Many patients note that esophagogastroduodenoscopy is an unpleasant procedure. In order to prepare, before a gastroscopy, the patient must perform several simple steps. Preparation Algorithm:
- gastroscopy is performed in the morning on an empty stomach, so the last meal 12-14 hours before the examination,
- a light dinner is allowed around 18: 00-19: 00 the day before, according to the recommendation of doctors, this is an important point, since the duodenum is empty by this time,
- you can’t smoke one hour before endoscopy, cigarette smoke and tar emitted by it provoke excessive secretion of mucus of the stomach and bile of the duodenum,
- an important element of preparation is abstinence from taking oral medications before endoscopy,
- when morning comes, you should not eat or drink before the procedure on the day.
If the FGDS study is performed without preparation, there is a high probability of an increased vomiting reflex, vomiting at the time of esophagogastroduodenoscopy, asphyxiation by vomit, an uninformative or false-positive result.
Esophagogastroduodenoscopy is performed in an endoscopic room, where the necessary tools and drugs for FGDS are prepared in advance. Before the crime of endoscopy, the patient needs to be warned about his allergic history. Preparation for the process involves the use of a local anesthetic, they irrigate the throat to reduce pain.
Important recommendation: gastroscopy is performed in a calm environment, which serves as an element of preparation. Anxiety of the subject often interferes with complete and high-quality esophagogastroduodenoscopy. Sometimes injectable sedatives are used as sedation for endoscopy.
With FGDS, a person is laid on a couch, on his left side. The patient is given a plastic mouthpiece to fix with his teeth, then they proceed to the procedure itself - an endoscope is slowly inserted into the oral cavity and asked to take a sip. An elastic tube with an optical device at the end penetrates through the esophagus into the stomach, the last thing examined is the duodenum.
FGDS makes it possible to visually assess the condition of the mucous membranes of the upper digestive tract. Esophagogastroduodenoscopy is prescribed only according to the strict indications of the doctor. With FGDS, it is possible to take biomaterial for biopsy, gastric contents to detect Helicobacter pylori bacillus. Analyzes are sent to a specialized laboratory.
Nutrition on the eve of gastroscopy
Regarding evening meals, adult patients ask questions: how much can be eaten in the evening and what foods to carefully prepare the stomach and duodenum for FGDS. A proper dinner consists of a piece of steamed fish and vegetables. Also, those preparing for endoscopy, eat chicken boiled breast and well-boiled buckwheat porridge.
It is recommended that individuals who are preparing for FGDS to refuse:
- alcohol drinks
- chocolate and icing containing products,
- all kinds of nuts
- sunflower and pumpkin seeds,
- vegetables causing flatulence (cabbage, radish, legumes),
- carbonated drinks
- spicy, spicy and flour dishes.
It should be taken into account that such a set of products in a healthy person will be digested in 10 hours, however, examination is prescribed and carried out for people with gastropathy, and therefore, the importance of preparing for esophagogastroduodenoscopy increases.
An adult, aware of the person, will try to get as close as possible to the implementation of these several requirements before the examination. It is necessary to prepare in such a way that the endoscopy has passed quickly, without complications.
After FGDS, a sore throat is allowed, crushing unpleasant sensations. This effect is associated with muscle tension of the pharyngeal ring during endoscopy or the occurrence of microtraumas. How many patients were examined, all undesired symptoms disappear 2-3 days after endoscopy.
The correct tactics of conducting a research by a doctor and observing the necessary rules for preparing a patient are mandatory.
What is FGDS?
FGDS, or fibrogastroduodenoscopy is a research method in which a special device is inserted into the gastrointestinal tract through the mouth - an endoscope. The first part of the word, “fibro,” denotes the type of endoscope - a flexible tube. At the end of this tube is high-tech equipment - a camera that transmits an image on the screen, a flashlight for illumination. Today, most of the devices, in addition to the above, provide the ability to supply air or water (for example, to smooth out the folds of an organ, remove mucus, etc.), dyes (this is important in the diagnosis of complications of gastroesophageal reflux disease). During the examination, the doctor can also take a biopsy - with the help of special "clamps" a small organ fragment is removed for histological examination. This is important for the diagnosis of cancer.
Organs that can be examined using this method:
- cardiac sphincter,
- pyloric sphincter,
- Vater Nipple.
