ULTRATHIN ENDOSCOPY FOR GASTROINTESTINAL STRICTURES
A. KADAYİFCİ, M. AYDİNLİ, I. KORUK, M. SAİT DAG, M.C. SAVASH
Gaziantep University, Gaziantep, TURKEY
Introductıon: Endoscopy has a major role in management of the gastrointestinal (GI) strictures. In tight strictures (unable to pass with standard endoscopes) the evaluation and treatment may be more difficult (patency of lumen, length of stricture). Ultrathin endoscopes (diameter<6.0mm) have been using mainly for pediatric patients, transnasal endoscopy, percutaneous endoscopic gastrostomy or feeding tube placements. The data about value of ultrathin endoscopy (UE) for the management of advanced GI strictures is limited.
Aıms & Methods: The aim of the study was to evaluate the diagnostic accuracy and efficacy on decision making on therapeutic approach for GI strictures. This study was conducted in a tertiary endoscopy center. Standard gastroscope (8.8mm) and colonoscope (12.8mm) were used for diagnostic procedures. The patients who had tight strictures were
enrolled to the study. These patients underwent a second procedure with an ultrathin endoscope (Fujinon EG-530N; 5.9mm) in the same session. The procedure was accepted as successful when reached to duodenum second part or transvers colon segment. The diagnostic and therapeutic outcomes were recorded and followed up prospectively.
Results: During the study period (Jan2010-April2011), total of 57 patients (47 of 7815 upper and 10 of 3320 lower GI endoscopy) were diagnosed as tight strictures. The upper GI strictures were located commonly at esophagus (26/47; 55%) and followed by duodenum (12/47; 25%), antrum and pylorus in 5 (10.6%) and surgical anastomosis in 4 (8.5%) patients. The strictures were secondary to benign diseases in 33 (70.2%) and malignant in 14 (29.8%) patients. UE was successful in 38 of 47 (80.8%) patients with upper GI strictures and unsuccessful in 9 (19.2%). 14 of 38 (36.8%) patients were managed with endoscopic interventions (8 balloon or bougie dilation, 5 metallic stent placement and 1 gastric feeding tube placement). 14 of 38 (36.8%) patients were referred to surgical evaluation, 6 patients (15.7%) did not accept second endoscopic intervention and remaining 4 patients (10.5%) were missed. Seven of 10 patients with lower GI stricture (70%) were located at rectosigmoid section, one patient each at descending colon, splenic flexure and ileum in a patient with total colectomy. Strictures were secondary to benign causes in 7 and malignant causes in 3 patients. UE was successful in 8 of 10 (80%) lower GI strictures. 4/8 (50%) patients were operated (one after colonic decompression tube replacement by ultrathin endoscope); others were followed up medically.
Conclusıon: UE is useful for evaluation of patients with advanced GI strictures. It not only provides additional diagnostic accuracy to standard endoscopy but also helps on decision making of therapeutic approach.
Date: 2014-12-28; view: 497