PREVALENCE OF GASTRIC PRECANCEROUS LESIONS IN ARDABIL, A HIGH INCIDENCE PROVINCE FOR GASTRIC ADENOCARCINOMA IN THE NORTHWEST OF IRAN

M.J. FARAHVASH, R. MALEKZADEH, M. SOTOUDEH, M. H. DERAKHSHAN,

J. MIKAELI, AYAZDANBOD, S. MERAT, D. E. FLEISCHER

Ardabil University of Medical Sciences, Ardabil, IRAN

Digestive disease research center (DDRC), Shariati Hospital, Tehran University

of Medical sciences, Tehran, IRAN

Background/Aims: Ardabil province, in northwestern Iran, has the highest rate of gastric (predominantly cardia) adenocarcinoma in Iran. This study aimed to investigate the feasibility of endoscopic screening and to look for associated Helicobacter pylori infection and gastric precancerous lesions.

Methods: One thousand one hundred and five adult volumteers residents of Ardabil and Meshkin districts, 40 years old and above were selected and invited by a simple random household canvass in rural and urban locations. Informed consents were obtained and upper gastrointestinal video endoscopy was performed to biopsy all visible lesions and standard sites in the antrum, corpus, and cardia

Results: One thousand and eleven of the invited individuals agreed to participate, including 494 men and 517 women, with a mean (SD) age of 53.32 (10.39) years. Endescopy was well tolerated by all subjects; 96.7% of antral and 80.7% of cardia mucisal biopsies were satisfactory. The urea test or histology for H. pylori was positive in at least 89.2% of subjects. Histological evidence of mucosal atrophy was seen in 39.3% of antral and 21.9% of cardia samples. Chronic gastritis with or without activity, reactive atypia f glandular epithelium, intestinal metaplasia, dysplasia, and cancer were found in 95.1% 38.0% 8.7%, 0.2%, and 0.3% of antral and 85.3%, 22.9%, 3.8%, 0.3%, and 0.1% of cardiac biopsies, respectively.

Conclusion: Endoscopic screening for upper gastrointestinal disease was feasible and well tolerated in Ardabil, Iran. Most subjects showed H.pylori infection. Atrophic gastritis, reactive atypia, and intestinal metaplasia were common in antrum, corpus, and cardia subsidies.

MINIINVASIVE ANTIREFLUX SURGERY

O.V GALIMOV, V.O. KHANOV, T.R IBRAGIMOV

Bashkiria Medical University, Ufa, RUSSIA

In the discussion of modern methods of surgical correction of hiatal hernia restoration of the functional state of esophageal-gastric junction and creation of anti reflux barrier are of paramount importance. The widespread introduction of new minimally invasive technology allowed improving of surgical treatment of GERD and hiatal hernia. In the clinic of surgical diseases and new technologies laparoscopic surgery for Hiatal Hernia for the last 3 years was successfully performed in 189 patients, predominantly females. Instrumental evaluation of patients was supplemented by the method of radioballongraphic traction developed in our clinic, which allows to determine the true dimensions of

esophageal opening. The method of choice in antireflux surgery was Nissen fundoplication in various modifications. The most common cause of failure of surgical treatment of GERD is an insufficient or excessive closure of diaphragm legs during extension of esophageal opening for more than 3.5 cm. We have proposed the new method (RF patent for invention N 47 646) which technical nature is based on the prevention of complications associated with abnormal narrowing of the esophageal opening, as well as with sliding of sleeve and thereby deteriorating antireflux properties of cardia. For this purpose we use an explant of polytetrafluoroethylene, which models an esophageal opening of physiological size. Then fundoplikational cuff is formed. The proposed method was applied in the clinic in 51 patients with GERD, and in 13 observations simultaneous interventions were carried out. Intraoperative complications were diagnosed in 2 (3.9%) patients. In 161 (85.2%) patients all major manifestations of the disease have disappeared in the immediate postoperative period, and they were discharged with recovery on the 4th-10th days after the surgery. The most frequent early postoperative complication - transient dysphagia, was observed in 22 (11.6%) patients. At the same time in all patients with this complication antireflux surgery included diafragmokruroraphia. Respiratory dysfunction occurred in 4 cases (2.1%). Reactive serosal pleural effusion has developed in these patients and required the implementation of 2-4 pleural punctures for evacuation of fluid. In 2 (1.05%) cases postoperative period was complicated by acute sural phlebothrombosis. These complications were transient and were arrested by conservative therapy.
Long-term results were studied in 112 (59.2%) patients for 8 years after the surgery. Excellent and good results were obtained in 91 patients (81.3%) (including patients with esophageal opening plasticexplants).
Thus, laparoscopic technology for the treatment of GERD helps to reduce the number of complications and to improve outcomes. It is a promising area of ​​surgery and provide a high medical social and economic efficiency.

PECULIARITIES OF SURGICAL TREATMENT OF CHRONIC DUODENAL OBSTRUCTION IN PATIENTS WITH REFLUX ESOPHAGITIS

N.A. GASIMOV, I.K. AKBEROVA

Azerbaijan State Advanced Training Institute for Doctors named after A.Aliyev, Baku, AZERBAIJAN

Chronic duodenal obstruction generally initially leads to functional and further organic insufficiency of esophagogastric passage, and reflux esophagitis. However, the integral mechanism ensuring normal operation of physiologic cardiac orifice in modern gastroenterology is the esophagogastric pressure gradient. Numerous operations aimed at the normalization of duodenal passage reduce the intragastral pressure and thus increase the esophagogastric pressure gradient. Nevertheless, it is not sufficient in cases of complete loss of the tonus of cardiac orifice and therefore causes recurrences of reflux esophagitis. The aim of the research is to study peculiarities of surgical correction of duodenostasis in patients with reflux esophagitis. We defined mechanical form of chronic duodenal obstruction in 27 patients with reflux esophagitis. The reason for duodenostasis in 7 of them was arteriomesenteral compression, in 12 – high location of duodenojejunal passage, and in 7 - cicatricial inflammatory process surrounded by numerous periduodenal adhesions. In one patient, small intestine hypertension formed in the result of ring-shaped cicatricial narrowing of the small intestine was the cause of duodenostasis. In all the 27 patients, fundoplication was used for the restoration of functions of cardiac orifice. 12 patients underwent Strong’s operation, in 8 of them the operation was carried out jointly with selective proximal vagotomy (SPV). The 8 patients were ones with duodenostasis formed due to sharp shortening of Trace ligament and high location of duodenojejunal passage. During the operation the Trace ligament was cut, and the duodenojejunal passage was replaced downwards.

Date: 2014-12-28; view: 750