Vater (large duodenal) nipple
In addition to diagnosis, FGDS can be used also for medicinal purposes: stopping bleeding from an opened ulcer, removing polyps, removing foreign bodies, etc.
In what cases is a study prescribed? This is not only a suspicion of a pathology of the gastrointestinal tract, but also a number of other diseases.
Table. Diseases in which an examination is performed.
Impaired patency through the cardiac sphincter
Signs of an ulcer bleeding
Impaired pyloric sphincter
Stenosing duodenal papillitis
In addition to diseases and lesions of the gastrointestinal tract, the following pathologies are indications for FGDS.
- Anemia. FGDS is carried out as part of a diagnostic search. They are looking for bleeding ulcers, erosion, from which blood can be chronically released, which leads to a decrease in hemoglobin levels.
- Liver disease, especially cirrhosis. In the presence of cirrhotic changes in the liver, portal hypertension develops - an increase in pressure in the portal vein system. This causes varicose veins of hemorrhoidal veins, veins of the anterior abdominal wall, as well as veins of the esophagus. This condition is a risk factor for bleeding (given the general decrease in blood coagulability in liver pathology), therefore, strict control is necessary.
As with any medical intervention, there are contraindications for FGDS. Two groups of prohibitions on the procedure are distinguished: relative, which do not allow diagnosis at a particular time, but there is the possibility of eliminating them and conducting a study later, as well as absolute, in which FGDS can be resolved only after a radical change in the situation.
Table. Absolute and relative contraindications.
It is important to note that in an acute condition requiring urgent intervention (foreign body, bleeding), FGD can be performed with almost any pathology, since the risk from the procedure in this case will be significantly lower than the benefit.
How to prepare for FGDS?
A therapist or gastroenterologist, surgeon can give a referral to the study, and if there are indications, the procedure can be prescribed in any hospital. The specialist who sent for endoscopy usually explains in detail how to prepare for it and what to take with you.
The bulk of the preparation is dieting.. Two days before the proposed procedure, fatty, fried, spicy, spices and spices, fast food, alcohol are excluded from the diet. Fiber, cereals, dairy products, soups are welcome. Overeating, eating at night is unacceptable. To help the body digest food, you can use pro- and prebiotics, enzymes. These are such drugs as Panzinorm, Creon, Mezim. Carminants are also used, Espumisan. On the evening before the study, the last meal should take place no later than 19.00, you can have dinner with porridge, dairy products.
Why is nutritional preparation so important? On the one hand, so that the study remains informative. Lost among the food that did not have time to digest, the endoscope quickly gets dirty, and the walls of the stomach remain inaccessible for examination. On the other hand, vomiting with the introduction of an endoscope will become effective, which will not only violate the purity of the functional diagnostics room, it will become an unpleasant incident, but it can also pose a threat to life: the endoscopist simply fails to remove the equipment in time, aspiration of vomit can occur. In addition, damage to high-tech equipment is possible.
Nutritional preparation is very important.
As soon as a person hears about the need to "swallow a pipe", he begins to panic, he gets a lot of stress. This is due to the expected discomfort during the procedure. That is why one of the most important parts of training is shaping the right attitude. A person must understand that FGDS is not a torture procedure, but an extremely informative study that will help to identify the presence of a pathological process in the gastrointestinal tract. It should be understood that the tense muscles of the pharynx will prevent the endoscope from being easily inserted into the esophagus, and the general stiffness will only intensify the vomiting reflex, which will make it unpleasant. During the introduction of the gastroscope, you need to breathe evenly and deeply, mentally tuning yourself in a positive way.
Two hours before the procedure, you must stop smoking. For three days, cancel the therapy that affects the acidity of the stomach (only if there is no purpose to check its effectiveness). Before starting the procedure, it is important to notify the doctor of any allergic reactions. It is vital to talk about an allergy to lidocaine or other local anesthetics, as well as cases of anaphylactic shock or Quincke's edema in history. In the presence of removable dentures of the jaw, they must be removed during the study.
Removable dentures must first be removed
They usually ask them to take a diaper with them to put on a couch (although in many modern hospitals there is disposable underwear, and this requirement "disappears"). In addition, it is worth having a towel with you, because with the introduction of the endoscope, not only the gag reflex works: a large amount of saliva is released, which must be removed with something.
How is FGDS performed?
