerance for pain, or pursues a comfortable examination process, he can choose painless examination, but the cost will increase. Among the 128 medical institutions announced in Beijing, 110 medical institutions can simultaneously carry out general gastrointestinal endoscopy and painless gastrointestinal endoscopy.
Ling Huenqiang said that in addition to the traditional intubation gastroscope mentioned above, people have been exploring more comfortable examination modes in recent years. Take the capsule gastroscope as an example. "The patient swallows a capsule with a built-in camera and signal transmission device with water, and the doctor can complete the stomach examination in 15 minutes by accurately controlling the trajectory of the capsule in the stomach."
Routine physical examination of absent ordinary people
Although gastrointestinal endoscopy is very necessary, and there is a breakthrough in the form of examination, at present, the routine physical examination of ordinary people generally does not have this examination item, and only high-end physical examination or some people with requirements will do these examinations.
Why is gastrointestinal endoscopy absent from general physical examination?
Ling Huenqiang pointed out that this kind of inspection operation is complicated, which requires intestinal preparation and disinfection of instruments, and requires related technology and supporting equipment. In addition, invasive endoscopy has certain risks, unlike non-invasive examinations such as B-ultrasound, which are simple, do not need special preparation and have less risk of physical injury. Therefore, there are obstacles from patients, hospitals, physical examination concepts and other aspects, and it has not become a routine physical examination item.
However, in developed countries in Europe and America, Japan and other countries, gastrointestinal endoscopy is a routine physical examination for people over 50 years old. "For example, in Japan, there are very few patients with advanced gastric cancer. The reason is that Japanese national medical examinations generally include gastroscopes as compulsory items. The government has included the gastroscope physical examination project in the protection of relevant laws and regulations, provided it to the public free of charge as a social welfare, and urged it to be completed. Patients with symptoms over 40 years old and asymptomatic people over 50 years old in Japan have regular gastroscopy every year. Gastroscopy has greatly improved the early diagnosis and treatment rate of gastric cancer, so the detection rate of early gastric cancer in Japan is very high, but the mortality rate is very low. " Ling Hu enqiang said.
On the other hand, in China, although many hospitals have advanced endoscopy technology in the world, few citizens can take the initiative to do gastroscopy screening. "In addition to patients who have immediate family members who have had digestive tract cancers such as gastric cancer, in the outpatient clinic, they encounter more ‘ Fear ’ Patients who do gastroscopy. " Ling Hu enqiang said.
"The public’s attention to gastrointestinal endoscopy and reasonable cognition need to be improved, and popular science propaganda is very important." Jia Shujuan added.
Both experts stressed that it is urgent to incorporate digestive endoscopy into physical examination, so that early detection and treatment under endoscope can minimize the physical, mental and economic losses caused by diseases.
High-risk groups should be examined at the age of 40.
Who needs gastrointestinal endoscopy?
"For people with gastrointestinal discomfort, it is recommended to consider gastrointestinal endoscopy under the guidance of a doctor. Symptoms such as stomach discomfort, upper abdominal pain, lower abdominal pain, acid regurgitation, belching, fullness, etc. It also includes symptoms such as intestinal discomfort, changes in bowel habits, and changes in stool characteristics. " Jia Shujuan said that these symptoms are common in life, and many people think that it is ordinary gastroenteritis and do not pay attention to it. In fact, early gastric cancer may also show similar symptoms, so we must not delay treatment. Patients with "alarm" symptoms such as loss of appetite, anemia and emaciation, and bloody stool, or those who are found to be positive for occult blood in stool by physical examination, should complete gastrointestinal endoscopy as soon as possible, so that the lesions can be found and treated in time.
Although gastrointestinal discomfort makes people feel pain and listlessness, it also reminds and urges people to have corresponding examinations in disguise and find the symptoms as early as possible. Every coin has two sides, and some people, because their bodies have no relevant symptoms of illness, will not send out an "alarm" signal, so it is easy to fall into the whirlpool of "being ill and not knowing it". Such people should also be vigilant and have gastrointestinal endoscopy.
As advocated by Japan and other countries, "people over 50 years old should have a gastrointestinal examination even if they have no symptoms." Jia Shujuan pointed out that if the test results are positive, such as polyps and gastric ulcers, they should be treated in time and reviewed regularly.
Although the causes of most cancers have not been proved, they are usually related to heredity. Therefore, people with a family history of digestive tract tumors should pay special attention. Some experts pointed out that this group of people can advance the age of initial examination to 40 or even 35 years old.
Initial examination is very important, however, it is also essential to review and monitor regularly after the symptoms are found and treated. Jia Shujuan pointed out that once the patient is found to have some precancerous lesions, such as dysplasia under endoscope, it is recommended that the patient be reexamined within one year after treatment, and then the next examination time will be decided according to the reexamination. For patients with relatively complicated or serious illness, the review time can be shortened to 3-mdash; Six months. For another example, especially severe atrophic gastritis should be reviewed once a year.
Experts agree that gastrointestinal endoscopy can’t be avoided, and there is no need to hide. After all, there are many options to choose from in clinic. After the examination, you can feel at ease without illness, and you can find and treat problems early. No matter what the result is, it is the optimal solution of health management.