UPPER GASTROINTESTINAL ENDOSCOPİC FINDINGS IN THE EASTERN ANATOLIA REGION OF TURKEY: AN ENDEMIC UPPER GASTROINTESTINAL CANCER REGION
A. UYANİKOGLU, M. COSKUN, D.N.BİNİCİ, Y.OZTURK
Erzurum Training Hospital, Erzurum, TURKEY
Objectives: The purpose of this trial was to evaluate the outcomes of endoscopic findings in the Eastern Anatolia Region.
Material and Methods: The records of 1950 esophagogastroduodenoscopy (EGD) which were performed in Gastroenterology Endoscopy Unit of Erzurum Training Hospital, between February-July 2010 were evaluated retrospectively. Procedures were performed by gastroenterologists with pharyngeal xylocain, without sedation.
Results: 924 (47%) patients were male, mean age was 48.27 ± 17.09; (range 14-100 years). The most common findings were 1109 (%56.9) erythamatoz/antral gastritis for stomach, 284 (%14.6) duodenitis for duodenum, 361 (%20), esophagitis for esophagus. Total 131 (% 6.5) patients had upper gastrointestinal cancer; 45 (11 operated) (%2.3) had esophagus cancer, 86 (%4.2) had gastric cancer. Patients tolerated the procedure without sedation. No complication was noted.
Conclusion: EGD is a diagnostic procedure which is well tolerated without any sedation and the complication risk is minimal. We found the incidence of upper gastrointestinal cancer as % 6.5. Eastern Anatolia Region is found endemic area for upper gastrointestinal cancer.
ANALYSIS OF POSTOPERATIVE COMPLICATIONS AND LETHALITY AFTER PLASTIC SURGERY OF ESOPHAGUS IN OUR CLINIC
Stavropol State Medical Academy, Stavropol, RUSSIA
The aim of the investigation is the analysis of postoperative complications and lethality after plastic surgery of esophagus in the territorial clinic center of the specialized medical aid of Stavropol city.
Over the period since 1997 more than 50 patients suffering from esophagus cancer have been surveyed by us. It was possible to implement radical operation only at 14 patients out of them. We implemented resection of under-chest section with intrapleural esophagogastric anastamosis according to Garlok method at eight patients, according to Lewes method at three patients, in small intestine at one patient suffering from adenocarcinoma of lower tret of esophagus and cardio-esophagitis cancer and also we implemented extirpation of the organ with abdominocervical plastic surgery of isoperistaltic gastric tube at two patients suffering from cancer of mesothoracic section of esophagus. 41 patients (17 women and 24 men from 18 to 72 age) suffering from post-burn corrosive structure of esophagus and stomach have been operated. Extirpation of esophagus with single-stage abdominocervical plastic surgery of isoperistaltic gastric tube was implemented at 31 patients, resection of under-chest section of esophagus with right-side intrapleural esophagogastric anastamosis at five patients and retrosternal shunt plastic surgery of esophagus of large intestine at 5 patients.
Postoperative complications occurred at three patients (21.4%) out of fourteen patients operated in connection with esophagus cancer: one patient out of them suffered from intrapleural bleeding in early postoperative period that required re-operative intervention, two patients out of them suffered from incapacity of sutures of esophagogastric anastomosis, mediastinitis, empyema of pleura with lethal end. Different complications occurred at 11 patients (26.8%) out of 41 patients operated in connection with post-burn cicatrical stenosis of esophagus and 6 patients (14.6%) out of them died. Though 4 lethal cases took place in the first three years of introduction and adaptation to the method of plastic surgery pf esophagus in our clinic. As well, these years were accompanied by poor drug supply. The reason of those two patients was incapacity of esophagogastric anastamosis on the neck and mediastinitis and incapacity of intrapleural esophagogastric anastamosis with pleural empyema and mediastinitis at one patient and multiple organ failure at three patients.
Thereby, early diagnostics of esophagus cancer, groundlessness durable bougienage of benign esophageal stricture and impossibility of effective preoperative preparation of emaciated patients because of lack of drug supply remains as an outstanding problem.