FGDS is usually carried out in the morning. The study does not require hospitalization; it can be done on an outpatient basis. The entire study can be decomposed into separate steps.
How is FGDS
Step 1. Location. The subject lays on the couch, sitting on his left side. In this case, one knee should be bent at 90 °, and the second bent so that the posture is more stable. It is important to straighten your back.
Step 2. Anesthesia. The study is conducted under local anesthesia: the root of the tongue is treated with a lidocaine spray.
Step 3. Insert the mouthpiece. This occurs 5-10 minutes after the injection of anesthesia and is done so that the patient cannot close his mouth during the study and there is no damage to the oral cavity or equipment.
Step 4. Introduction of the endoscope. The most unpleasant stage, because at this moment a person feels the urge to vomit.
Step 5. Actually research.
Step 6. Withdrawing the endoscope.
Long recovery after the procedure is not required. It is enough to lie down for a couple of minutes, smoothly get up. After research during the day, it is not recommended to eat large meals, fatty, spicy or acidic foods.
FGDS is not considered a difficult or dangerous procedure: complications are extremely rare. However, the following problems are possible.
- Sore throat. It is associated with minor damage to the mucosa during the introduction of the gastroscope. Most often, it does not require therapy and passes on its own on the second or third day after the study.
Indications for video capsule endoscopy
Thus, lengthy complex preparation for FGDS examination is not required. It is enough to follow a diet, properly set up psychologically and follow all the instructions of a doctor. And in this case, the procedure will be quick, painless and informative.
Indications for the procedure
It is necessary to prepare for FGDS for that category of patients who have the presence of the following pathological conditions:
- persistent nausea
- after meals, belching appears with air,
- systematic pain in the stomach,
- there is a complete or partial lack of appetite,
- heartburn often occurs
- there are problems while swallowing,
- rapid weight loss, with good nutrition,
- anemia has developed.
Fibrogastroduodenoscopy is prescribed for patients in whom specialists suspect the development of malignant neoplasms in the stomach, or an atrophic form of gastritis. In such cases, during the examination of the mucous membranes of an organ, biological material is taken. Also, this procedure is carried out in order to monitor the progress of drug therapy, or postoperative healing.
Stages of behavior
Fibrogastroduodenoscopy is performed as follows:
- Initially, the specialist punctures the rhizome of the tongue with a drug called Lidocaine, which has a local anesthetic effect.
- After this, the patient should lie on the couch and roll over on his left side.
- A special spacer, called a mouthpiece, is inserted into the patient’s oral cavity so that during the introduction of the gastroscope he does not damage it with his teeth.
- A specialist introduces a flexible tube through an opening in the mouthpiece. In order for the gastroscope to enter the cavity of the stomach as quickly as possible, the patient must make swallowing movements.
- As soon as the end of the tool reaches the desired location, air begins to flow into it. This is done so that the body is straightened, and it is possible to examine its walls.
- This diagnostic procedure lasts for 5-15 minutes, after which the tool is removed.
Each specialist before starting the manipulation should conduct a local check:
- mandatory checks the condition of the mucous membranes and skin,
- if a person has signs of colds, the procedure is delayed until complete recovery,
- with increased foaming in the gastrointestinal tract, the doctor may prescribe Espumisan to the patient, which should be taken five minutes before the start of the examination.
If a person has an individual intolerance to the components that make up Lidocaine, then he will be given general anesthesia. Indications for such anesthesia are the following conditions:
- a person cannot endure pain
- local anesthesia can lead to increased pressure,
- the patient may have a panic attack,
- there is a likelihood of developing an epileptic seizure, etc.
Preparing the patient for FGDS
So that the patient does not have to re-experience the discomfort, he needs to properly prepare for EFG:
- During the day before the examination, you must refuse to eat. Thanks to a hungry diet, you can avoid an attack of vomiting, because of which the specialist can postpone the procedure to another day.
- On the day of the examination, you must stop smoking, since nicotine provokes the generation of gastric mucus.
- Before FGDS, the patient should not take medicines, especially if they have a tablet or capsule form. But, if a person drinks vital medicines, they should not be canceled, they should be warned about this by a specialist. Such a ban does not apply to medicines that are used in the form of solutions, drops, injections.
- On the day of the examination, you can not brush your teeth, smoke, have breakfast, as mucus production may increase.
