LONG-TERM RESULTS OF ENDOSCOPIC STENTING IN PATIENTS WITH CICATRICAL ESOPHAGEAL STRICTURES

R.E. LIGAY, L.P. STRUSSKIY, Z.M. NIZAMKHOJAEV, A.M. KHUSANOV, J.A.HAJIBAYEV

Republican Specialized Centre of Surgery named after acad. V. Vakhidov, Tashkent,

UZBEKISTAN

Purpose: To study long-term results of endoscopic stenting postburn cicatricial esophageal strictures (PCES).

Materials and methods: In the department of esophageal and gastric surgery jointly with the endoscopic department there was performed stenting in 25 patients with PCES. Patients were divided according to the extent of stricture: extended (3-9 cm) in 11; subtotal (10-15cm) in 12 and total strictures (more than 16cm) in 2 patients. In 18 patients with PCES previous numerous (2-6) courses of bougienage were performed, other 7 – were admitted for the first time.

There was used own model of the silicone tube stent, with a special anti-migration mechanism in the form of a funnel, which is fixed on a suprastenotic segment of the esophagus. The length of the stent ranged between 7 - 19 cm, subject to length of the stricture.

Patients were first carried out a staged bougienage of the stricture along the string or by endoscopic method by replaceable metal olives. Further, there was conducted diagnostic endoscopy, during which we measured the required length of the stent. Insertion of a stent consists of several stages: stomach is inserted a string, the stent got on the bougie from the beginning part and introduced into the esophageal lumen along the guide. Correct insertion of a stent is determined by endoscopy and X-ray-contrast study. Average duration of stenting was 6-8 months, the maximum term of observation for this category of patients - 3 years.

Results and discussion: In a long-term period within the terms of 6 months to 3 years, all 25 patients were examined: 4 (16%) patients 1 year after endoscopic stenting were performed reconstructive surgery (shunting coloesophagoplasty), 2 (8%) patients 6 and 8 months after removal of the stent needed repeated bougienage of the esophagus, 2 (8%) patients needed repeat stenting as a result of continuing cicatrical process above the funnel of prosthesis 3 and 6 months after the insertion of the prosthesis, in 17 patients (68%) patients patency of the esophagus was satisfactory after the removal of the stent and the patients did not need repeated courses of bougienage.

Conclusion: Thus, in 68% of patients satisfactory long-term outcomes were achieved by the method of stenting. Only 8% needed repeated courses of bougienage, and 8% - restenting in the result of continuing cicatricial process. In 16% stenting was used as an adequate preoperative preparation of patients with total and subtotal esophageal strictures.

ABOUT EARLY ENDOSCOPY IN THE FORECASTING OF THE DEVELOPMENT OF ESOPHAGEAL STRICTURES AFTER CHEMICAL BURN

R.E. LIGAY, Z.M. NIZAMKHOJAEV, D.B. SHAGAZATOV, J.A.HAJIBAYEV

Republican Specialized Centre of Surgery named after acad. V. Vakhidov, Tashkent,

UZBEKISTAN

Purpose: To substantiate appropriateness and to study effectiveness of early endoscopy in patients with chemical esophageal burns (CEB)

Material and methods of study: 152 patients with CEB were treated at the Department of esophageal and gastric surgery of RSSC named after acad. V. Vahidov and department of toxicology of RSSUMA. All patients in the acute stage of burns against the background of general clinical, radiographic studies were performed diagnostic EGDFS, which allowed determination of the degree of CEB. Diagnostic endoscopy was performed in within up to 3 days after the burn by flexible fiberoptic endoscopes. While determining the degree of CEB Razukas V.A. (1977) classification was used. Endoscopically there were revealed: mild burns - in 51 (33.6%) patients, moderate burns - in 39 (25.6%), severe burns - in 62 (40.8%).

Results and discussion: Given the degree of CEB patients were performed complex of remedial measures, aimed directly at the burn surface of the esophageal wall. In addition to anesthesia, patients were carried out antishock and infusion therapies, local therapy, including intake of an emulsion containing sea buckthorn oil, hydrocortisone, chloramphenicol, novocaine solution and suprastin.

Further, the adequacy of treatment was controlled by means of endoscopy. Case monitoring showed that within first three months after the burn only 89 (58.5%) patients of 152, complained on post-burn cicatricial strictures of the esophagus (PCSE) of various locations and length.

We have carried out a comparative analysis of the dependence of the PCSE to the severity of CEB. It was also found that patients with mild burns had not cases of PCSE, and in patients with II degree of burn, PRSP occurred in 53.6%, and in patients with severe burns scar strictures developed in all cases. Thus, data of early endoscopy allow to forecast the possibility of the development of esophageal stricture.

Conclusion: The use of modern flexible esophagoscopes allows clear identification of the extent of CEB in the acute stage of the disease. Early endoscopy allows to forecast the development of cicatrical stricture at the initial stage of the disease, while the incidence of PCSE in direct relation with degree of CEB.

Date: 2014-12-28; view: 832