EVALUATION OF THE EFFECTIVENESS OF THE TRIPLE DIAGRAM OF ERADICATION WITH LEVOFLOXACIN IN PATIENTS WITH CHRONIC GASTRITIS ASSOCIATED WITH H. PYLORI IN PATIENTS OF MILITARY AGE
T.N.YAKUBCHIK, E.N.BOJKO, E.I.RUSINA
Grodno State Medical University, Grodno, BELARUS
According to the results of recent researchs, eradication rates of H.pylori (Hp) with the application of first-line therapy, including proton pump inhibitor, clarithromycin and amoxicillin, reduced to 70-85%, that is partially due to the increase of resistance to clarithromycin.
The aim of this study was to evaluate the effectiveness and tolerance of triple diagram of eradication of Hp with levofloxacin in chronic gastritis (CG), associated with Hp.
Materials and methods. A total of 35 patients with Hp-associated CG were examined. All patients were performed FEGDS with biopsy. The presence of chronic gastritis and Hp in the gastric mucosa was confirmed morphologically and by rapid urease test in biopsy samples taken from the body and the pyloric segment of stomach. Patients were at the age from 18 to 28 years, that were previously performed on eradication of Hp by triple scheme (proton pump inhibitor + amoxicillin + clarithromycin within 10 days), but symptoms of dyspepsia recurred within one year. All patients were prescribed the following diagram of eradication: proton pump inhibitor pantoprazole (Nolpaza) 40 mg x 2 times a day + levofloxacin (Tavanic - 250 mg tablets) 250 mg. x 2 times a day + amoxicillin (Hiconcil - 500 mg capsules.) 1000 mg x 2 times a day within 10 days. The effectiveness of eradication was assessed six months later. Regular medical check-up continued throughout the year.
Results. Eradication of Hp was observed in 100% of cases. 2 patients reported about side effects: one had nausea, the other - diarrhea, although no side event was serious. During the year, patients had no symptoms of recurrent gastric dyspepsia.
Conclusion. Thus, the results of study show that Levofloxacin may be very effective in combination, especially, with a proton pump inhibitor and amoxicillin.
Whereas, Tavanic (Levofloxacin) is a relatively safe drug for short courses of treatment and is easy to use.
ENDOSCOPIC INTERVENTIONS IN FOREIGN BODIES OF UPPER
Branch of the Republican scientific center for emergency medical care, Navoi, UZBEKISTAN
Purpose: To share experience in medical endoscopy in case of foreign bodies of upper segment of the digestive tract.
We have carried out 10 year of analysis of diagnostic and therapeutic endoscopy in 224 patients with various foreign bodies that entered the upper digestive tract accidentally or deliberately, as well as the in 8 patients operated at different times for iatrogenic injuries of esophagus and stomach due to foreign bodies. Age of patients ranged between 8 months and 74 years. Among the examined there were 126 men, and 98 women. Admission time - from 30 min. to 8 days. 42 patients were admitted after unsuccessful attempts to remove a foreign body in other medical institutions. In 48 patients no foreign bodies were found during diagnostic endoscopy, but only superficial abrasions, scratches of the mucous membrane were detected. At the moment of admission all the patients were carried out a comprehensive examination (anamnesis, assessment of objective condition, review radiography with the use of water-soluble radiopaque drug for the identification of localization of a foreign body localization and possible injury of esophageal wall, esophagogastrofibroscopy).
Foreign bodies were located in the esophagus in 142, in the stomach in 64, in the duodenum in 12 of our patients. The nature of foreign bodies was as follows: pieces of meat and meat bone in 88, metal objects (paper clips, needles, metal crosses, coins, nails, batteries) in 118, dentures in 12, and phyto and trichobezoars in 6 patients. After the extraction of a foreign body there was performed and control review of the mucosa for the identification of the nature of possible injuries at the place of location of a foreign body, and control x-ray with water-soluble radiopaque substance. Of the 224 patients, foreign bodies were removed endoscopically in 216. In the remaining 8 (3.6%) patients, foreign bodies were removed during the operation (of them in four cases, bones and metal items perforated esophagus, and in 4 cases, were removed from the stomach: bezoar, “cross” made of a metal wire).
Thus, the analysis shows that the removal of foreign bodies from the upper part of the digestive tract with the help of endoscopy is the most effective, and the most dangerous are foreign bodies of the esophagus, which can perforate the wall of the esophagus with the emergence of the dangerous mediastinitis complications.