The last meal before fibrogastroduodenoscopy should consist of low-fat dishes that are quickly absorbed by the stomach. For example, a portion of buckwheat porridge with a slice of boiled fish, or steamed chicken breast with a vegetable side dish. 2-3 days before the procedure, the patient should be excluded from the diet:
- alcohol-containing drinks,
- chocolates and other sweets,
- spicy, smoked dishes,
- fresh vegetables
- nuts and seeds.
With regard to fluid intake before fibrogastroduodenoscopy, experts recommend that you adhere to the following rules:
- Two hours (no later) before the examination, the patient can drink a small amount of mineral still water.
- Four hours before fibrogastroduodenoscopy, a cup of strong black tea is allowed.
- It is forbidden to use dairy or sour-milk products on the day of research or the day before.
To minimize risks and make the procedure less unpleasant, people should follow the following recommendations of specialists:
- At the time the instrument is inserted into the stomach, there is a feeling of lack of air. You can reduce the discomfort by unbuttoning the shirt in the neck so that the collar loosens.
- To reduce the feeling of tightness in the peritoneum, you need to unfasten the buttons on the trousers or skirts.
- Due to the fact that people undergo local anesthesia before the procedure, they need to notify specialists about the presence of an allergy to medicines and indicate their names.
- If a person has removable dentures in the oral cavity, they will have to be removed, since they can jump off and enter the esophagus at the time of insertion of the probe.
- Before visiting a medical institution, you do not need to use deodorants and perfumes.
- During the diagnostic procedure, people should relax, breathe their nose deeply and evenly.
- If the specialist does not ask, then it is better not to make swallowing movements.
- You can distract yourself from unpleasant feelings by thoughts about pleasant things, although it is difficult.
It is worth noting that if a person has cardiovascular pathologies, then before fibrogastroduodenoscopy it is necessary to consult a doctor and, if necessary, undergo drug preparation, since there is a risk of complications.
Preliminary medical consultation before the diagnostic procedure is needed for patients who have been diagnosed with such ailments:
- respiratory failure
- angina pectoris.
Fibrogastroduodenoscopy is unlikely to be called a pleasant procedure by any patient. As a rule, it causes a wide range of negative emotions in people.
Many patients deliberately avoid examination, thereby causing harm to themselves.
In order for the procedure to proceed as quickly and calmly as possible, people should psychologically prepare themselves for it:
- Everyone should realize that without this examination, the doctor will not be able to make an accurate diagnosis.
- You should know in advance from a specialist how and in what sequence the diagnostic procedures will be performed.
- It is necessary to take sedative drops before visiting a medical facility in the evening.
Explain to the patient (relative) the purpose and course of the forthcoming study and preparation for it, to obtain consent.
from 7 p.m. evenings on the eve of the study do not eat, drink, smoke
the study is carried out on an empty stomach in the morning,
to reduce pain during the introduction of the endoscope, the patient will undergo irrigation of the pharyngeal mucosa with anesthetic (lidocaine), clarify the patient's tolerance of lidocaine,
during the study, he will be unable to speak, swallow saliva,
after FGDS, the patient will temporarily have difficulty speaking and swallowing (do not eat within 2 hours after the study, in order to eliminate the risk of aspiration of food or liquid,
To warn the patient about the place and time of the study, the need to remove dentures before the examination, have a towel or absorbent towel.
Ask to repeat the course of preparation (if necessary, give written instructions)
Guide (transport) the patient to the endoscopic room.
Check the condition after FGDS.
8. Accompany the patient to the ward after examination.
if the patient is planned to undergo FGDS with targeted biopsy, then the food should be cool during the day after the study (eliminate the risk of bleeding)
Indications for the procedure
A doctor may prescribe a fibrogastroduodenoscopy procedure in the following cases:
- Pain in the stomach after eating. This may indicate gastritis or peptic ulcer,
- Pain arising after a few hours after eating. They may indicate duodenitis (inflammation of the duodenum),
- Frequent burping with an unpleasant odor
- Heartburn, which bothers the patient for a long period,
- Fast weight loss without following certain diets,
- Difficulty swallowing
- Frequent vomiting
- Before surgery, after which a long and serious treatment is required,
- If gastric bleeding is suspected.
The procedure can be carried out not only for diagnosis, but also for treatment:
- To remove a foreign body from the stomach cavity,
- To remove benign neoplasms,
- For drug administration,
- For electrocoagulation of a bleeding vessel,
- For applying a ligature or clip for gastric bleeding,
- For biopsy.
What to do and not to do before the examination
In order for the procedure to be successful, and it was easier to transfer, it is necessary to adhere to the following recommendations:
- 2 days before the procedure, the following should be excluded from the diet: alcoholic beverages, fatty, salty foods, seeds, nuts, chocolate and strong coffee. Since a sick stomach does not always do well with digesting food, its remnants may be there for several days and may interfere with an adequate assessment of the condition,
- In the evening on the eve of the procedure, you must have dinner before 18.00. Food should be light and quickly absorbed. It is not recommended to use salads, it is better to opt for baked apples,
- On the morning before the procedure, you can not eat. From drinks you can weak tea with a little sugar. It must be drunk at least 2 hours before the appointed time. Patients with diabetes who need to have breakfast, FGDS carried out only in the morning,
- Before the procedure, it is not recommended to use drugs in the form of capsules or tablets.. If this is a vital necessity, they should be discussed with your doctor,
- In case of bronchial asthma or coronary heart disease, medications in the form of a spray or tablets that dissolve under the tongue must be taken before the procedure, informing the doctor,
- On the day when FGDS is carried out, it is forbidden to smoke, since even one smoked cigarette can provoke an increase in the amount of mucus in the stomach, which lengthens the study period and also enhances the vomiting reflex,
What to bring with you on FGDS
- Medicines that the patient takes continuously (they may need to be taken before or after the procedure),
- Outpatient card,
- Data from previous studies to determine the dynamics of treatment,
- Data from a previous biopsy to clarify the indications for a repeat procedure,
- Analysis answers,
- Replaceable shoes or shoe covers,
- A large towel that absorbs liquid well (it must be folded into a plastic bag).
Fibrogastroduodenoscopy is performed using a special apparatus - an endoscope. It is a backlit handset that connects to the camcorder and monitor. It can also be carried out using a special optical system.
The patient is placed on the left side, on the couch. His hands should be folded on his stomach. In order to facilitate the passage of the apparatus, not to injure the patient and not damage the equipment, a special plastic mouth guard is inserted into his mouth, which prevents the teeth from closing.
As an anesthetic, use a solution of lidocaine, which is sprayed on the mucous membranes of the mouth or sleeping pills during the procedure, immersing the patient in sleep.
After the analgesic has acted, the doctor inserts the tube of the device inside and conducts an examination. The procedure itself can last from 5 to 15 minutes.
If fibrogastroduodenoscopy was performed under local anesthesia, the patient can immediately go home. He needs to refrain from eating for 2 hours. In general anesthesia, a person is transferred to the ward, where he is until the effect of the medicine is over.
FGDS procedure is safe. But in rare cases, perforation of the esophagus, duodenum or stomach is possible. Seek medical attention immediately if you have symptoms such as:
- Abdominal pain
- Vomiting, sometimes “coffee grounds,” which indicates stomach bleeding,
- Diarrhea, in which feces are black.
The essence of the method
FGDS is an endoscopic procedure that is performed using a special apparatus (gastroscope). A probe with a camera is inserted through the oral cavity into the esophagus, then pushed into the cavity of the stomach and duodenum (duodenum). This study allows you to visually assess the condition of the mucous membrane of these organs, to determine the presence of areas of inflammation, ulcers, erosion, polyps, tumors. In addition, during the procedure, the doctor can take tissue samples for a biopsy.
The study is considered safe provided that all the doctor's recommendations on how to prepare for gastroscopy of the stomach are followed.
What is the value of the procedure that can be done using this method:
- detect the causes of symptoms of diseases of the digestive tract,
- to take a closer look at areas with damage,
- stop bleeding (for example, from an ulcer) with hemostatic agents by plugging or suturing,
- pick up material for targeted biopsy,
- to introduce medicinal solutions
- remove foreign bodies, polyps, calculi in the pancreatic duct of the duodenum 12,
- eliminate by surgery small stenosis, narrowing and other obstacles to the flow of bile into the duodenum,
- eliminate the pathological narrowing of the esophagus,
- determine the level of acidity in the stomach (pH-metric method).
FGS can be done at any age of the patient if there are special indications that are established by the attending physician when the child or adult addresses the corresponding complaints. The main thing is to know how to properly prepare for a gastroscopy of the stomach or for the FGDS procedure (when you need to examine not only the stomach, but also the duodenum).
About indications and contraindications
The main indications are the following conditions:
- persistent abdominal pains that do not go away on their own,
- persistent dyspeptic symptoms - heartburn with acid belching, nausea, impaired appetite, rotten bad breath,
- difficulty swallowing due to obstruction of the esophagus,
- unexplained anemia, when all other possible causes are excluded,
- a sharp decrease in weight in a person in a short time,
- suspected gastrointestinal oncology,
- monitoring the therapy of gastritis or gastric ulcer and duodenum in dynamics.
Examination cannot be done in the following situations:
- a person does not give consent (before FGDS it must be obtained),
- the patient did not have time to prepare for FGS,
- condition after a heart attack,
- patient during a hypertensive crisis,
- there are bleeding disorders,
- pathology of the esophagus in the form of burns, scars and deformities,
- a patient with aortic aneurysm,
- acute phase of cerebrovascular accident,
- severe course of bronchial asthma and the presence of anesthesia allergy,
- a person has a mental illness or disorder in an acute stage,
- general severe condition of a person, which does not allow preparation for fibrogastroscopy.
About the technique
The necessary algorithm for the procedure includes the following steps:
- Lidocaine spray is applied to the patient’s tongue base as a local anesthetic.
- The patient lies on a high couch on the left side of the body.
- About 5-10 minutes after anesthesia, a plastic mouthpiece or mouthpiece is inserted into the person’s mouth to prevent involuntary compression of the jaws during the procedure.
- An endoscope tube is inserted through the hole in the mouthpiece. At this time, the patient is asked to do swallowing movements.
- When the probe with the camera reaches the bottom of the stomach, they begin to supply air for better expansion of the organ, then the examination begins.
- A simple diagnostic procedure is carried out for several minutes, then the doctor removes the endoscope.
- When performing medical treatment procedures, it may take a little longer, depending on the amount of work envisaged.
Many people believe that it is very difficult to pass this study, and try to avoid it. However, discomfort and discomfort can be minimized if you are not afraid of the gastroscopy itself and preparation for the procedure.
Any diagnostic or therapeutic study should be approached responsibly.
What you need to observe before gastroscopy to come prepared:
- The study is carried out on an empty stomach, so you can eat 8 hours before the upcoming diagnosis.
- If the procedure is scheduled in the morning, then the period of preparation for FGDS is calculated in the evening. You can have dinner the day before 3 or 4 hours before going to bed.
- If gastroscopy of the stomach is carried out in the afternoon, a very light breakfast is allowed no later than 8.30 in the morning.
- Preparation for the examination involves observing an easy diet for several days, it is recommended to exclude fatty, fried foods, nuts, seeds, smoked meats, chocolate.
- Immediately before the procedure, the patient must remove the dentures.
- It is better to come to the study in loose clothing that is easy to unfasten.
- It is important to tune in a positive way, try not to worry.
- The attending physician, who spoke about the essence of the upcoming gastric FGP and how to prepare for it, should know about the presence of concomitant diseases in the patient and the allergic mood of the body.
- You need to have a referral for an examination with you, sometimes they require an outpatient card, the results of past examinations, and a towel.
- It is worth informing the doctor of the endoscopic cabinet about the current intake of medicines that have a history of chronic diseases, allergies.
What can not be done on the day when a person is preparing for gastroscopy:
- take inside any form of medication (tablets, syrups, suspensions) before the study,
- drink alcohol-containing drinks the night before and before the procedure,
- smoke and use chewing gum 3 hours before the manipulation,
- use perfumes.
What can be done in the morning, how to prepare for FGDS, if it is held in the afternoon:
- allowed to brush teeth and tongue,
- to inject drugs
- do physiotherapeutic procedures,
- drink plain water or weak tea,
- do other non-invasive examinations - for example, ultrasound (ultrasound).
After the study, a person may have a sore throat for some time. For half an hour, it is recommended to refrain from eating.
The benefits of the results of the survey significantly exceed possible unpleasant moments. If the preparation for gastroscopy of the stomach was carried out correctly, then the procedure will go quickly and will not leave any consequences and negative memories.